Toronto
Download
1 / 30

Toronto I-II 1:00 pm - PowerPoint PPT Presentation


  • 67 Views
  • Uploaded on

Toronto I-II 1:00 pm Towards improving health outcomes for MSM in Africa and African diaspora communities. Moderator: Winston Husbands Director of Research and Program Development at the AIDS Committee of Toronto and a co-chair of the African and Caribbean Council on HIV/AIDS in Ontario.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Toronto I-II 1:00 pm' - kimball


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

Toronto I-II 1:00 pm

Towards improving health outcomes for MSM in Africa and African diaspora communities

Moderator:

Winston HusbandsDirector of Research and Program Development at the AIDS Committee of Toronto and a co-chair of the African and Caribbean Council on HIV/AIDS in Ontario

LaRonNelsonAssistant Professor and Assistant Dean for Global and Community Affairs at the University of South Florida College of Nursing


Towards improving health outcomes for msm in african and african diaspora communities

Towards Improving Health Outcomes for MSM in African and African DiasporaCommunities

LaRon E. Nelson, PhD, RN, NP

Assistant Dean of Global & Community Affairs

Assistant Professor of Nursing and Pharmacy


Background
Background African Diaspora

  • Men account for approximately 50% of the estimated 240,802 people living with HIV in Ghana

  • HIV Prevalence among MSM estimated at 25%

  • MSM account for 25% of HIV cases among most-at-risk populations in Ghana— (includes female sex workers and their patrons)

  • 20% new HIV infections annually among MSM

    Ghana National AIDS Control Programme, 2012






Cultural leaders
Cultural Leaders disclosures


Human rights ngos
Human Rights NGOs disclosures

Centre for Popular Education & Human Rights, Ghana



Focused on three communities in ghana with high hiv prevalence
Focused on three communities in Ghana with high HIV prevalence

Kumasi

Accra

Koforidua


Self administered survey
Self-Administered Survey prevalence

  • Cross-Sectional

    • Relative Frequency of Condom Use

    • STD Knowledge

    • HIV Knowledge

    • Gender Non Conformity Stigma and HIV Stigma

    • Gender Equity

    • Substance Use

    • Affiliation/Security within the social network


Focus groups and interviews
Focus Groups and Interviews prevalence

  • Focus Groups with MSM

  • Conversational Interviews

    • MSM Peer Leaders

    • Community/Cultural Leaders

    • Healthcare Professionals


Identified 23 social networks of msm
Identified 23 social networks of MSM* prevalence

* 137 total men


Findings from survey
Findings from Survey prevalence

  • Overall low condom use (23%)

    • Highest in Accra

    • Lowest in Kumasi

  • High proportion of men with female sex partners (53%)

    • Higher than proportion of men who reported bisexual attraction

  • Low non-alcoholic substance use


Findings from survey1
Findings from Survey prevalence

  • Networks were significantly different from one another on all study variables

  • All psychosocial and knowledge variables were predicted by the network

  • Measures of network affiliation/security was the biggest predictor of condom use

    • More affiliated people used condoms more anal and oral sex

    • More affiliated people use condoms less for vaginal sex


Findings from focus groups
Findings from Focus Groups prevalence

  • General Interest in PrEP (22 out of 23 groups)

    • Concern about efficacy

    • Guinea Pigs for the West (why no scale up in US)

    • Costs

    • Discontinuation of condom use

  • Gender Norms Inequitable towards women

    • Most had female partners

  • Informal underground network of providers that they used to get their sexual health related needs met.


Finding from interviews
Finding from Interviews prevalence

  • Cultural Leaders (n=23)

    • Mixed on acceptability of targeted care for MSM

    • Felt that MSM should be able to live in “peace”

    • No willingness to offer visible political support

    • Their was resistance to language of “gay-rights”

    • Believe all MSM are in Accra

  • Healthcare Providers (n=25)

    • Believed in fair treatment

    • Duty to educate clients about morality of behavior (but said they are free to choose)

    • Only two recalled ever encountering an MSM in clinical practice


Implications
Implications prevalence

  • Focus on the close social networks as the target of intervention

    • Versus as a recruitment mechanism

  • Prevention needs are multifaceted and require a combination approach

    • Targeting behavioral, social, and biomedical factors for MSM

    • Needs to accommodate complexity of men’s sexualities

  • Attention must be directed to MSM outside of urban core

  • Healthcare Climate needs structural intervention

    • Nurses and physicians attitudes and behaviors as barriers to scale up efforts


Level 1 structural intervention
Level 1: Structural Intervention prevalence

  • Targeted for change in the healthcare climate

  • Human Rights Support Training for Healthcare providers


Medical Professionalism – A Physician Charter & Biomedical Ethics

  • Primacy of patient welfare: a dedication to serving patients’ interests

  • Patient autonomy: to empower patients to make informed decisions

  • Social justice: to eliminate discrimination

ABIM Foundation. Ann Intern Med. 2002;136:243-246

Beauchamp & Childress. Biomedical Ethics 2009.

Courtesy of Geoffrey C. Williams, University of Rochester

26


Informed decision making
Informed Decision Making Ethics

  • 1478 MD-patient encounters audiotaped

  • 91% of the time, MDs don’t support autonomy

  • Most frequent error is providing too little structure, not too much

Braddock CH 3rd, et al. JAMA. 1999;282:2313-2320

Courtesy of Geoffrey C. Williams, University of Rochester

27


Implications1
Implications Ethics

  • Focus on the close social networks as the target of intervention

    • Versus as a recruitment mechanism

  • Prevention needs are multifaceted and require a combination approach

    • Targeting behavioral, social, and biomedical factors for MSM

    • Needs to accommodate complexity of men’s sexualities

  • Attention must be directed to MSM outside of urban core

  • Healthcare Climate needs structural intervention

    • Nurses and physicians attitudes and behaviors as barriers to scale up efforts


THANK Ethics

YOU


ad