Wanyenze Rhoda K, Musinguzi Geofrey, Kiguli Juliet, Nuwaha Fred, Mujisha Geoffrey, Musinguzi Joshua, Arinaitwe Jim, Matovu Joseph K B
Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.
Department of Community Health & Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda.
BMC Int Health Hum Rights. 2017 May 5;17(1):11. doi: 10.1186/s12914-017-0119-1.
HIV prevalence among female sex workers (FSWs) in high burden countries in sub-Saharan Africa varies between 24 and 72%, however their access to HIV services remains limited. This study explored FSWs' perspectives of the barriers and opportunities to HIV service access in Uganda.
The cross-sectional qualitative study was conducted between October and December 2013. Twenty-four focus group discussions were conducted with 190 FSWs in 12 districts. Data were analysed using manifest content analysis, using Atlas.ti software, based on the socio-ecological model.
FSWs indicated that HIV services were available and these included condoms, HIV testing and treatment, and management of sexually transmitted infections. However, access to HIV services was affected by several individual, societal, structural, and policy related barriers. Individual level factors included limited awareness of some prevention services, fears, and misconceptions while societal stigma was prominent. Structural and policy level barriers included inconvenient hours of operation of the clinics, inflexible facility based distribution of condoms, interuptions in the supply of condoms and other commodities, and limited package of services with virtually no access to lubricants, HIV pre- and post-exposure prophylaxis, and support following client perpetrated violence. Policies such as partner testing and involvement at antenatal care, and using only one facility for antiretroviral drug refills hindered HIV service uptake and retention in care. FSWs had major concerns with the quality of services especially discrimination and rude remarks from providers, denial or delay of services, and potential for breach of confidentiality. However, some FSWs reported positive experiences including interface with friendly providers and participated in formal and informal FSW groups, which supported them to access health services.
Despite availability of services, FSWs faced major challenges in access to services. Comprehensive multilevel interventions targeting individual, societal, structural and policy level barriers are required to increase access to HIVservices among FSWs in Uganda. Policy and institutional adjustments should emphasize quality friendly services and expanding the package of services to meet the needs of FSWs.
在撒哈拉以南非洲的高负担国家，女性性工作者（FSW）中的艾滋病毒流行率在24%至72%之间，但她们获得艾滋病毒服务的机会仍然有限。本研究探讨了乌干达女性性工作者对获得艾滋病毒服务的障碍和机会的看法。
这项横断面定性研究于2013年10月至12月进行。在12个地区与190名女性性工作者进行了24次焦点小组讨论。基于社会生态模型，使用Atlas.ti软件，采用显性内容分析法对数据进行分析。
女性性工作者表示可以获得艾滋病毒服务，这些服务包括避孕套、艾滋病毒检测与治疗以及性传播感染的管理。然而，获得艾滋病毒服务受到几个与个人、社会、结构和政策相关的障碍的影响。个人层面的因素包括对一些预防服务的认识有限、恐惧和误解，而社会耻辱感很突出。结构和政策层面的障碍包括诊所营业时间不方便、基于设施的避孕套发放不灵活、避孕套和其他商品供应中断，以及服务套餐有限，几乎无法获得润滑剂、艾滋病毒暴露前和暴露后预防药物，以及在客户实施暴力后得不到支持。伴侣检测和产前护理参与等政策，以及仅在一个机构进行抗逆转录病毒药物再填充，阻碍了艾滋病毒服务的接受和持续护理。女性性工作者对服务质量主要存在担忧，特别是提供者的歧视和粗言秽语、服务被拒绝或延迟，以及存在违反保密规定的可能性。然而，一些女性性工作者报告了积极的经历，包括与友好的提供者接触，以及参与正式和非正式的女性性工作者群体，这些群体支持她们获得医疗服务。
尽管有服务提供，但女性性工作者在获得服务方面面临重大挑战。需要针对个人、社会、结构和政策层面的障碍采取全面的多层次干预措施，以增加乌干达女性性工作者获得艾滋病毒服务的机会。政策和机构调整应强调提供优质友好的服务，并扩大服务套餐以满足女性性工作者的需求。
