Dovel Kathryn, Paneno Rose, Balakasi Kelvin, Hubbard Julie, Magaço Amílcar, Phiri Khumbo, Coates Thomas, Cornell Morna
University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, United States of America.
Partners in Hope Medical Center, Lilongwe, Malawi.
PLOS Glob Public Health. 2023 Oct 24;3(10):e0001356. doi: 10.1371/journal.pgph.0001356. eCollection 2023.
Men are underrepresented in HIV services throughout sub-Saharan Africa. Little is known about health care worker (HCW) perceptions of men as clients, which may directly affect the quality of care provided, and HCWs' buy-in for male-specific interventions. Focus group discussions (FGDs) were conducted in 2016 with HCWs from 15 facilities across Malawi and Mozambique and were originally conducted to evaluate barriers to universal treatment (not HCW bias). FGDs were conducted in local languages, recorded, translated to English, and transcribed. For this study, we focused on HCW perceptions of men as HIV clients and any explicit bias against men, using inductive and deductive coding in Atlas.ti v.8, and analyzed using constant comparison methods. 20 FGDs with 154 HCWs working in HIV treatment clinics were included. Median age was 30 years, 59% were female, and 43% were providers versus support staff. HCWs held strong explicit bias against men as clients. Most HCWs believed men could easily navigate HIV services due to their elevated position within society, regardless of facility-level barriers faced. Men were described in pejorative terms as ill-informed and difficult clients who were absent from health systems. Men were largely seen as "bad clients" due to assumptions about men's 'selfish' and 'prideful' nature, resulting in little HCW sympathy for men's poor use of care. Our study highlights a strong explicit bias against men as HIV clients, even when gender and bias were not the focus of data collection. As a result, HCWs may have little motivation to implement male-specific interventions or improve provider-patient interactions with men. Framing men as problematic places undue responsibility on individual men while minimizing institutional barriers that uniquely affect them. Bias in local, national, and global discourses about men must be immediately addressed.
在撒哈拉以南非洲地区,男性在艾滋病服务中的占比不足。医护人员对男性作为服务对象的看法鲜为人知,这可能直接影响所提供的护理质量,以及医护人员对针对男性的特定干预措施的支持度。2016年,我们与来自马拉维和莫桑比克15家医疗机构的医护人员进行了焦点小组讨论(FGD),最初开展这些讨论是为了评估普遍治疗的障碍(而非医护人员的偏见)。焦点小组讨论以当地语言进行,录音后翻译成英文并转录。在本研究中,我们聚焦于医护人员对男性作为艾滋病服务对象的看法以及对男性的任何明显偏见,在Atlas.ti v.8中使用归纳和演绎编码,并采用持续比较法进行分析。纳入了对在艾滋病治疗诊所工作的154名医护人员进行的20次焦点小组讨论。中位年龄为30岁,59%为女性,43%为医护人员与辅助人员。医护人员对男性作为服务对象存在强烈的明显偏见。大多数医护人员认为,由于男性在社会中的地位较高,他们能够轻松应对艾滋病服务,而无视所面临的机构层面的障碍。男性被用贬义词描述为信息匮乏且难打交道的服务对象,他们不在卫生系统就医。由于认为男性具有“自私”和“骄傲”的本性,男性在很大程度上被视为“糟糕的服务对象”,这导致医护人员对男性不善利用医疗服务的情况几乎没有同情心。我们的研究凸显了对男性作为艾滋病服务对象的强烈明显偏见,即使性别和偏见并非数据收集的重点。因此,医护人员可能几乎没有动力去实施针对男性的特定干预措施,或改善与男性患者的互动。将男性视为有问题会将过多责任归咎于个体男性,同时最小化了对他们有独特影响的机构层面的障碍。必须立即解决在关于男性的地方、国家和全球话语中的偏见问题。
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