School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Health Services, Administration and Campus Support Services, University of Nairobi, Nairobi, Kenya.
BMC Public Health. 2024 Jan 2;24(1):52. doi: 10.1186/s12889-023-17555-x.
BACKGROUND: Globally, young gay, bisexual and other men who have sex with men (YMSM) experience a disproportionate burden of disease compared to young heterosexual men and older MSM. However, YMSM experience major inequities in access and use of health services. We sought to gain a detailed understanding of YMSM's healthcare engagement experiences across public, private, tertiary institution-based and MSM-friendly health facilities in Nairobi, Kenya, to inform development of interventions to improve access and use of health services by YMSM. METHODS: In September 2021, in-person qualitative in-depths interviews were conducted among 22 YMSM purposively sampled from 248 YMSM who had previously participated in a respondent-driven sampling integrated bio-behavioral survey. Interviews were done in English, transcribed verbatim and analyzed descriptively using NVivo version 12. RESULTS: Participants were 18-24 years old, all identified as cisgender male, three-quarters as gay and a quarter as bisexual. Themes that were defined from the analysis included: YMSM's experiences during healthcare seeking in various clinical settings, priority health needs, desired healthcare provider (HCP) characteristics, and the potential role of digital health interventions in improving access and use of health services. Participants relayed experiences of prejudice, stigma and discrimination when seeking services in public and institution-based health facilities, unlike in community pharmacies, private and MSM-friendly health facilities where they felt they were handled with dignity. Health needs prioritized by YMSM centered on prevention and control of HIV, sexually transmitted infections (STIs), depression and substance abuse. Participants desired HCPs who were empathetic, non-judgmental and knowledgeable about their unique health needs such as management of anorectal STIs. Participants highlighted the usefulness of digital media in offering telehealth consultations and health education on subjects such as HIV/STIs prevention. CONCLUSION: During engagement with healthcare, YMSM experience various barriers that may cause them to postpone or avoid seeking care hence resulting in poor health outcomes. There is need to equip HCPs with knowledge, skills and cultural competencies to enable them offer equitable services to YMSM. Considerations should also be made for use of digital health interventions that may help YMSM circumvent some of the aforementioned barriers to service access and use.
背景:在全球范围内,年轻的男同性恋者、双性恋者和其他与男性发生性关系的男性(YMSM)比年轻的异性恋男性和年长的男同性恋者/双性恋者面临更大的疾病负担。然而,YMSM 在获得和使用医疗保健服务方面存在重大不平等。我们试图深入了解内罗毕肯尼亚公共、私人、三级机构和男同性恋友好型卫生设施中 YMSM 的医疗保健参与经验,以为改善 YMSM 获得和使用医疗服务的干预措施提供信息。
方法:2021 年 9 月,对之前参加过基于应答者驱动抽样的综合生物行为调查的 248 名 YMSM 中 22 名 YMSM 进行了面对面深入定性访谈。访谈使用英语进行,逐字记录并使用 NVivo 版本 12 进行描述性分析。
结果:参与者年龄在 18-24 岁之间,均为顺性别男性,四分之三为同性恋,四分之一为双性恋。从分析中确定的主题包括:YMSM 在各种临床环境中寻求医疗保健时的经历、优先健康需求、理想医疗保健提供者(HCP)特征以及数字健康干预在改善获得和使用医疗服务方面的潜在作用。参与者在公立和机构卫生机构寻求服务时,会经历偏见、耻辱和歧视,而在社区药店、私人和男同性恋友好型卫生机构中则不会,在这些地方他们觉得自己受到了尊重。YMSM 优先考虑的健康需求集中在预防和控制艾滋病毒、性传播感染(STIs)、抑郁和药物滥用上。参与者希望 HCP 富有同情心、不评判、了解他们独特的健康需求,例如管理肛门直肠 STIs。参与者强调了数字媒体在提供远程医疗咨询和关于艾滋病毒/性传播感染预防等主题的健康教育方面的有用性。
结论:在参与医疗保健时,YMSM 会遇到各种障碍,这可能导致他们推迟或避免寻求护理,从而导致不良的健康结果。需要为 HCP 提供知识、技能和文化能力,使他们能够为 YMSM 提供公平的服务。还应考虑使用数字健康干预措施,这些措施可能有助于 YMSM 避免服务获取和使用方面的一些上述障碍。
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