Pilgrim Nanlesta, Musheke Maurice, Raymond H Fisher, Keating Ryan, Mwale John, Banda Lunda, Mulenga Drosin, Phiri Lyson, Geibel Scott, Tun Waimar
a Population Council , Washington , DC , USA.
b Population Council , Lusaka , Zambia.
AIDS Care. 2019 Apr;31(4):460-464. doi: 10.1080/09540121.2018.1524119. Epub 2018 Sep 27.
HIV epidemic control requires improving access and uptake of HIV services by key populations (KPs). In Zambia, the behaviors of female sex workers (FSWs), men who have sex with men (MSM), and people of who use drugs (PWUD) are criminalized, and little information exists about their HIV/STI service use. Using a quality of care (QOC) framework, we compared barriers to and opportunities for HIV/STI service access and uptake among the three KPs. We conducted in-depth interviews and focus group discussions with 314 KP members between July 2013 and September 2015 in eight districts. Poorer QOC was received at public health facilities compared to private, NGOs and traditional healers. Stigma and discrimination, confidentiality, and legal prosecution were barriers to service use and more salient among MSM than FSWs and PWUD. Invasive facility policies were barriers and more prominent among FSWs than MSM and PWUD. Service unavailability was of equally high salience among MSM and PWUD than FSWs. Comfort in the clinic and perceived treatment effectiveness were facilitators for all three KPs. The health care experiences of KPs are not monolithic; HIV/STI service improvement strategies should address the concerns and be tailored to the needs of each key population.
控制艾滋病流行需要改善重点人群获取和接受艾滋病服务的情况。在赞比亚，女性性工作者、男男性行为者以及吸毒者的行为被定为犯罪，关于他们使用艾滋病病毒/性传播感染服务的信息很少。我们运用医疗服务质量（QOC）框架，比较了这三类重点人群在获取和接受艾滋病病毒/性传播感染服务方面的障碍和机会。2013年7月至2015年9月期间，我们在八个地区与314名重点人群成员进行了深入访谈和焦点小组讨论。与私立医疗机构、非政府组织和传统治疗师相比，公共卫生机构提供的医疗服务质量较差。耻辱感和歧视、保密性以及法律起诉是接受服务的障碍，在男男性行为者中比在女性性工作者和吸毒者中更为突出。侵入性的机构政策是障碍，在女性性工作者中比在男男性行为者和吸毒者中更为突出。服务不可得在男男性行为者和吸毒者中与在女性性工作者中同样突出。诊所的舒适度和感知到的治疗效果对所有三类重点人群都是促进因素。重点人群的医疗保健经历并非千篇一律；改善艾滋病病毒/性传播感染服务的策略应关注这些问题，并根据每个重点人群的需求进行调整。
