Challenges in Providing Counseling to MSM in Highly Stigmatized Contexts: Results of a Qualitative Study from Kenya

July 2013 - Structural Prevention

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Taegtmeyer, M., Davies, A., Mwangome, M. et al. PLOS One (June 2013), Vol. 8 No. 6.

The authors conducted in-depth interviews with 16 health care providers near Mombasa, Kenya who had interacted with high-risk men who have sex with men (MSM) to explore their attitudes and perceptions about working with MSM. Four interviewees self-reported as being from the local MSM community. Overall, providers were concerned that they had insufficient skills for providing MSM with HIV risk-reduction counseling and addressing other client challenges. The findings underscored the need for tailored training and supervisory support to improve counseling for MSM. The research also revealed other themes including personal, cultural, and religious beliefs that impeded maintenance of neutral attitudes towards MSM; lack of distinction between male sex work and sexual orientation; limited exposure to MSM clients (although continued exposure improved professionalism); sexual attraction (by both clients and counselors); and stigma towards and criminalization of MSM. The authors highlight areas for improvement in training and supervisory support, such as developing separate HIV counseling protocols for MSM; training in professionalism; and supervision skills-building. The findings uncover specific challenges to meeting the needs of MSM in the African context, and show the importance of training, support, counseling, and consideration of the local context to guide HIV prevention programs for MSM.

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