Browsing by Author "Ross, Michael W."

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    Being Forced to become your Own Doctor – Men Who Have Sex with Men's Experiences of Stigma in the Tanzanian Healthcare System
    (Taylor and Francis, 2016) Larsson, Markus; Ross, Michael W.; Månsson, Sven A.; Nyoni, Joyce E.; Shio, Jasmine; Agardh, Anette
    Objective: To acquire a deepened understanding of how stigma in healthcare affects health-seeking behaviors of same-sex practising men in Tanzania. Methods: In-depth interviews with 12 men were conducted in Dar es Salaam, 2012. Data were interpreted through qualitative content analysis. Results: Narratives revealed that men's healthcare perceptions were shaped by previous encounters, rumors in gay community, norms, and legislation around homosexuality. Fears of exposure aggravated men's possibilities of giving full anamnesis and detached them from formal healthcare services. Conclusions: Stigma in healthcare might lead to severe public health problems due to perceived exclusion from the health system by sexual minorities.
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    Condom Use and HIV-Related Behaviors in Urban Tanzanian Men Who Have Sex with Men: A Study of Beliefs, HIV Knowledge Sources, Partner Interactions and Risk Behaviors
    (Taylor and Francis, 2013) Nyoni, Joyce E.; Ross, Michael W.
    Although studies have been conducted in neighboring countries, there are no published data on men who have sex with men (MSM) in mainland Tanzania. We report on a respondent-driven sampling study of 271 MSM in Dar es Salaam, Tanzania. The sample covered a wide range of educational attainment and employment, median age was 24, and all respondents had heard of HIV/AIDS, mostly through public media. Those satisfied with media information on HIV were younger, had lower education, and had obtained their information from health facilities. Over two-thirds believed that having one faithful partner and using condoms would protect against HIV: nevertheless, more than two-thirds were worried about HIV infection. Two-thirds had had a relationship with a woman, one-third in the past year. Predictors of non-use of condoms for anal sex with last casual partner were younger age, not being worried about HIV infection, and agreeing to have sex even if a condom was refused. There was no significance in proportion using a condom with last casual (43%) and last regular (49%) partner. Most partners (MSM knew a median of 10 other MSM) were met in bars, music halls, and in the home/local environment, and 70% of MSM described their sexual position as “bottom.” Sixty percent reported having an HIV test and the great majority was comfortable discussing condoms with partners and friends: half would refuse to have sex if condoms were not agreed to. These data suggest a significant “gay” community in Dar es Salaam with relatively accurate HIV information but moderate condom use, HIV testing and ability to refuse unsafe sex. There is clearly scope for targeted HIV prevention programs in the MSM community in Tanzania.
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    Depression and HIV Risk Among Men Who Have Sex with Men in Tanzania
    (Taylor and Francis, 2016) Ahaneku, Hycienth; Ross, Michael W.; Nyoni, Joyce E.; Selwyn, Beatrice J.; Troisi, Catherine; Mbwambo, Jessie; Adeboye, Adeniyi; Mccurdy, Sheryl
    Studies have shown high rates of depression among men who have sex with men (MSM) in developed countries. Studies have also shown association between depression and HIV risk among MSM. However, very little research has been done on depression among African MSM. We assessed depression and HIV risk among a sample of MSM in Tanzania. We reviewed data on 205 MSM who were recruited from two Tanzanian cities using the respondent driven sampling method. Demographic and behavioral data were collected using a structured questionnaire. HIV and sexually transmitted infections data were determined from biological tests. Depression scores were assessed using the Patient Health Questionnaire (PHQ-9). For the analysis, depression scores were dichotomized as depressed (PHQ > 4) and not depressed (PHQ ≤ 4). Bivariate and multivariable Poisson regression analyses were conducted to assess factors associated with depression. The prevalence of depression in the sample was 46.3%. The mean (±SD) age of the sample was 25 (±5) years. In bivariate analysis, depression was associated with self-identifying as gay (p = .001), being HIV positive (p < .001: <8% of MSM knew they were HIV infected) and having a high number of sexual partners in the last 6 months (p = .001). Depression was also associated with sexual (p = .007), physical (p = .003) and verbal (p < .001) abuse. In the Poisson regression analysis, depression was associated with verbal abuse (APR = 1.91, CI = 1.30–2.81). Depression rates were high among MSM in Tanzania. It is also associated with abuse, HIV and HIV risk behaviors. Thus, reducing the risk of depression may be helpful in reducing the risk of HIV among MSM in Africa. We recommend the colocation of mental health and HIV preventive services as a cost-effective means of addressing both depression and HIV risk among MSM in Africa.
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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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    Lubricant Use and Condom Use during Anal Sex in Men Who Have Sex with Men in Tanzania
    (2015) Romijnders, Kim A.; Nyoni, Joyce E.; Ross, Michael W.; Mccurdy, Sheryl; Mbwambo, Jessie; Kok, Gerjo; Crutzen, Rik
    The lack of data on condom and lubricant use among African men who have sex with men hinders prevention efforts. We describe use, knowledge, and access to lubricants in Dar es Salaam and Tanga, Tanzania. Data were collected in 2012 and 2013 from a cross-sectional survey of 200 men who have sex with men in Dar es Salaam and 100 men who have sex with men in Tanga, Tanzania. The most common reason for not using condoms was dislike of condoms. Two-thirds of the men reported always using a lubricant for anal sex. Fewer men who have sex with both men and women know about lubricants, more gay men look for, have difficulty finding, and find lubricants to be expensive; and men who have sex with men use lubricants to facilitate penetration. Men who have sex with both men and women commonly receive their lubricants from their sexual partner, while gay men got them from friends and pharmacies. HIV-negative men who have sex with men used lubricants to facilitate penetration and reduce pain. HIV-positive men who have sex with men are likely to get their lubricants from pharmacies or friends. Men who have sex with men and women use Vaseline® significantly more than gay men as a lubricant. Results suggest that HIV prevention knowledge among gay men is greater; HIV prevention efforts should emphasise carrying water-based lubricant among men who have sex with men and women. Consequently, there is an opportunity to co-market condoms and water-based lubricants.
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    Sexual and Geographic Organisation of Men Who Have Sex with Men in a Large East African City: Opportunities for Outreach
    (2012) Ross, Michael W.; Nyoni, Joyce E.; Bowen, Anne M.; Williams, Mark L.; Kashiha, John J.
    Objectives To describe geographical and dispersion patterns of men who have sex with men (MSM)-related venues in a large East African city and their associations with times, participants and venue type. Methods Mapping of MSM sites in Dar es Salaam was carried out by community research workers who catalogued, observed and reported data on venue sites, formality, times of operation, type of participant, police or vigilante activity, length of operation and the degree to which it is known both in and outside the MSM and gay communities. Results There is a large and widely disseminated MSM/gay satellite cultures of at least 98 sites, which has some formal sites, but is largely informal and operates within mixed entertainment environments and at particular times (including some weekend-only locales) across the city. There is a mix of places for sexual contact, largely social venues and sex on location sites. Cruising appears to be limited to open spaces and parks, with no vehicular component and almost no internet component. They are widely disseminated across all suburbs and there is no central location for MSM activities. MSM sex workers (SWs) operate at a third of these sites. Conclusions There is a large number of ‘local’ MSM contact, social and sex sites and any work with MSM will have to include these less-formal and less-known sites. The widely disseminated nature of the MSM sites, however, also suggests that sexual networks may not be closely linked between sites. The climate of stigma, abuse and potential violence appear to be limiting the development of more formal sites. This pattern is probably typical of other large urban areas in East Africa and perhaps across sub-Saharan Africa (SSA).
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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.