Institute of Resource Governance and Social Change, Jl. R. W. Monginsidi II, No. 2, Kupang, Nusa Tenggara Timur, 85221, Indonesia.
Stikes Jenderal Achmad Yani Yogyakarta, Jl. Ringroad Barat Ambarketawang, Gamping, Sleman, Yogyakarta, 55294, Indonesia.
Int J Equity Health. 2018 May 30;17(1):68. doi: 10.1186/s12939-018-0782-4.
BACKGROUND: Frequent engagement of men in sexual encounters with female sex workers (FSWs) without using condoms places them at a high risk for HIV infection. HIV testing has been noted to be among important strategies to prevent HIV transmission and acquisition. However, it is known that not all men willingly undertake an HIV test as a way to prevent HIV transmission and/or acquisition. This study aimed to identify barriers to accessing HIV testing services among men who are clients of FSWs (clients) in Belu and Malaka districts, Indonesia. METHODS: A qualitative inquiry employing face to face open ended interviews was conducted from January to April 2017. The participants (n = 42) were clients of FSWs recruited using purposive and snowball sampling techniques. Data were analysed using a qualitative data analysis framework. RESULTS: Findings indicated three main barriers of accessing HIV testing services by clients. These included: (1) personal barriers (lack of knowledge of HIV/AIDS and HIV testing availability, and unwillingness to undergo HIV testing due to low self-perceived risk of HIV and fear of the test result); (2) health care service provision barriers (lack of trust in health professionals and limited availability of medication including antiretroviral (ARV)); and (3) social barriers (stigma and discrimination, and the lack of social supports). CONCLUSIONS: These findings indicated multilevelled barriers to accessing HIV testing services among participants, who are known to be among key population groups in HIV care. Actions to improve HIV/AIDS-related health services accessibility are required. The dissemination of the knowledge and information on HIV/AIDS and improved available of HIV/AIDS-related services are necessary actions to improve the personal levelled barriers. System wide barriers will need improved practices and health policies to provide patients friendly and accessible services. The societal levelled barriers will need a more broad societal approach including raising awareness in the community and enhanced discussions about HIV/AIDS issues in order to normalise HIV in the society.
背景：男性频繁与性工作者发生无保护性行为，使他们面临感染艾滋病毒的高风险。艾滋病毒检测已被证明是预防艾滋病毒传播和感染的重要策略之一。然而，并非所有男性都愿意接受艾滋病毒检测，以此来预防艾滋病毒的传播和/或感染。本研究旨在确定印度尼西亚贝鲁和马拉开区性工作者客户（客户）中艾滋病毒检测服务的获取障碍。
方法：采用定性研究方法，于 2017 年 1 月至 4 月进行面对面开放式访谈。采用目的抽样和滚雪球抽样技术招募性工作者的客户作为参与者（n=42）。使用定性数据分析框架对数据进行分析。
结果：研究结果表明，客户获取艾滋病毒检测服务存在三大障碍。这些障碍包括：（1）个人障碍（缺乏艾滋病病毒/艾滋病知识和艾滋病毒检测服务的可及性，由于对艾滋病毒感染风险的自我认知低和对检测结果的恐惧，不愿意接受艾滋病毒检测）；（2）卫生保健服务提供障碍（对卫生专业人员缺乏信任，以及抗逆转录病毒药物等药物的供应有限）；（3）社会障碍（耻辱和歧视，以及缺乏社会支持）。
结论：这些发现表明，参与者在获取艾滋病毒检测服务方面存在多层次的障碍，他们是艾滋病毒关怀的关键人群之一。需要采取行动改善与艾滋病毒/艾滋病相关的卫生服务的可及性。传播艾滋病毒/艾滋病相关知识和信息，改善艾滋病毒/艾滋病相关服务的可及性，是改善个人层面障碍的必要措施。需要在系统层面采取改进措施和卫生政策，为患者提供友好和可及的服务。在社会层面，需要采取更广泛的社会方法，包括提高社区的认识，并加强关于艾滋病毒/艾滋病问题的讨论，以使艾滋病毒在社会中正常化。
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