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      Anti-homosexual legislation and HIV-related stigma in African nations: what has been the role of PEPFAR?

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          ABSTRACT

          Background: Gay men and other men who have sex with men are disproportionately burdened by HIV infection. Laws that penalize same-sex intercourse contribute to a cycle of stigma, homonegativity and discrimination. In many African nations, laws criminalizing homosexuality may be fueling the epidemic, as they dissuade key populations from seeking treatment and health care providers from offering it.

          Objectives: We analyzed the ways in which policies and practices of the US President’s Emergency Plan for AIDS Relief (PEPFAR) program addressed pervasively harsh anti-homosexuality laws across Africa. Given the aim of the US PEPFAR program to reduce stigma surrounding HIV, we explored how PEPFAR may have used its influence to reduce the criminalization of homosexuality in the countries where it operated.

          Methods: We assessed homosexuality laws in 21 African countries where PEPFAR funding sought to reduce the HIV epidemic. We examined PEPFAR Policy Framework agreements associated with those countries, and other PEPFAR documents, for evidence of attempts to reduce stigma by decriminalizing homosexuality.

          Results: We found 16 of Africa’s 21 PEPFAR-funded countries had laws characterized as harsh in relation to homosexuality. Among the top eight PEPFAR-funded countries in Africa, seven had harsh anti-homosexuality laws. Most (14) of the 16 African ‘Partnership Framework’ (PEPFAR) policy agreements between African governments and the US State Department call for stigma reduction; however, none call for reducing penalties on individuals who engage in homosexual behavior.

          Conclusions: We conclude that while PEPFAR has acknowledged the negative role of stigma in fueling the HIV epidemic, it has, so far, missed opportunities to explicitly address the role of the criminalization of homosexuality in feeding stigmatizing attitudes. Our analysis suggests mechanisms like PEPFAR Partnership Framework agreements could be ideal vehicles to call for removal of anti-homosexuality legislation.

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          Most cited references40

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          Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward.

          Although stigma is considered a major barrier to effective responses to the HIV/AIDS epidemic, stigma reduction efforts are relegated to the bottom of AIDS programme priorities. The complexity of HIV/AIDS-related stigma is often cited as a primary reason for the limited response to this pervasive phenomenon. In this paper, we systematically review the scientific literature on HIV/AIDS-related stigma to document the current state of research, identify gaps in the available evidence and highlight promising strategies to address stigma. We focus on the following key challenges: defining, measuring and reducing HIV/AIDS-related stigma as well as assessing the impact of stigma on the effectiveness of HIV prevention and treatment programmes. Based on the literature, we conclude by offering a set of recommendations that may represent important next steps in a multifaceted response to stigma in the HIV/AIDS epidemic.
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            Stigma, health care access, and HIV knowledge among men who have sex with men in Malawi, Namibia, and Botswana.

            Same-sex practices are stigmatized in much of sub-Saharan Africa. Cross-sectional relationships between discrimination, access to and use of health care services, and HIV knowledge among men who have sex with men (MSM) were assessed in Malawi, Namibia, and Botswana. A survey and HIV screening were used to explore these variables and the prevalence of HIV. Overall, 19% of men screened positive for HIV infection. Ninety-three percent knew HIV is transmitted through anal sex with men, however, only 67% had ever received information of how to prevent this transmission. Few (17%) reported ever disclosing same sex practices to a health professional and 19% reported ever being afraid to seek health care. Men reported ever been denied health care services (5%) and 21% had ever been blackmailed because of their sexuality. Strong associations were observed between experiences of discrimination and fear of seeking health care services. Characterizing the relationship between stigma and health care seeking practices and attitudes can inform the development and implementation of HIV interventions for African MSM.
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              • Abstract: not found
              • Article: not found

              Development and Validation of a Scale Measuring Modern Prejudice Toward Gay Men and Lesbian Women

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                Author and article information

                Journal
                Glob Health Action
                Glob Health Action
                ZGHA
                zgha20
                Global Health Action
                Taylor & Francis
                1654-9716
                1654-9880
                2017
                5 June 2017
                : 10
                : 1
                : 1306391
                Affiliations
                [ a ]Department of Health Services, University of Washington School of Public Health
                [ b ]School of Law, University of Washington
                [ c ]Department of Global Health, University of Washington School of Public Health , Seattle, Washington
                Author notes
                CONTACT Amy Hagopian hagopian@ 123456uw.edu University of Washington , Box 357660, Seattle, WA 98195-7660, USA
                Author information
                http://orcid.org/0000-0002-2120-8295
                Article
                1306391
                10.1080/16549716.2017.1306391
                5496073
                28580879
                5be8f1e9-217d-4289-8351-639160244de9
                © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 1 September 2016
                : 7 March 2017
                Page count
                Figures: 1, Tables: 1, References: 80, Pages: 11
                Funding
                Funded by: Centers for Disease Control and Prevention 10.13039/100000030
                Award ID: U48DP001911
                This publication is a product of a Health Promotion and Disease Prevention Research Center supported by Cooperative Agreement no. U48DP001911-03 from the Centers for Disease Control and Prevention. The findings and conclusions in this journal article are those of the authors and do not represent the official position of the Centers for Disease Control and Prevention.
                Categories
                Article
                Original Article

                Health & Social care
                homonegativity,homophobia,stigma,homosexuality laws,africa
                Health & Social care
                homonegativity, homophobia, stigma, homosexuality laws, africa

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