"If You Tell People That You Had Sex with a Fellow Man, It Is Hard to Be Helped and Treated"

Barriers and Opportunities for Increasing Access to HIV Services Among Men Who Have Sex with Men in Uganda

Published in: PLoS ONE, v. 11, no. 1, e0147714, 2016

Posted on RAND.org on May 02, 2016

by Rhoda K Wanyenze, Geofrey Musinguzi, Joseph K. Matovu, Juliet Kiguli, Fred Nuwaha, Geoffrey Mujisha, Joshua Musinguzi, Jim Arinaitwe, Glenn Wagner

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Research Questions

  1. What barriers do men who have sex with men (MSM) in Uganda face when trying to access HIV services?
  2. How could access to care be expanded for this population?

BACKGROUND: Despite the high HIV prevalence among men who have sex with men (MSM) in sub-Saharan Africa, little is known about their access to HIV services. This study assessed barriers and opportunities for expanding access to HIV services among MSM in Uganda. METHODS: In October-December 2013, a cross-sectional qualitative study was conducted in 12 districts of Uganda. Semi-structured in-depth interviews were conducted with 85 self-identified MSM by snowball sampling and 61 key informants including HIV service providers and policy makers. Data were analysed using manifest content analysis and Atlas.ti software. RESULTS: Three quarters of the MSM (n = 62, 72.9%) were not comfortable disclosing their sexual orientation to providers and 69 (81.1%) felt providers did not respect MSM. Half (n = 44, 51.8%) experienced difficulties in accessing health services. Nine major barriers to access were identified, including: (i) unwelcoming provider behaviours; (ii) limited provider skills and knowledge; (iii) negative community perceptions towards MSM; (iv) fear of being exposed as MSM; (v) limited access to MSM-specific services; (vi) high mobility of MSM, (vii) lack of guidelines on MSM health services; viii) a harsh legal environment; and ix) HIV related stigma. Two-thirds (n = 56, 66%) participated in MSM social networks and 86% of these (48) received support from the networks to overcome barriers to accessing services. CONCLUSIONS: Negative perceptions among providers and the community present barriers to service access among MSM. Guidelines, provider skills building and use of social networks for mobilization and service delivery could expand access to HIV services among MSM in Uganda.

Key Findings

  • High levels of stigmatization and discrimination of MSM among health care providers and the broader community constrain access to HIV services.
  • Half of the MSM surveyed experienced trouble accessing health services.
  • Three-quarters of MSM were not comfortable disclosing their sexual orientation to providers because of concerns about confidentiality and provider attitudes.
  • Guidance and procedures to improve patient-provider relationships could help address access issues.
  • Use of social networks for information dissemination could help provide resources and increase demand for and HIV-friendly programs and providers.

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