五种不同的推理方式：坦桑尼亚医护人员关于如何改善男同性恋者预防 HIV 的想法。
Five different ways of reasoning: Tanzanian healthcare workers' ideas about how to improve HIV prevention among same-sex attracted men.
机构信息
Department of Behavioural Sciences, Muhimbili University of Health and Allied Sciences (MUHAS), Dar Es Salaam, Tanzania.
Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.
出版信息
BMC Health Serv Res. 2023 Jul 28;23(1):807. doi: 10.1186/s12913-023-09771-3.
BACKGROUND
Same-sex attracted men in Tanzania and globally carry a disproportionate burden of HIV. Drawing on qualitative research, this article explores healthcare providers' ideas and recommendations regarding how to improve HIV prevention among same-sex attracted men.
METHODS
We carried out a qualitative study among healthcare workers in the cities of Dar es Salaam and Tanga in Tanzania between August 2018 and October 2019. Data were collected using qualitative methods of data collection, specifically in-depth interviews, focus group discussions, and participant observation. Study participants were recruited through a purposive sampling strategy that aimed to ensure variation in age, education, and work experience. Forty-eight interviews with 24 healthcare workers, six focus group discussions, and participant observation were conducted. A total of 64 persons participated in the study.
RESULTS
This paper describes five different "ways of reasoning" that were identified among healthcare workers regarding how to strengthen HIV prevention among same-sex attracted men. One held that punitive measures should be taken to prevent HIV transmission, another that health services needed to become more friendly towards men who have sex with men, a third that healthcare workers should reach out to provide more education to this population, a fourth called for strengthened collaboration between healthcare providers and same-sex attracted men in healthcare delivery, and the fifth proposed that activistic efforts be taken to remove structural barriers for same-sex attracted men to access healthcare.
CONCLUSION
When reflecting on what is needed to strengthen HIV prevention among men who have sex with men, healthcare workers described six different ideas. One was that restrictive and punitive measures ought to be taken to prevent HIV transmission through same-sex sex. The remaining five promoted understanding of and support for same-sex attracted men. They prescribed more healthcare education, measures to improve attitudes among healthcare workers, healthcare delivery with user involvement, and political action to achieve law reform. Finally, some study participants raised concerns about the implementation of the national comprehensive package for key populations.
背景
坦桑尼亚和全球范围内的同性恋男性感染艾滋病毒的比例过高。本文通过定性研究，探讨了医疗保健提供者对于如何改善同性恋男性艾滋病毒预防的想法和建议。
方法
我们于 2018 年 8 月至 2019 年 10 月在坦桑尼亚的达累斯萨拉姆和坦噶市进行了一项定性研究。使用定性数据收集方法，包括深入访谈、焦点小组讨论和参与式观察，收集数据。通过有目的的抽样策略招募研究参与者，旨在确保年龄、教育和工作经验的多样性。共进行了 48 次与 24 名医疗保健工作者的访谈、6 次焦点小组讨论和参与式观察，共有 64 人参加了研究。
结果
本文描述了医疗保健工作者在如何加强同性恋男性艾滋病毒预防方面确定的五种不同的“推理方式”。一种认为应该采取惩罚措施来阻止艾滋病毒传播，另一种认为卫生服务需要对男同性恋者更加友好，第三种认为医疗保健工作者应该伸出援手，为这一人群提供更多的教育，第四种呼吁加强医疗保健提供者与男同性恋者之间的合作，在医疗服务中提供帮助，第五种提议采取积极行动，为男同性恋者获得医疗保健服务消除结构性障碍。
结论
在反思加强男男性接触者艾滋病毒预防所需措施时，医疗保健工作者提出了六种不同的想法。一种是采取限制和惩罚措施来阻止男男性接触传播艾滋病毒。其余五种则倡导对男同性恋者的理解和支持。他们建议提供更多的医疗保健教育、改善医疗保健工作者态度的措施、以用户为中心的医疗服务提供和政治行动以实现法律改革。最后，一些研究参与者对国家重点人群综合包的实施表示担忧。
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