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15th Annual Conference of the British HIV Association1-3 April 2009, Liverpool, UK |
CHALLENGES IN ADDRESSING COUNSELLING NEEDS OF MSM IN HIGHLY STIGMATIZED CONTEXTS: RESULTS OF A QUALITATIVE STUDY FROM KENYA
HIV Med 2009 Apr 1-3; 10(Suppl. 1):15 (abstract no. P4)
M Taegtmeyer1, A Muhaari2, A Davies2, M Mwangome2, EM van der Elst2, SM Graham3 and EJ Sanders4
1Liverpool School of Tropical Medicine, Liverpool, UK, 2Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya, 3University of Washington, Seattle, USA, 4Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK
BACKGROUND: The role of men who have sex with men (MSM) in the African HIV epidemic is gaining recognition but capacity to address HIV prevention needs of this group is limited. We set out to assess the skills and attitudes of a group of Kenyan counsellors working with MSM and identify training and supervision needs.
METHODS: Qualitative in-depth interviews were conducted with 16 participants with experience counselling high risk MSM in Mombasa, Kenya in July 2008. Opened ended questions were asked that allowed exploration of the impact of personal and cultural value systems on the ability to conduct effective counselling. Data were transcribed and analysed using a framework approach.
RESULTS: Participants expressed a range of attitudes to MSM from affirmation through tolerance to negative and stigmatizing, with some expressing that gayness was a disease that good counselling could change. All said that they lacked skills to conduct effective risk- reduction counselling. Most had learned all they knew about MSM from male sex workers and mentioned triggers such as poverty, alcohol and drugs. Few linked risk taking behaviour with life issues, self worth and stigma. As a result counsellors knew about the complex issues faced by high risk MSM but few described this impacting on their approaches to risk-reduction counselling. Similarly, counsellors said they were non-judgemental yet our data reveal many had strong social constructs and were unable to ‘put aside their values’.
CONCLUSIONS: Counsellor training must challenge judgmental attitudes, as well as improving risk reduction skills, and link to on-going support supervision. On-going exposure, discussion and the presence of counsellors who themselves identified as MSM were powerful promoters of attitudinal change in counsellors which in turn impacted positively on the quality of risk reduction counselling. We will present the findings from this rich data to give a deeper understanding of the breadth and subtly of training and supervisory needs required to provide HIV prevention services to this highly stigmatized group in Africa.
2009-04-01
P4
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