Table 4: The extent of stigmatization and its anticipated impact on PrEP use among men who have sex with men (MSM), Bouaké, Côte d’Ivoire

The extent of stigmatization in MSM lifes
Impact of stigmatization on the capability to be oneself « It is not easy because you cannot live fully with your sexual identity. I mean you can’t be who you are because today [homosexuality] is perceived badly. Some people say it is an abomination.» (Participant #16, Interview)
Effeminate behaviours as a determinant of stigmatization « It is difficult to bear because we are being assaulted everywhere we go. Not mainly because we are gay, they don’t know we are gay, but because we are effeminate. There are some gays who are not effeminate, but they are not stigmatized. […] So, I think that discrimination is really difficult to bear in Côte d’Ivoire because they beat us, they see us walking like a girl, […] they hate it so when they see you walking like a woman […] they don’t think twice, they hit you. Walk like a man you are a man, that’s it.» (Participant #9, Interview)
Impact of stigmatization within the family « It is really complicated, mostly when you are under the authority of your parents. It is complicated because you dependent on them. If they learn [about your homosexuality], you can be denied, they can send you somewhere where you won’t be able to do what you want. You can forget your convictions, you can forget the dreams you had.» (Participant #32, Interview)
Stigmatization between MSM « There are some people who are not effeminate but are gay and who don’t accept to see effeminate men going out in the streets. These people join homophobic people and hit or insult other gays. It is not nice to see.» (Participant #31, Focus group)
Stigmatization in public institutions «I think that, talking about stigmatization, we are stigmatized on every aspect. I mean, the look, you are seen badly, you are badly approached, you have a problem and you want justice and you are not taken in charge, or you are sick and go to the hospital and you are not taken in charge. I think that on every aspect, MSM are stigmatized, they are isolated from the society, they are put away» (Participant #14, Focus group)
Anticipated impact of stigmatization on PrEP use
No impact on PrEP use « I think that, even if I’m insulted, hit, denigrated, blacklisted, I will take PrEP if it is available in Côte d’Ivoire, I will use it because it prevents from HIV.» (Participant #29, Interview)
Impact on PrEP use « […] if someone sees you taking the medication, he can say […]: “those are gay pills you are taking”. […] It can be a barrier to PrEP use. […] So these stigmatizations can be an obstacle to PrEP use I think.» (Participant #16, Focus group)

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