Abstract:
Gay, bisexual, and other men who have sex with men (GBMSM) are highly stigmatized
and male-male sex is often criminalized in sub-Saharan Africa, impeding access to
quality care for sexual health, HIV prevention, and treatment. To better understand HIV
care engagement and antiretroviral therapy (ART) adherence among GBMSM in this
context, a conceptual model incorporating sociocultural factors is needed. We conducted
a qualitative study of barriers to and facilitators of HIV care engagement and ART
adherence among Kenyan GBMSM, informed by a conceptual model based on an access,
information, motivation, and behavioral skills(access-IMB) model, with trust in
providers and stigma and discrimination as a priori factors of interest. We conducted 30
semi-structured interviews with HIV-positive Kenyan GBMSM, of whom 20 were taking
ART and 10 had not yet initiated treatment. A deductive approach was used to confirm
the relevance of basic concepts of the access-IMB model, while an inductive approach
was used to identify content that emerged from men's lived experiences. Access-related
information, motivation, and behavioral skills appeared relevant to HIV care engagement
and ART adherence, with stigma and discrimination appearing consistently across
discourse exploring facilitators and barriers. Trusted providers and supportive family and
friends helped many men, and resilience-related concepts such as selective disclosure of
GBMSM status, connection to lesbian, gay, bisexual, and transgender (LGBT)
organizations, self-acceptance, goal-setting, social identity and altruism emerged as
important facilitators. Findings suggest a need to increase support from providers and
peers for Kenyan GBMSM living with HIV infection. In addition, they point toward the
potential value of interventions that provide opportunities to build or enhance one's sense
of community belonging in order to improve HIV care engagement and promote ART
adherence for this vulnerable population.