Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh.
Universal Health Coverage, Health System and Population Studies Division, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh.
PLoS One. 2019 Sep 4;14(9):e0221637. doi: 10.1371/journal.pone.0221637. eCollection 2019.
BACKGROUND: In Bangladesh, community-based and peer-led prevention interventions for human immunodeficiency virus infection are provided to key populations (KPs) by drop-in centers (DICs), which are primarily supported by external donors. This intervention approach was adopted because public healthcare facilities were reportedly insensitive to the needs and culture of KPs, particularly with regard to the provision of sexually transmitted infection (STI) services. Nonetheless, in the absence of external funding, STI services need to be integrated into public healthcare systems. METHODS: A qualitative study was conducted in 2017 to understand the willingness of KPs to uptake the STI services of public healthcare facilities. Data were collected based on 34 in-depth interviews, 11 focus group discussions, and 9 key informant interviews. The social-ecological theoretical framework was used to analyze the data thematically and contextually. RESULTS: Most participants were either resistant or reluctant to uptake STI services from public healthcare facilities because of their previous firsthand experiences (e.g., disrespectful and judgmental attitudes and behaviors), perceived discrimination, anticipatory fear, and a lack of privacy. Very few participants who had visited these facilities to receive STI services were motivated to revisit them. Nevertheless, they emphasized their comfort in DICs over public healthcare facilities. Thus, it appears that KPs can be situated along a care-seeking continuum (i.e., resistance to complete willingness). Unless policymakers understand the context and reasons that underlie their movement along this continuum, it would be difficult to encourage KPs to access STI services from public healthcare facilities. CONCLUSION: KPs' willingness to uptake the STI services of public healthcare facilities depends not only on individual and community experiences but also on the nexus between socio-structural factors and health inequalities. Community mobilization and training about the needs and culture of KPs for healthcare professionals are essential. Therefore, addressal of a wide range of structural factors is required to motivate KPs into seeking STI services from public healthcare facilities.
背景：在孟加拉国，由 Drop-in 中心（DIC）向重点人群（KP）提供基于社区和同伴主导的预防艾滋病毒感染干预措施，这些中心主要由外部捐助者支持。之所以采用这种干预方法，是因为据报道，公共卫生保健机构对 KP 的需求和文化不敏感，特别是在提供性传播感染（STI）服务方面。尽管如此，在没有外部资金的情况下，需要将 STI 服务纳入公共医疗保健系统。
方法：2017 年进行了一项定性研究，以了解 KP 接受公共医疗保健设施提供的 STI 服务的意愿。数据是根据 34 次深入访谈、11 次焦点小组讨论和 9 次关键知情人访谈收集的。使用社会生态理论框架对数据进行主题和背景分析。
结果：大多数参与者对从公共卫生保健机构接受 STI 服务持抵制或不情愿的态度，原因是他们之前有过第一手经验（例如，不尊重和评判性的态度和行为）、感知到的歧视、预期的恐惧和缺乏隐私。很少有曾到这些机构接受 STI 服务的参与者有动力再次访问这些机构。然而，他们强调在 DIC 中比在公共医疗保健机构中更舒适。因此，KP 似乎可以沿着寻求护理的连续统（即从抵制到完全愿意）排列。除非政策制定者了解他们在这个连续统上移动的背景和原因，否则很难鼓励 KP 从公共医疗保健机构获得 STI 服务。
结论：KP 接受公共医疗保健设施 STI 服务的意愿不仅取决于个人和社区的经验，还取决于社会结构因素和健康不平等之间的关系。对医疗保健专业人员进行 KP 的需求和文化的社区动员和培训是必不可少的。因此，需要解决广泛的结构性因素，以激励 KP 从公共医疗保健机构寻求 STI 服务。
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