# Intersecting stigma against MSM in clinical settings in Zambia

> **NIH NIH R21** · UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA · 2020 · $168,586

## Abstract

Abstract
Zambia is one of the top 10 countries with the highest HIV prevalence rates (~12.3% prevalence rate among
adults) in the world1,2, with an estimated prevalence rate of 33% among men who have sex with men (MSM)3.
Although the Zambian government has recently included MSM in its HIV prevention agenda, intervention
efforts for MSM are limited due to criminalization of homosexual behaviors and persistent stigma and
discrimination against MSM2-4. Stigma against homosexual behaviors is often intertwined with the religious
notion that HIV infection is divine punishment for MSM5. The compounded effect of stigma associated with
multiple marginalized identities (intersecting stigma) impede MSM’s access to the HIV treatment cascade
(diagnosis, linkage to care, retention in care, initiation of antiretroviral therapy, treatment adherence, and viral
suppression)6,7. The anticipation and experience of intersecting stigma in clinical settings further drive MSM
away from receiving timely and quality HIV prevention and care services8,9. Although stigma reduction
interventions among healthcare providers have been identified as a priority in the HIV prevention and care
agenda for MSM in Sub-Saharan Africa8,10, none of such programs is available in Zambia. Research examining
the drivers, manifestations, and effects of intersecting stigma among healthcare providers in the legal and
cultural context of Zambia is extremely limited. Very few existing empirical studies have linked intersecting
stigma with MSM’s (dis)engagement in HIV prevention and care which is critical to achieve the 90-90-90
goals. In addition, limited data are available regarding the needs and efficacious strategies for stigma reduction
intervention in clinical settings in Zambia. To fill in these research gaps, we aim to conduct a mixed-methods
study that will: a) examine drivers/facilitators and manifestations of intersecting stigma against MSM through
policy reviews and in-depth qualitative interviews with MSM and key stakeholders; b) explore the effects of
intersecting stigma and potential mechanisms of such effects in clinical settings on MSM’s (dis)engagement in
the HIV treatment cascade through quantitative surveys among MSM and healthcare providers; and c) identify
the needs and effective strategies for stigma reduction interventions in clinical settings in Zambia based on
triangulation of data collected via policy reviews and qualitative and quantitative studies. The preliminary data
and experience we gain from this study will position us to develop a healthcare provider intervention that aims
to reduce intersecting stigma against MSM in clinical settings and to improve their linkage to the HIV
treatment cascade.

## Key facts

- **NIH application ID:** 9914082
- **Project number:** 5R21TW011064-02
- **Recipient organization:** UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
- **Principal Investigator:** GARY W HARPER
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $168,586
- **Award type:** 5
- **Project period:** 2019-04-15 → 2022-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9914082

## Citation

> US National Institutes of Health, RePORTER application 9914082, Intersecting stigma against MSM in clinical settings in Zambia (5R21TW011064-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9914082. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*