Health providers’ experiences, perceptions and readiness to provide HIV services to men who have sex with men and female sex workers in Uganda – a qualitative study

Abstract

Background Access to HIV services among men who have sex with men (MSM) and female sex workers (FSWs) remains suboptimal globally. While the reasons for this dismal performance have been documented, limited evidence exists on the experiences, perceptions and readiness of health providers to provide HIV services to MSM and FSWs. Methods This analysis uses data collected from 48 key informants (health providers in public and private health facilities) as part of a larger study conducted in 12 districts of Uganda between October and December 2013. Data were collected on health providers’ experiences and readiness to provide HIV services to MSM and FSWs and their perceptions on the effect of existing legislation on HIV services provision to MSM and FSWs. Data were captured verbatim, transcribed and analyzed following a thematic framework approach. Results All health providers reported that they had ever provided HIV services to FSWs and a majority of them were comfortable serving them. However, no health provider had ever served MSM. When asked if they would be willing to serve MSM, nearly three-quarters of the health providers indicated that they would be bound by the call of duty to serve them. However, some health providers reported that they “ would feel very uncomfortable ” handling MSM because they engage in “ a culture imported into our country ”. A majority of the health providers felt that they did not have adequate skills to effectively serve MSM and called for specific training to improve their clinical skills. There were mixed reactions as to whether existing criminal laws would affect MSM or FSWs access to HIV services but there was agreement that access to HIV services, under the existing laws, would be more constrained for MSM than FSWs since society “ does not blame FSWs [as much as it does] with MSM ”. Conclusion A majority of the health providers were generally comfortable serving FSWs but there were strong homophobic tendencies towards MSM. A majority of the health providers lacked skills in how to handle MSM. Interventions aimed at improving health providers’ skills in handling MSM while minimizing the negative attitude towards them are urgently needed. Electronic supplementary material The online version of this article (10.1186/s12879-019-3713-0) contains supplementary material, which is available to authorized users.

Cultural and clinical challenges in sexual health care provision to men who have sex with men in Tanzania: a qualitative study of health professionals’ experiences and health students’ perspectives

“…Across most of Africa, key populations face discrimination, judgements, and negative attitudes from health care workers. These factors act as barriers in accessing healthcare services by lesbian, gay, bisexual and transgender (LGBT) populations [27,38,39]. Furthermore, same sex relationships in sub-Saharan Africa are heavily stigmatized and criminalized in many countries in the continent [40,41].…”

Peer distribution of HIV self-test kits to men who have sex with men to identify undiagnosed HIV infection in Uganda: A pilot study

“…HIV testing is the entry point to HIV care; increasing testing coverage is a key step to reaching the first UNAIDS 90-90-90 target, i.e., 90% of people living with HIV knowing their HIV status. However, testing uptake is still low among MSM despite efforts to scale up prevention services for key populations (KP) in Uganda [5][6][7][8]. A recent bio-behavioral survey of Ugandan MSM found that 35% had never tested for HIV [6].…”

Attitudes of medical students towards men who have sex with men living with HIV: implications for social accountability

“…Several previous studies have documented that a lack of specific skills can affect continuum of care for MSM. 36 , 37 , 40 In contrast, other studies showed that health care providers trained in MSM specificity provide better holistic care while considering the social aspects of their lives. 30 It follows that training of health care providers will lead to skill improvement for quality of healthcare; however, efforts to shift attitudes have to consider the cultural components of the society.…”

“…However, it has been proved that negative attitudes of health care providers have shifted due to the implementation of educational interventions; one of the recommendations made by the participants. 37 …”