April 17, 2019
By 2016, it was estimated that 1.2 million people in Zambia were living with HIV. With an adult prevalence of 12.3 percent, Zambia is one of the top 10 countries with the highest HIV prevalence rates in the world. Although the Zambian government has recently included men who have sex with men in its HIV prevention agenda, intervention efforts have been limited among this population. Previous research suggests that men who have sex with men in Zambia face heightened risk of HIV infection as a result of substance abuse and unprotected sex.
The stigmatization toward men who have sex with men and homosexual behaviors contributes to these high rates and risk of HIV for this population, and there is a dearth of programs in place to counteract the different forms of stigma that men who have sex with men face in Zambia. There is also limited research on the specific impacts of stigma on men who have sex with men and how stigma may play a role in the delivery of healthcare services to this group by providers.
Assistant professor of health promotion, education, and behavior (HPEB) Shan Qiao has received a $360K R21 grant from the National Institutes of Health to address this gap in the research. She and her mentor, Xiaoming Li, will work with colleagues from the University of Michigan, University of Zambia and a community-based LGBT organization in Zambia (Friends of Rainka) to examine the needs and approaches of reducing stigma against men who have sex with men among healthcare providers in Zambia.
Through data triangulation of policy reviews, in-depth interviews of men who have sex with men, healthcare providers, and other stakeholders and surveys among 200 men who have sex with men and 200 healthcare providers in Zambia, Qiao and her team will be able to identify drivers/facilitators and manifestations of intersecting stigma against men who have sex with men in clinical settings in Zambia from the perspectives of culture, religion, law, social policy, and health practices. They will also explore the effects of intersecting stigma and potential mechanisms of these effects in clinical settings on this population’s (dis)engagement in the HIV treatment cascade.
“Stigma has been a significant barrier for achieving the ‘90-90-90’ goal—which is that by 2020, 90 percent of all people living with HIV will know their HIV status, 90 percent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90 percent of all people receiving antiretroviral therapy will have viral suppression—among men who have sex with men who have been ‘left-behind’ in the national HIV response of Zambia and many other Sub-Saharan African countries,” Qiao says. “Our study could generate important preliminary data regarding intersecting stigma experienced by men who have sex with men in Zambia and identify strategies for interventions with healthcare providers to reduce stigma and increase utilization of HIV-related services.”
Li, who is an HEPB professor and the director of the South Carolina SmartState Center for Healthcare Quality (CHQ), has worked with Qiao on numerous projects related to HIV research in a global context and is co-investigator on this new grant. “We are excited about the collaboration with University of Michigan, University of Zambia and the local partners, which is an extension of the African research by CHQ faculty, ” he says.
The findings from this study will inform how best to develop, introduce and implement culturally appropriate stigma reduction programs in clinical settings to improve effective responses to the HIV epidemic among men who have sex with men in Zambia and other Sub-Saharan African countries.
“Capacity building in a resource-poor setting is always one of the aims in our research,” says Qiao. “Our long-term goal is to develop, evaluate and implement a healthcare provider training program in Zambia to reduce intersecting stigma in clinical settings, improve the quality of integrated sexual health care, and increase men who have sex with men’s linkage to the treatment cascade.”