1 Independent consultant, Harare, Zimbabwe.
2 Cicely Saunders Institute of Palliative care, Policy & Rehabilitation, King's College London, London, UK.
Palliat Med. 2019 Jun;33(6):685-692. doi: 10.1177/0269216319835398. Epub 2019 Mar 12.
Ensuring palliative care for all under a new global health policy must include key populations, that is, lesbian, gay, bisexual, transgender and intersex (LGBTI) people, and sex workers. Accessibility and quality of care have not been investigated in lower and middle-income countries where civil rights are the weakest.
To examine the accessibility to, and experiences of, palliative care for key populations in Zimbabwe.
Qualitative study using thematic analysis of in-depth interviews and focus groups.
SETTING/PARTICIPANTS: A total of 60 key population adults and 12 healthcare providers and representatives of palliative care and key population support organisations were interviewed in four sites (Harare, Bulawayo, Mutare and Masvingo/Beitbridge).
Participants described unmet needs and barriers to accessing even basic elements of palliative care. Discrimination by healthcare providers was common, exacerbated by the politico-legal-economic environment. Two dominant themes emerged: (a) minimal understanding of, and negligible access to, palliative care significantly increased the risk of painful, undignified deaths and (b) discriminatory beliefs and practices from healthcare providers, family members and the community negatively affected those living with life-limiting illness, and their wishes at the end of life. Enacted stigma from healthcare providers was a potent obstacle to quality care.
Discrimination from healthcare providers and lack of referrals to palliative care services increase the risk of morbidity, mortality and transmission of infectious diseases. Untreated conditions, exclusion from services, and minimal family and social support create unnecessary suffering. Public health programmes addressing other sexually taboo subjects may provide guidance.
在新的全球卫生政策下，确保所有人群都能获得姑息治疗，这必须包括重点人群，即女同性恋、男同性恋、双性恋、跨性别和间性（LGBTI）人群以及性工作者。在公民权利最薄弱的中低收入国家，姑息治疗的可及性和质量尚未得到调查。
调查津巴布韦重点人群获得姑息治疗的情况和姑息治疗体验。
使用对深入访谈和焦点小组的主题分析的定性研究。
地点/参与者：在四个地点（哈拉雷、布拉瓦约、穆塔雷和马斯文戈/比铁布）共采访了 60 名重点人群成年人和 12 名医疗保健提供者以及姑息治疗和重点人群支持组织的代表。
参与者描述了未满足的需求和获得基本姑息治疗的障碍。医疗保健提供者的歧视很常见，政治、法律和经济环境使情况更加恶化。出现了两个主导主题：（a）对姑息治疗的理解甚少，几乎无法获得姑息治疗，这大大增加了痛苦、不体面死亡的风险；（b）来自医疗保健提供者、家庭成员和社区的歧视性信念和做法对患有绝症的人及其临终愿望产生了负面影响。医疗保健提供者实施的污名化是优质护理的一个强大障碍。
医疗保健提供者的歧视和缺乏姑息治疗服务的转诊增加了发病率、死亡率和传染病传播的风险。未经治疗的病情、被排除在服务之外以及家庭和社会支持的匮乏造成了不必要的痛苦。解决其他性禁忌话题的公共卫生项目可能会提供指导。
