Perceived and experienced stigma among male sex workers who sell sex to men in Mombasa, Kenya
Background: Male sex workers (MSW) who sell sex to men are highly stigmatized and vulnerable to HIV and STIs in Africa. Little is known about MSW in this setting and their experiences with health care providers, community, relatives, friends, and clients. Examining their perceptions and experiences of stigma and its influence on health-seeking behavior is important for the prevention and care of infection.
Methods: Three focus group discussions with 26 participants and 10 in-depth interviews where conducted among men, selected during a cross-sectional survey examining social characteristics and sexual risk behaviors among MSW who sell sex to men in Mombasa, Kenya. Participants of different ages, sexual identities and workplaces were selected. For in-depth interviews, informants considered likely to provide important information were selected.
Results: Some respondents alluded being called “dume jike”–a derogatory term meaning “man-woman”–upon revealing their sexual orientation to family members and friends. Due to fear of disclosure of their sexual behavior to health care providers, MSW reported delays in seeking health care services or absconded. Self-medication was sometimes thought to be a solution. Also, mis-presentation of clinical symptoms occurred. All were mainly seen with rectal symptoms. MSW reported humiliation, stress, and alienation when seeking health care services.
Conclusions: Perceived and experienced stigma among MSW who sell sex to men presents barriers to accessing health care that require urgent attention at the individual, community, and health care level. Policy development and capacity building should be promoted to sensitize institutions and service providers in order to understand MSW health issues, and to better address their health needs. Further research on stigma reduction is crucial in combating HIV/STI prevention among MSW who sell sex to men.
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