Browsing by Author "Mccurdy, Sheryl A."

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    Health Care in a Homophobic Climate: The SPEND Model for Providing Sexual Health Services to Men Who Have Sex with Men Where Their Health and Human Rights are Compromised
    (Co-Action, 2015-03) Ross, Michael W.; Nyoni, Joyce E.; Larsson, Markus; Mbwambo, Jessie; Agardh, Anette; Kashiha, John J.; Mccurdy, Sheryl A.
    We present a model for developing health services for men who have sex with men (MSM) in sub-Saharan Africa and other places where MSM are heavily stigmatized and marginalized. The processes of the SPEND model include Safe treatment for sexually transmissible infections (STIs) and HIV; Pharmacy sites for treatment of STIs in countries where pharmacies and drug stores are the source of medical advice and treatment; Education in sexual health issues for health professionals to reduce discrimination against MSM patients; Navigation for patients who have HIV and are rejected or discriminated against for treatment; and Discrimination reduction through educating potential leaders in tertiary education in issues of human sexuality. Supporting empirical evidence from qualitative and quantitative studies is summarized, and barriers to implementation are discussed. Health care for MSM is one of the casualties of anti-homosexual social and legal climates. There is no amnesty for MSM in health care settings, where the stigma and discrimination that they face in the rest of society is replicated. Such conditions, however, make it necessary to consider ways of providing access to health care for MSM, especially where rates of HIV and STIs in MSM populations are high, and stigma and discrimination encourages high proportions of MSM to marry. This in itself enhances the status of MSM as an important bridge population for STIs including HIV. Where anti-homosexual laws encourage, or are believed to encourage, the reporting of MSM to authorities, health care may be seen as an agent of authority rather than an agency for care.
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    High HIV Seroprevalence, Rectal STIs and Risky Sexual Behaviour in Men Who Have Sex with Men in Dar es Salaam and Tanga, Tanzania
    (2014) Ross, Michael W.; Nyoni, Joyce E.; Ahaneku, Hycienth; Mbwambo, Jessie; Mcclelland, Raymond S.; Mccurdy, Sheryl A.
    Objectives: To assess HIV and sexually transmitted infection (STI) prevalence and associated risk factors in men who have sex with men (MSM) in two cities in mainland Tanzania. Methods: We conducted respondent-driven sampling of 300 MSM in Dar es Salaam and Tanga. Results: In Dar es Salaam, 172 (86%) men (median age 23, IQR 21–28) consented to HIV/STI testing, and 30.2% were HIV seropositive. Only five reported a previous positive HIV test: >90% were new HIV detections. 2.5% were syphilis-exposed and none hepatitis B positive, but 21.4% had a curable STI. Over 90% of the gonorrhoea and chlamydia was rectal. In Tanga, 11.1% of MSM were HIV seropositive, 8% hepatitis B positive and 0% were syphilis-exposed, with 4.4% having a curable STI. Predictors of HIV infection were number of MSM known, city, identifying as gay and having first sex with a man. Predictors for STIs were recent unprotected receptive anal intercourse, and number of MSM seen in the last month. 30% of the sample reported that they sold sex. There was no significant association between HIV and STI infection. Conclusions: HIV and STI rates were substantially lower in MSM in a provincial city than in a large metropolis and rates appear to depend on larger numbers of MSM known. Most HIV detected were new cases, and there was a high burden of asymptomatic curable rectal STIs (>1 in 5 MSM). Owing to stigma, MSM may not report homosexuality and thus not have rectal STIs treated. High need for tailored HIV testing and STI screening and treatment of MSM in Tanzania is apparent.
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    High Prevalence of Stigma-Related Abuse among a Sample of Men Who Have Sex with Men in Tanzania: Implications for HIV Prevention
    (Taylor and Francis, 2015) Anderson, Alexandra M.; Ross, Michael W.; Nyoni, Joyce E.; Mccurdy, Sheryl A.
    In sub-Saharan Africa, the prevalence of stigma-related abuse and violence among men who have sex with men (MSM) and its potential impact on the HIV/AIDS epidemic is unknown. This study estimated the prevalence and source of violence and abuse among a sample of MSM in Tanzania and characterized the association between levels of violence and sexual and mental health variables. Data were taken from a larger study of 200 MSM in Tanzania. Frequency tabulations, bivariate analysis, and logistic regression were performed to describe the prevalence and source of abuse and to determine the association between levels of violence and sexual demographics and mental health variables. The MSM sample for this study was young (median age 23), somewhat educated with the majority having attained secondary school (80%) and mostly employed (60%). Verbal (48.5%) and moral (32.5%) abuses were the most predominant types of abuse among the sample and were mostly from people in the street and neighbors. Sexual abuse (30%) was mostly from partners, and physical violence (29.5%) was largely from people in the street. Participants in the high-violence level group had a significantly greater number of sexual partners, depression scores, and internalized homonegativity (IH) scores. IH predicted HIV infection and verbal abuse predicted IH.There is a need for an increased awareness of violence and abuse faced by MSM in Tanzania, as well as effective programs to specifically target the issue of violence among MSM, and its implication for mental health and for risky sexual behaviors and HIV transmission.
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    Sexual Motivation, Sexual Transactions and Sexual Risk Behaviors in Men who have Sex with Men in Dar es Salaam, Tanzania
    (2014) Bui, Thanh C.; Nyoni, Joyce E.; Ross, Michael W.; Mbwambo, Jessie; Markham, Christine M.; Mccurdy, Sheryl A.
    Understanding the associations between sexual motivation and sexual risk behaviors of men who have sex with men (MSM) is critical for developing effective HIV prevention interventions. To examine these associations, we employed data from a survey of 200 MSM in Dar es Salaam, Tanzania, recruited through respondent driven sampling. Results showed that 44.5% of surveyed participants most often looked for love/affection when having sex, and 36.5% most often looked for money. Money-motivated MSM were more likely to identify themselves as bisexual, more likely to have anal sex, and had significantly higher numbers of partners of both sexes. Those who most often looked for love/affection were less likely to ask for condom use, to actually use a condom, and to use lubrication in anal sex. MSM with different sexual motivations had dissimilar sexual risk behaviors. Tailored health interventions for each group to reduce these sexual risks for STIs/HIV prevention are needed.