Duby Zoe, Nkosi Busisiwe, Scheibe Andrew, Brown Ben, Bekker Linda-Gail
Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, South Africa.
South Afr J HIV Med. 2018 Jan 19;19(1):701. doi: 10.4102/sajhivmed.v19i1.701. eCollection 2018.
Men who have sex with men (MSM), sex workers (SW) and people who use drugs (PWUD) are at increased risk for HIV because of multiple socio-structural barriers and do not have adequate access to appropriate HIV prevention, diagnosis and treatment services.
To examine the context of access to healthcare experienced by these three 'Key Populations', we conducted a qualitative study in two South African cities: Bloemfontein in the Free State province and Mafikeng in the North West province.
We carried out in-depth interviews to explore healthcare workers' perceptions, beliefs and attitudes towards Key Populations. Focus group discussions were also conducted with members of Key Populations exploring their experiences of accessing healthcare.
Healthcare workers described their own attitudes towards Key Populations and demonstrated a lack of relevant knowledge, skills and training to manage the particular health needs and vulnerabilities facing Key Populations. Female SW, MSM and PWUD described their experiences of stigmatisation, and of being made to feel guilt, shame and a loss of dignity as a result of the discrimination by healthcare providers and other community. members. Our findings suggest that the uptake and effectiveness of health services amongst Key Populations in South Africa is limited by internalised stigma, reluctance to seek care, unwillingness to disclose risk behaviours to healthcare workers, combined with a lack of knowledge and understanding on the part of the broader community members, including healthcare workers.
This research highlights the need to address the broader healthcare provision environment, improving alignment of policies and programming in order to strengthen provision of effective health services that people from Key Populations will be able to access.
男男性行为者（MSM）、性工作者（SW）和吸毒者（PWUD）由于多种社会结构障碍，感染艾滋病毒的风险增加，且无法充分获得适当的艾滋病毒预防、诊断和治疗服务。
为了研究这三类“重点人群”获得医疗保健的情况，我们在南非的两个城市进行了一项定性研究：自由州省的布隆方丹和西北省的马菲金。
我们进行了深入访谈，以探讨医护人员对重点人群的看法、信念和态度。还与重点人群的成员进行了焦点小组讨论，探讨他们获得医疗保健的经历。
医护人员描述了他们对重点人群的态度，表明缺乏管理重点人群特殊健康需求和脆弱性的相关知识、技能和培训。女性性工作者、男男性行为者和吸毒者描述了他们遭受污名化的经历，以及由于医护人员和其他社区成员的歧视而感到内疚、羞耻和尊严丧失。我们的研究结果表明，南非重点人群中卫生服务的接受度和有效性受到内化污名、不愿寻求护理、不愿向医护人员披露风险行为的限制，同时更广泛的社区成员，包括医护人员，缺乏知识和理解。
这项研究强调需要解决更广泛的医疗保健提供环境问题，改善政策和规划的一致性，以加强提供重点人群能够获得的有效卫生服务。
