CDC319 - Publication only
Men at risk: a qualitative sub-study on HIV and identity among men who have sex with men in Kampala, Uganda
R. King1,2, S. Nakayiwa3, D. Katuntu3, W. Hladik3, Crane Study Group
1University of California - San Francisco, San Francisco, United States, 2Karolinska Institute (KI) School of Public Health, Stockholm, Sweden, 3CDC-Uganda, Entebbe, Uganda
Background: Men who have sex with men (MSM) are at high risk for HIV in sub-Saharan Africa
Methods: Between May 2008 and February 2009, we used respondent driven sampling to recruit MSM ≥18 years in Kampala, Uganda, reporting sex with another man in the past three months. We collected demographic and HIV-related behavioral data through audio computer-assisted self-administered interviews and qualitative face-to-face interviews. Lab testing included HIV and other sexually transmitted infections. RDSAT was used to weight quantitative data. We used thematic descriptive content analysis on topics including: sexual behavior and identity, stigma and violence, health seeking behavior. Analysis focused on dominant explanations for emerging themes across and within participant groups.
Results: Out of 300 men participating in the ACASI, 16 men were selected for face-to-face qualitative interviews. Among the 300 men 14% were found HIV-positive. In the qualitative sample, 31% of the men were HIV-positive. Though sexual identity was not static, three sexual identity categories emerged: men who believe they were born gay, men who identify as transgender and men who identify as bisexual. All groups of men described conflictual feelings related to their sexual identity and social, cultural and policy issues that do not accept homosexuality. The emerging domains for facilitating condom use included: lack of trust in partner, and fear of HIV infection. Barriers to condom use included: trust in partner, lack of money,” it is tiresome”, use of alcohol, spontaneity, condom breakage. Coping mechanisms emerged out of health-care seeking challenges and included identifying gay health care providers and self-treatment.
Conclusion: MSM are at higher risk for HIV that the adult male population in Kampala. Sexual identity is fluid and acceptance was not related to condom use. Social and policy issues surrounding homosexuality directly affect men's lives, risk and health seeking behavior.
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