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HIV-related stigma and autonomy-supportive healthcare climate predict linkage to HIV care in men who have sex with men in Ghana, West Africa

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2019, MS, University of Cincinnati, Medicine: Biostatistics (Environmental Health).
In Ghana, men who have sex with men (MSM) are 15 times more likely to live with HIV compared to the general adult population, and rates of engagement in medical care for HIV are low among MSM diagnosed with HIV. Using structured survey interviews, we investigated the impact of HIV-related stigma (deconstructed into four components: enacted, felt normative, vicarious, and internalized HIV stigmas), same-sex behavior stigma, and gender nonconformity stigma on linkage to HIV care in 225 MSM living with HIV in Ghana. We found that vicarious HIV stigma (i.e., hearing stories of HIV discrimination) positively predicted linkage to care, such that MSM were three times more likely to be linked to care for each unit increase in vicarious stigma scale. Conversely, we found felt normative HIV stigma (i.e., perception of pervasiveness of HIV stigmatization) to negatively predict linkage to care, such that odds of being linked to care were decreased by 37% for each unit increase in felt normative scale. Perceived autonomy-supportive healthcare climate was a positive predictor of linkage to care, such that MSM were twice as likely to be linked to care for each unit increase in healthcare climate score. Finally, we identified locational differences in linkage to care, such that MSM in Takoradi were over three to four times more likely to be linked to care compared to MSM in Greater Accra or Kumasi. Ultimately, our findings highlight the nuanced roles that stigmas can play in shaping care-seeking behaviors and illustrate the need for open-minded perspectives of inquiry towards understanding engagement in the HIV care cascade for marginalized populations.
Marepalli Rao, Ph.D. (Committee Chair)
LaRon E. Nelson, Ph.D. (Committee Member)
Jun Ying, Ph.D. (Committee Member)
Nanhua Zhang, Ph.D. (Committee Member)
52 p.

Recommended Citations

Citations

  • Gu, L. Y. (2019). HIV-related stigma and autonomy-supportive healthcare climate predict linkage to HIV care in men who have sex with men in Ghana, West Africa [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1552377696238772

    APA Style (7th edition)

  • Gu, Lily. HIV-related stigma and autonomy-supportive healthcare climate predict linkage to HIV care in men who have sex with men in Ghana, West Africa. 2019. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1552377696238772.

    MLA Style (8th edition)

  • Gu, Lily. "HIV-related stigma and autonomy-supportive healthcare climate predict linkage to HIV care in men who have sex with men in Ghana, West Africa." Master's thesis, University of Cincinnati, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1552377696238772

    Chicago Manual of Style (17th edition)