Transcript Promoting the health of men who have sex with men worldwide

PROMOTING
THE HEALTH OF MEN
WHO HAVE SEX WITH
MEN WORLDWIDE
A training curriculum
for providers
Module 3:
Barriers to Health
2
Learning Objectives
3
1
Identify barriers, facilitators, and critical enablers that impact
access to and utilization of healthcare services
2
Describe how stigma undermines the health of gay men and
other MSM
3
Identify provider advocacy roles in mitigating barriers to
healthcare access
Module Overview
4
1
Definitions, terminology, and causes of stigma and
discrimination toward gay men and other MSM
2
HIV-related and multi-layered stigma
3
The link between social discrimination and health
4
The role of health professionals in advocacy on behalf of gay
men and other MSM
Introduction
1
Gay men and other MSM experience stigma and
discrimination
•
Outside the health system
o Laws, policies, other factors
•
2
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5
Inside the health system
Stigma and discrimination
•
•
Exacerbate vulnerability
Decrease access to healthcare
Providers can help overcome stigma and discrimination
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Framework: Structural Factors
1
7
Barriers
•
•
Homophobia
•
Provider stigma and
insensitivity
•
•
Poverty
Social
norms/heteronormative
attitudes
Criminalization of same-sex
behaviors
2
Facilitators
•
•
Safe spaces
•
Comprehensive healthcare
Mental health and
psychosocial services
Framework: Community Factors
1
Barriers
•
•
•
•
•
•
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Social exclusion by families
and friends, from cultural
and religious activities, and
from health institutions
Extortion and blackmail
Ridicule
Eviction
Job termination
Violence
2
Facilitators
•
•
•
Community engagement
Family support
Stable relationships
Framework: Individual Factors
1
Barriers
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•
•
•
•
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Fear of being recognized
as gay or MSM
Poor self-worth
Depression
Anxiety
Suicidality
2
Facilitators
•
•
•
Financial resources
Sustainable work
Education
Stigma and Discrimination
1
Stigma – An attribute that shames an individual or group in the
eyes of others
•
Three types:
o Enacted
o Felt
o Internalized
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3
10
Discrimination – When behaviors or actions are perpetrated that
lead to inequality, inequity, or unfairness based on belonging to a
particular group
Homophobia – The irrational hatred, fear, or intolerance against
homosexuality or against gay men and other MSM
Group Activity
Rotational Brainstorm Naming Stigma and
Discrimination Toward MSM
11
Stigma against MSM
1
Stigma occurs due to:
• Sexual orientation (being gay)
• Sexual behavior (having multiple partners or having
anal sex)
• Engagement in sex work (being a sex worker)
• Diseases (having HIV or other STIs)
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2
Gay men and other MSM can be stigmatized for more than
one reason
3
Gay men and other MSM can stigmatize each other
Stigma within MSM
Stigma within MSM can be based on:
• Ethnicity
• Rural background
• Religion
• Perceived socioeconomic status
• Perceived engagement in sex work
• Perceived promiscuity
• HIV status
• Gender expression
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HIV-related Stigma
1
HIV is often linked to negative perceptions of certain behaviors for e.g.
•
Promiscuity
•
Sex Work
• Injection drug use
2
HIV-related stigma is caused by
•
Lack of knowledge and misperceptions about HIV
• Exaggerated fears of HIV infection
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•
Negative representations of people living with HIV in the media
•
Association of HIV with illegal or immoral behavior
Schematic diagram of stigma and discrimination against people living with HIV (PLHIV)
in Ho Chi Minh City: Causes, effects, and relationships
Fear of HIV
Transmission
Negative
representations of
PLHIV in the
media and public
health messages
Association of HIV
with illegal and
immoral behavior
Misperceptions
about HIV
transmission risk
STIGMA against
PLHIV in the
community
Negative attitudes
about PLHIV
Discrimination
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Family and Community
Healthcare Sector Workplace
Isolation
Loss of social and family support
Self-stigmatization
Loss of employment and income
Suicidal thoughts
Decreased access to healthcare
Depression
Fewer job opportunities
Group Activity
Addressing Stigma Targeted Against
Gay Men and other MSM
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Criminalization of Same-sex Behavior
1
77 of 193 countries currently criminalize same-sex behavior
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Criminalization:
•
Increases stigma and discrimination against gay men and other MSM
• Decreases representation in program and policy development
•
Decreases health surveillance of gay men and other MSM
•
Decreases uptake and provision of HIV-related services
• Limits the ability of health workers to provide services to gay men and
other MSM
•
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Limits resources devoted to gay men and other MSM health
Social Discrimination and Health
Stigmatizing attitudes do not always result in discrimination,
but the effects are still harmful
• Mental health issues, anxiety, stress, and depression
• Riskier sexual behavior
• Increased risk for HIV and other STIs
It is estimated that less than one in ten gay men and other MSM globally
are reached by HIV prevention services
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Homophobia and the Health System
1
2
MSM often utilize mainstream healthcare settings
• Gay- or MSM-specific services are not available everywhere
Many providers lack specialized knowledge of unique needs
• May intentionally or unintentionally express disapproval and prejudice
against gay and other MSM clients
3
4
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Homophobia in the health system has a negative impact on the
health of MSM
MSM who face stigma in the health system are:
• Less likely to openly discuss their sexuality
• Less likely to provide complete or accurate sexual histories
• More likely to avoid the health system altogether
Health Professional Advocacy Roles
1
Health professionals play a central role in reducing stigma
and discrimination
2
Education for providers about gay men and other MSM is
critical
3
4
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In the health setting, health professionals can:
• Promote a welcoming atmosphere
• Educate co-workers to ensure respect and dignity for gay men and other MSM
Outside of the health setting, health professionals can:
• Treat families and communities equally and with respect
• Empower MSM to participate in community activities
• Lobby local authorities to support gay men and other MSM
Case Study
Chike, 17 year old male from Nigeria
Questions for Discussion:
1. What types of issues is Chike facing in his life?
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2.
Identify the barriers preventing Chike from receiving the care he needs.
3.
Are there ways in which the clinic could improve Chike’s experience? Describe.
Summary
1
MSM face barriers at all levels, from structural to individual to
engaging with the health system
2
Stigma and discrimination underlie the majority of barriers
3
Criminalization of homosexuality has a highly negative effect on
MSM health
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5
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Gay men and other MSM may experience multi-layered stigma,
such as with HIV
Health professionals play a central role in reducing stigma and
discrimination