Exploring the perspectives of healthcare providers on providing HIV prevention and treatment services for Key Populations in Rwanda: a qualitative study.

Abstract

Background:The HIV prevalence and incidence among the general population in Rwanda have decreased significantly in the past decade, with only about 3% prevalence as of 2019. However, opposite trends are seen among the key populations (KP). The prevalence among commercial sex workers is as high as 51%, and the HIV rates among this group continue to rise. While the prevalence among key populations remains high, their adherence to HIV treatment is low compared to the general population. Healthcare providers play a vital role in ensuring key populations’ access to HIV treatment, adherence, and program retention. This study aimed to explore the experiences of healthcare providers in providing HIV services to key populations in Rwanda.Methods:A qualitative phenomenological study was conducted with nurses, doctors, social workers, and psychologists who provide HIV services in health facilities in Rwanda. In-depth interviews were conducted using a semi-structured interview guide. Transcribed and translated data were coded according to a structured code book. All data were organized and analyzed using Dedoose software (version 8.3.35).Results: Interviews with 18 healthcare providers were conducted; participants included 1 doctor (5.6%), 5 social workers (27.8%), and 12 nurses (66.7%). All participants had worked with key populations, especially commercial sex workers and men who have sex with men. Three overarching themes emerged from the interviews: healthcare providers’ intrinsic feelings affect the ways they provide HIV services to key populations, key populations face a multitude of challenges related to accessing treatment and preventing the spread of HIV, and a more comprehensive and sensitive approach should be used to improve HIV services for key populations. Conclusion: Healthcare providers expressed difficulties in providing services to key populations as they tend not to adhere to treatment and prevention guidelines, caused by some structural barriers, their lack of trust in the system, and the discrimination and abuse they have faced. More comprehensive services including clinical, financial, and psychosocial support from trusted sources are needed. Some important policy changes may be needed to allow KPs to purchase community-based health insurance.

A qualitative study to explore the healthcare-seeking experiences of men who have sex with men and transgender women in Rwanda

“…The other study explored the perspectives of healthcare providers on providing HIV prevention and treatment services for key populations in Rwanda, found MSM and commercial sex workers experienced stigma within the communities and health facilities resulting in their delay to seek care (20). Similar stigma hampered access to healthcare services for key populations were found in sub-Saharan African region as well as neighboring countries including Uganda and Kenya (3,19,20,21,22).…”

“…Isano and colleagues in a 2019 study assessed the barriers to HIV post-exposure prophylaxis access among MSM in sub-Saharan Africa, reported that Rwandan MSM face rampant stigma and discrimination at various levels: family, community, and the healthcare settings which negatively impacted their healthcare seeking behavior (19). The other study explored the perspectives of healthcare providers on providing HIV prevention and treatment services for key populations in Rwanda, found MSM and commercial sex workers experienced stigma within the communities and health facilities resulting in their delay to seek care (20). Similar stigma hampered access to healthcare services for key populations were found in sub-Saharan African region as well as neighboring countries including Uganda and Kenya (3,19,20,21,22).…”

A community informed cross-sectional analysis of the sexual and reproductive health barriers and recommendations of MSM and TGW in Rwanda

“…While the CBHI does cover multiple services, a lack of acceptance and potential of being disowned from their families has been noted across other studies in Rwanda as a notable impediment for these populations to obtain insurance coverage (21). The structural challenges that are propagated by inadequate insurance coverage for gender and sexual minorities have been well documented and can act as an impediment to care seeking behaviors, including HIV testing and treatment (22,22). Hence, individual insurance plans may be bene cial for gender and sexual minorities to ensure continued access to services despite societal stigma.…”