Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.
Department of Global Health, Academic Medical Centre, University of Amsterdam, the Netherlands.
J Int AIDS Soc. 2020 Oct;23 Suppl 6(Suppl 6):e25597. doi: 10.1002/jia2.25597.
HIV healthcare services for men who have sex with men (MSM) in Kenya have not been openly provided because of persistent stigma and lack of healthcare capacity within Kenya's decentralized health sector. Building on an evaluation of a developed online MSM sensitivity training programme offered to East and South African healthcare providers, this study assessed views and responses to strengthen HIV healthcare services for MSM in Kenya.
The study was conducted between January and July 2017 in Kilifi County, coastal Kenya. Seventeen policymakers participated in an in-depth interview and 59 stakeholders, who were purposively selected from three key groups (i.e. healthcare providers, implementing partners and members of MSM-led community-based organizations) took part in eight focus group discussions. Discussions aimed to understand gaps in service provision to MSM from different perspectives, to identify potential misconceptions, and to explore opportunities to improve MSM HIV healthcare services. Interviews and focus group discussions were recorded, transcribed verbatim and analysed using Braun and Clarke's thematic analysis.
Participants' responses revealed that all key groups navigated diverse challenges related to MSM HIV health services. Specific challenges included priority-setting by county government staff; preparedness of leadership and management on MSM HIV issues at the facility level; data reporting at the implementation level and advocacy for MSM health equity. Strong power inequities were observed between policy leadership, healthcare providers and MSM, with MSM feeling blamed for their sexual orientation. MSM agency, as expressed in their actions to access HIV services, was significantly constrained by county context, but can potentially be improved by political will, professional support and a human rights approach.
To strengthen HIV healthcare for MSM within a decentralized Kenyan health system, a more responsive, multi-pronged strategy adaptable and relevant to MSM's healthcare needs is required. Continued engagement with policy leadership, collaboration with health facilities, and partnerships with different community stakeholders are critical to improve HIV healthcare services for MSM.
由于肯尼亚分散的卫生部门持续存在污名化和医疗能力不足的问题，肯尼亚没有公开为男男性行为者（MSM）提供艾滋病毒医疗服务。本研究在评估为东非和南非医疗保健提供者开发的在线 MSM 敏感培训计划的基础上，评估了肯尼亚加强 MSM 艾滋病毒医疗服务的意见和反应。
该研究于 2017 年 1 月至 7 月在肯尼亚沿海基利菲县进行。17 名政策制定者参加了深度访谈，59 名利益攸关方从三个关键群体（即医疗保健提供者、实施伙伴和 MSM 领导的社区组织成员）中有意选择，参加了 8 次焦点小组讨论。讨论旨在从不同角度了解向 MSM 提供服务的差距，确定潜在的误解，并探讨改善 MSM 艾滋病毒医疗服务的机会。访谈和焦点小组讨论均进行了录音、逐字记录，并使用 Braun 和 Clarke 的主题分析进行了分析。
参与者的回应表明，所有关键群体都在为 MSM 的艾滋病毒健康服务面临着各种挑战。具体挑战包括县政府工作人员的优先事项设定；设施一级领导层和管理层对 MSM 艾滋病毒问题的准备情况；执行一级的数据报告和争取 MSM 健康公平的宣传。在政策领导、医疗保健提供者和 MSM 之间观察到强烈的权力不平等，MSM 因性取向而受到指责。MSM 的代理，正如他们为获得艾滋病毒服务而采取的行动所表明的那样，受到县情的严重限制，但通过政治意愿、专业支持和人权方法，有可能得到改善。
要在肯尼亚分散的卫生系统中加强对 MSM 的艾滋病毒医疗服务，需要制定更具响应性、多管齐下、适应和满足 MSM 医疗需求的战略。继续与政策领导接触、与卫生设施合作以及与不同社区利益攸关方建立伙伴关系，对于改善 MSM 的艾滋病毒医疗服务至关重要。
