Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.
J Int AIDS Soc. 2013 Dec 2;16 Suppl 3(4Suppl 3):18748. doi: 10.7448/IAS.16.4.18748.
Healthcare workers (HCWs) in Africa typically receive little or no training in the healthcare needs of men who have sex with men (MSM), limiting the effectiveness and reach of population-based HIV control measures among this group. We assessed the effect of a web-based, self-directed sensitivity training on MSM for HCWs (www.marps-africa.org), combined with facilitated group discussions on knowledge and homophobic attitudes among HCWs in four districts of coastal Kenya.
We trained four district "AIDS coordinators" to provide a two-day training to local HCWs working at antiretroviral therapy-providing facilities in coastal Kenya. Self-directed learning supported by group discussions focused on MSM sexual risk practices, HIV prevention and healthcare needs. Knowledge was assessed prior to training, immediately after training and three months after training. The Homophobia Scale assessed homophobic attitudes and was measured before and three months after training.
Seventy-four HCWs (68% female; 74% clinical officers or nurses; 84% working in government facilities) from 49 health facilities were trained, of whom 71 (96%) completed all measures. At baseline, few HCWs reported any prior training on MSM anal sexual practices, and most HCWs had limited knowledge of MSM sexual health needs. Homophobic attitudes were most pronounced among HCWs who were male, under 30 years of age, and working in clinical roles or government facilities. Three months after training, more HCWs had adequate knowledge compared to baseline (49% vs. 13%, McNemar's test p<0.001); this was most pronounced in those with clinical or administrative roles and in those from governmental health providers. Compared to baseline, homophobic attitudes had decreased significantly three months after training, particularly among HCWs with high homophobia scores at baseline, and there was some evidence of correlation between improvements in knowledge and reduction in homophobic sentiment.
Scaling up MSM sensitivity training for African HCWs is likely to be a timely, effective and practical means to improve relevant sexual health knowledge and reduce personal homophobic sentiment among HCWs involved in HIV prevention, testing and care in sub-Saharan Africa.
非洲的医疗工作者（HCWs）通常在男男性行为者（MSM）的医疗需求方面接受的培训很少或根本没有，这限制了基于人群的艾滋病毒控制措施在该人群中的有效性和覆盖面。我们评估了一种基于网络的、自我指导的敏感性培训对 MSM 医疗工作者的效果（www.marps-africa.org），同时在肯尼亚沿海四个地区的医疗工作者中进行了促进小组讨论，以了解他们的知识和恐同态度。
我们培训了四名地区“艾滋病协调员”，为肯尼亚沿海地区提供抗逆转录病毒治疗的设施中的当地 HCWs 提供为期两天的培训。自我指导的学习辅以小组讨论，重点关注 MSM 的性风险行为、艾滋病毒预防和医疗保健需求。在培训前、培训后立即和培训后三个月评估知识。同性恋恐惧症量表评估恐同态度，并在培训前和培训后三个月进行测量。
共有 74 名 HCWs（68%为女性；74%为临床医生或护士；84%在政府机构工作）来自 49 个卫生机构接受了培训，其中 71 名（96%）完成了所有措施。在基线时，很少有 HCWs 报告接受过任何关于 MSM 肛交性行为的培训，大多数 HCWs 对 MSM 的性健康需求知之甚少。在男性、30 岁以下、从事临床工作或在政府机构工作的 HCWs 中，恐同态度最为明显。培训三个月后，与基线相比，更多的 HCWs 具有足够的知识（49%比 13%，McNemar 检验 p<0.001）；在具有临床或行政角色的 HCWs 和来自政府卫生提供者的 HCWs 中更为明显。与基线相比，在培训三个月后，恐同态度明显下降，特别是在基线时恐同情绪得分较高的 HCWs 中，并且知识的提高与恐同情绪的降低之间存在一定的相关性。
为非洲 HCWs 扩大 MSM 敏感性培训可能是一种及时、有效和实用的方法，可以提高相关的性健康知识，减少参与撒哈拉以南非洲艾滋病毒预防、检测和护理的 HCWs 的个人恐同情绪。
