Prevalence and factors associated to disclosure of same-sex practices to family members and health care workers among men who have sex with men in Togo

ABSTRACT

Disclosure of same-sex practices is associated with improved access to health services and better health outcomes. Our aim was to estimate the prevalence of same-sex practice disclosure to family members and health care workers (HCW) in two cities in Togo. 683 MSM ≥18 years of age were surveyed using respondent driven sampling (RDS) for a cross-sectional survey using a structured questionnaire in Lomé (354 (51.8%)) and Kara (n = 329 (48.2%)). Median age was lower in Lomé than in Kara. A significantly higher proportion of MSM in Lomé (RDSa: 37.0%; 95% CI: 29.7, 44.3) than in Kara (RDSa: 8.0%; 95% CI: 4.7, 11.3) told a HCW that they have sex with men. Disclosure to a family member was associated with female gender, living with HIV, difficulties accessing health services, and blackmail. Disclosure to a HCW was associated with living with HIV, and physical abuse. MSM had decreased odds of disclosure to a HCW if they were living in Kara, reported female gender or intersex, or if had difficulties accessing health services. These data highlight the positive health outcomes associated with disclosure contextualized by the complex environments in which disclosure of same-sex practices takes place.

KEYWORDS:

• MSM
• Togo
• disclosure
• HIV
• respondent driven sampling

Acknowledgements

The authors thank the men who participated in the study for their engagement and making this analysis possible. The authors concurrently thank the Togo Ministry of Health for approving and collaborating on this study as well as Erin Papworth and Ping-An Chen for their support in implementing the study. The authors also acknowledge the team at USAID and USAID West Africa, for their continued dedication and important role in the success of this study and similar studies across the region. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funding sources had no role in the study design; in the collection, analysis and interpretation of data; in the writing of the articles; or in the decision to submit the manuscript for publication.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The study was implemented by USAID | Project SEARCH, Task Order No.2, which is funded by the United States Agency for International Development under Contract No. GHH-I-00- 07-00032-00, beginning 30 September 2008, and supported by the U.S. President’s Emergency Plan for AIDS Relief. SB’s efforts for this publication were supported by National Institutes of Mental Health and Office of AIDS Research of the National Institutes of Health under award number R01MH110358. Finally, this publication was made possible with help from the Johns Hopkins University Center for AIDS Research, an NIH funded program (P30AI094189), which is supported by the following NIH co-funding and participating Institutes and Centers: National Institute of Allergy and Infectious Diseases (NIAID), National Cancer Institute (NCI), National Institute of Child Health and Human Development (NICHD), National Heart, Lung, and Blood Institute (NHLBI), National Institute on Drug Abuse (NIDA), National Institute of Mental Health (NIMH), National Institute on Aging (NIA), Fogarty International Center (FIC), National Institute of General Medical Sciences (NIGMS), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and the Office of AIDS Research (OAR).