Influence of stigma and homophobia on mental health and on the uptake of HIV/sexually transmissible infection services for Cameroonian men who have sex with men
Charles W. Cange A B G , Matthew LeBreton C , Serge Billong D , Karen Saylors E , Ubald Tamoufe C , Erin Papworth A , Yves Yomb F and Stefan Baral A
+ Author Affiliations
- Author Affiliations
A Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
B Department of Sociology and Anthropology, University of Maryland (UMBC), 1000 Hilltop Cir, Baltimore, MD, 21250 USA.
C Global Viral Cameroon, Yaoundé, Cameroon.
D Comité national de lutte contre le sida (CNLS), Ministère de la Santé Publique (MINSANTE), Face Fondation Chantal BIYA, BP 1459 Yaoundé, Cameroon.
E Global Viral, 1 Sutter St # 600 Metabiota, San Francisco, CA 94104, USA.
F Alternatives-Cameroun, Douala, Cameroon.
G Corresponding author. Email: cange@umbc.edu
Sexual Health 12(4) 315-321 https://doi.org/10.1071/SH15001
Submitted: 7 January 2015 Accepted: 24 March 2015 Published: 29 June 2015
Abstract
Background: Men who have sex with men (MSM) in Cameroon consistently face significant stigma and discrimination. The urban HIV prevalence in MSM is estimated at 35%. This study investigates the effect of stigma, discrimination and alienation on Cameroonian MSM’s engagement of the HIV treatment cascade. Methods: Qualitative interviews were semi-structured using a guide. Participants in Douala, Ngaoundere, Bamenda, Bertoua and Yaoundé were asked to describe the MSM social and structural context, MSM knowledge of existing HIV-related services in public and MSM-focussed non-governmental organisation (NGO) clinics. Using a codebook, coded text was extracted from 40 transcripts with Microsoft Word Macros. These texts were analysed for recurring themes that were developed into results. Results: There were three main themes that emerged. First, among those MSM participants seeking HIV services, many commonly reported experiences of discrimination and physical violence outside the healthcare setting. Second, a few respondents used services provided by the Ministry of Health and local NGOs. However, most participants observed limited clinical and cultural competency of public clinic staff. Third, MSM declared that lack of social support and healthcare access caused them much stress. Several individuals recounted their alienation greatly discouraged them from seeking HIV prevention, treatment and care services. Conclusions: Community-level and public healthcare-related stigma impacts the mental wellbeing of Cameroonian MSM. Alienation among MSM also represents a common obstacle to the uptake of MSM-oriented HIV/AIDS services. Improving provider cultural and clinical competency among Cameroonian health care workers combined with a broader stigma-reduction intervention for Cameroonian healthcare may increase the uptake of HIV prevention, treatment and care among MSM.
Additional keywords: Cameroon, entrapment, extortion, HIV/STI prevention, homophobia, human rights, gay rights, sexual assault.
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