Research Article: Multilayered Stigma and Vulnerabilities for HIV Infection and Transmission: A Qualitative Study on Male Sex Workers in Zimbabwe

Date Published: January 28, 2019

Publisher: SAGE Publications

Author(s): Eileen Yuk-ha Tsang, Shan Qiao, Jeffrey S. Wilkinson, Annis Lai-chu Fung, Freddy Lipeleke, Xiaoming Li.

http://doi.org/10.1177/1557988318823883

Abstract

Male sex workers are marginalized in most societies due to intersectional stigma between prostitution and homosexuality. In Zimbabwe, a proliferation of male sex workers in major cities such as Harare and Bulawayo has been reported. However, there is a shortage of studies that explore their lives. The current qualitative study aims to describe the practices of sex work, life contexts, and HIV risks and vulnerabilities based on in-depth interviews among 15 male sex workers in Bulawayo. Our studies suggest that the stigma against male sex workers comes from diverse sectors including culture (“homosexuality is un-African, introduced by the Whites”), religion (“same sex is a sin before the God”), law and police (“homosexuality is illegal in Zimbabwe. Engaging in it can send one to prison”), media (“the media is hostile to sex workers particularly men as we are regarded as abnormal and unclean”), and their family (“should they get to know about it, they will disown me”). In this context, male sex workers were excluded from national HIV prevention and treatment programs. They had limited knowledge and many misconceptions about HIV. The stigma and discrimination from health-care providers also discouraged them from health seeking or HIV testing. The non-disclosure to female partners of convenience and sexual relations further increased their vulnerabilities to HIV infection and transmission. Current efforts to address the HIV epidemic should pay attention to male sex workers and tackle the intersecting stigma issues. male sex workers need support and tailored HIV prevention and treatment services to improve their HIV prevention practices, health, and well-being.

Partial Text

The participants were young with an average age of 27 years (from 19 to 38). There were nine unemployed persons in addition to three college students, one waiter, one bank teller, and one tour guide. Six participants were in college or had finished college and two completed high school, but the rest either dropped out of primary or high school. Seven participants were single, one was married, two had stable male partners, four had girlfriends before, and four were currently engaged in stable relationships with women. In terms of sexual orientation, 10 of them identified as gay, four were heterosexual, while one confessed he was not sure about his identity.

The current study is an initial effort to understand the sociocultural context of felt and enacted stigma toward male sex workers in Zimbabwe. The authors illustrated various causes of stigma and discrimination against male sex workers and explored how the combination of both enacted and felt sigma increases the vulnerability of HIV infection and transmission among this vulnerable population in terms of accessing HIV-related knowledge and health services as well as not disclosing sexual orientation to partners and families. These findings confirm that a broader range of structural level factors including culture, religion, and legislation must be taken into account for interpreting and addressing obstacles to accessing HIV prevention and treatment services (Amon & Kasambala, 2009). In Zimbabwe, same-sex relations are framed as “un-Christian” and “un-African” by the government and the media (Epprecht, 1998). The illegal nature of sex work and criminalization of same-sex contribute toward an environment of enacted stigma and multilayered marginalization for male sex workers. On the one hand, they have to suffer harassment and unfair treatment from the police and face heightened occupational health risks (e.g., abuse, violence, condomless sex) due to their powerlessness. On the other hand, no national HIV prevention project exists to address the needs of male sex workers in Zimbabwe, although there are some HIV prevention and treatment programs for female sex workers in recent years (Cowan et al., 2017; Hargreaves, Busza, Mushati, Fearon, & Cowan, 2017).

Male sex workers in Zimbabwe are a subset of individuals who have been mostly ignored in the context of the national response to HIV/AIDS. Multilayered enacted and felt stigma and discrimination stemming from cultural practices, religious beliefs, legal frameworks and policies as well as families augment vulnerabilities to HIV infection and transmission among this marginalized population. Interventions are needed to improve access to HIV-related knowledge and prevention and care services and promote disclosure of same-sex behaviors to female partners and health-care providers. Comprehensive HIV prevention programs for male sex workers should address not only the biological drivers of HIV infection, but also the social contexts where male sex workers live and the structural factors that shape the environment for their health seeking.

 

Source:

http://doi.org/10.1177/1557988318823883

 

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