van der Elst Elise M, Kombo Bernadette, Gichuru Evans, Omar Anisa, Musyoki Helgar, Graham Susan M, Smith Adrian D, Sanders Eduard J, Operario Don
Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya;
Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya.
J Int AIDS Soc. 2015 Oct 21;18(1):20226. doi: 10.7448/IAS.18.1.20226. eCollection 2015.
INTRODUCTION: Although men who have sex with men (MSM) in sub-Saharan Africa are at high risk for HIV acquisition, access to and quality of health and HIV services within this population are negatively affected by stigma and capacity within the health sector. A recently developed online MSM training programme (www.marps-africa.org) was shown to contribute to reductions in MSM prejudice among healthcare providers (HCPs) in coastal Kenya. In this study, we used qualitative methods to explore the provision of MSM healthcare services two years post-training in coastal Kenya. METHODS: From February to July 2014, we held 10 focus group discussions (FGD) with 63 participants, including HCP from 25 facilities, county AIDS coordinators and MSM from local support groups. Participants discussed availability, acceptability and accessibility of HIV healthcare for MSM. HCP also discussed changes in their health service practices after completing the training. FGD were recorded, transcribed verbatim and analyzed using Ritchie and Spencer's "framework approach" for qualitative data. RESULTS: HCPs described continued improvements in their ability to provide service in a non-stigmatizing way to MSM patients since completing the training programme and expressed comfort engaging MSM patients in care. Four additional recommendations for improving MSM healthcare services were identified: 1) expanding the reach of MSM sensitivity training across the medical education continuum; 2) establishing guidelines to manage sexually transmitted anal infections; 3) promoting legal and policy reforms to support integration of MSM-appropriate services into healthcare; and 4) including MSM information in national reporting tools for HIV services. CONCLUSIONS: Positive impacts of this sensitivity and skills training programme were reflected in HCP attitudes two years post-intervention. Scaling-up of efforts will rely on continued policies to include MSM in healthcare programmes to reduce stigma in health settings and guidelines for MSM STI service delivery.
引言：尽管撒哈拉以南非洲地区的男男性行为者（MSM）感染艾滋病毒的风险很高，但该人群获得卫生保健和艾滋病毒服务的机会以及服务质量受到耻辱感和卫生部门能力的负面影响。最近开发的一个在线男男性行为者培训项目（www.marps-africa.org）已被证明有助于减少肯尼亚沿海地区医疗服务提供者（HCP）对男男性行为者的偏见。在本研究中，我们采用定性方法探讨了在肯尼亚沿海地区培训两年后男男性行为者医疗服务的提供情况。 方法：2014年2月至7月，我们与63名参与者进行了10次焦点小组讨论（FGD），其中包括来自25个机构的医疗服务提供者、县艾滋病协调员以及当地支持小组的男男性行为者。参与者讨论了男男性行为者艾滋病毒医疗服务的可获得性、可接受性和可及性。医疗服务提供者还讨论了他们完成培训后卫生服务实践的变化。焦点小组讨论进行了记录，逐字转录，并使用里奇和斯宾塞的定性数据“框架方法”进行分析。 结果：医疗服务提供者表示，自完成培训项目以来，他们以无耻辱感的方式为男男性行为者患者提供服务的能力持续提高，并表示在为男男性行为者患者提供护理时感到自在。确定了另外四项改善男男性行为者医疗服务的建议：1）在整个医学教育过程中扩大男男性行为者敏感性培训的范围；2）制定管理肛门性传播感染的指南；3）推动法律和政策改革，以支持将适合男男性行为者的服务纳入医疗保健；4）在国家艾滋病毒服务报告工具中纳入男男性行为者信息。 结论：这项敏感性和技能培训项目的积极影响在干预两年后的医疗服务提供者态度中得到了体现。扩大努力将依赖于持续的政策，将男男性行为者纳入医疗保健项目，以减少医疗机构中的耻辱感以及男男性行为者性传播感染服务提供的指南。
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