Chynoweth Sarah K, Buscher Dale, Martin Sarah, Zwi Anthony B
Women's Refugee Commission, 15 West 37th St, New York, NY 10018 USA.
Health, Rights and Development (HEARD@UNSW), School of Social Sciences, Faculty of Arts and Social Sciences, The University of New South Wales, Sydney, NSW 2052 Australia.
Confl Health. 2020 Jul 8;14:43. doi: 10.1186/s13031-020-00288-8. eCollection 2020.
Post-sexual violence service utilization is often poor in humanitarian settings. Little is known about the service uptake barriers facing male survivors specifically.
To gain insights into this knowledge gap, we undertook a qualitative exploratory study to better understand the barriers to service utilization among male survivors in three refugee-hosting countries. The study sites and populations included refugees who had travelled the central Mediterranean migration route through Libya living in Rome and Sicily, Italy; Rohingya refugees in Cox's Bazar, Bangladesh; and refugees from eastern Democratic Republic of the Congo, Somalia, and South Sudan residing in urban areas of Kenya. Methods included document review, 55 semi-structured focus group discussions with 310 refugees, semi-structured key informant interviews with 148 aid workers and human rights experts, and observation of service delivery points. Data were thematically analyzed using NVivo 12.
We identified eleven key barriers and situated them within a social ecological framework to describe impediments at the policy, community (inter-organizational), organizational, interpersonal, and individual levels. Barriers entailed: 1) restrictions to accessing legal protection, 2) legislative barriers such as the criminalization of same-sex sexual relations, 3) few designated entry points, 4) poor or nonexistent referral systems, 5) lack of community awareness-raising and engagement, 6) limited staff capacity, 7) negative provider attitudes and practices, 8) social stigma, 9) limited knowledge (at the individual level), 10) self-stigma, and 11) low formal help-seeking behaviors.
The social ecological framework allowed us to better understand the multifaceted ways that the barriers facing male survivors operate and reinforce one another, and may be useful to inform efforts promoting service uptake. Additional research is warranted in other refugee settings.
在人道主义环境中，遭受性暴力后寻求服务的情况往往很不理想。对于男性幸存者面临的服务利用障碍，我们知之甚少。
为了深入了解这一知识空白，我们开展了一项定性探索性研究，以更好地理解三个难民收容国男性幸存者在服务利用方面的障碍。研究地点和人群包括通过利比亚走地中海中部移民路线来到意大利罗马和西西里岛生活的难民；孟加拉国科克斯巴扎尔的罗兴亚难民；以及居住在肯尼亚城市地区的来自刚果民主共和国东部、索马里和南苏丹的难民。方法包括文献回顾、与310名难民进行55次半结构化焦点小组讨论、与148名援助工作者和人权专家进行半结构化关键信息访谈，以及对服务提供点的观察。使用NVivo 12对数据进行主题分析。
我们确定了11个关键障碍，并将它们置于社会生态框架内，以描述政策、社区（组织间）、组织、人际和个人层面的阻碍。障碍包括：1）获得法律保护的限制；2）立法障碍，如同性性行为定罪；3）指定的进入点很少；4）转介系统不完善或不存在；5）社区意识提升和参与不足；6）工作人员能力有限；7）提供者的负面态度和行为；8）社会耻辱感；9）（个人层面）知识有限；10）自我耻辱感；11）正式求助行为较少。
社会生态框架使我们能够更好地理解男性幸存者面临的障碍相互作用和强化的多方面方式，可能有助于为促进服务利用的努力提供信息。在其他难民环境中，有必要进行更多研究。
