The Fenway Institute, Fenway Health, Boston, MA, USA.
Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
J Int AIDS Soc. 2021 Jul;24 Suppl 3(Suppl 3):e25728. doi: 10.1002/jia2.25728.
Training in care for sexual and gender minority (SGM) populations is critical for ending the HIV epidemic. SGM people, particularly men who have sex with men (MSM) and transgender women, experience disproportionate HIV infection across the globe. The objective of this commentary was to synthesize facilitators of and barriers to SGM health training efforts for healthcare workers in Uganda, in order to help inform potential priorities, strategies and next steps to advance culturally responsive HIV-related care for SGM communities across Uganda and sub-Saharan Africa.
SGM health training often includes education on: foundational concepts and language; stigma, discrimination and SGM health disparities; understanding and addressing implicit bias; sensitive and effective communication and building SGM-inclusive and welcoming healthcare environments. Clinicians' education includes sexual and gender histories, sex-positive HIV counselling, sexually transmitted infections, HIV pre-exposure prophylaxis and gender-affirming hormone therapy. SGM communities in sub-Saharan Africa have often experienced discrimination, persecution, incarceration and physical violence, and they encounter unique barriers to engagement in sexual health services and HIV prevention and treatment. SGM health training efforts in Uganda reveal challenges to and opportunities for advancing equity for SGM communities in sexual health and HIV medical care across the region. In Uganda, SGM community advocacy, as well as policies and programmes of the Ministry of Health and US President's Emergency Plan for AIDS Relief, have increased readiness and need for scaling up training and skills-sharing in SGM-focused HIV and sexual healthcare, including Ugandan-led and international initiatives.
Numerous challenges exist to widespread culturally responsive HIV and sexual healthcare for SGM communities in sub-Saharan Africa. Lessons learned from healthcare worker training efforts in Uganda may inform future replication, adaptation and dissemination initiatives to meet the needs of more SGM communities in the region. Evaluation of SGM health training programmes to determine the impact on HIV virological suppression and sexual health outcomes will be critical for identifying best practices and strategies that may support advancing HIV epidemic control for SGM communities in Uganda and across sub-Saharan Africa.
培训医疗保健工作者关爱性少数群体（SGM）人群对于终结艾滋病流行至关重要。在全球范围内，SGM 人群，尤其是男男性行为者（MSM）和跨性别女性，面临不成比例的 HIV 感染。本评论的目的是综合 SGM 健康培训工作中促进因素和障碍因素，以便为乌干达的医疗保健工作者提供信息，帮助确定优先事项、战略和下一步措施，为乌干达和撒哈拉以南非洲的 SGM 群体提供文化响应的 HIV 相关关怀。
SGM 健康培训通常包括以下内容：基本概念和语言；耻辱、歧视和 SGM 健康差距；理解和解决隐性偏见；敏感有效的沟通和建立 SGM 包容和欢迎的医疗环境。临床医生的教育包括性和性别史、性健康促进 HIV 咨询、性传播感染、HIV 暴露前预防和性别肯定激素治疗。撒哈拉以南非洲的 SGM 群体经常经历歧视、迫害、监禁和身体暴力，他们在参与性健康服务和 HIV 预防和治疗方面面临独特的障碍。乌干达的 SGM 健康培训工作揭示了该地区 SGM 群体在性健康和 HIV 医疗保健方面实现公平的挑战和机遇。在乌干达，SGM 社区的倡导，以及卫生部和美国总统艾滋病紧急救援计划的政策和方案，提高了 SGM 重点 HIV 和性保健培训和技能共享的准备程度和需求，包括乌干达主导的和国际倡议。
撒哈拉以南非洲 SGM 群体获得广泛的文化响应 HIV 和性保健服务面临众多挑战。乌干达医疗保健工作者培训工作的经验教训可能为满足该地区更多 SGM 群体的需求，为未来的复制、适应和传播倡议提供信息。评估 SGM 健康培训方案，以确定其对 HIV 病毒学抑制和性健康结果的影响，对于确定最佳实践和战略以支持乌干达和撒哈拉以南非洲的 SGM 群体控制 HIV 流行至关重要。
