Abstract
BackgroundAccess to HIV services among men who have sex with men (MSM) and female sex workers (FSWs) remains suboptimal globally. While the reasons for this dismal performance have been documented, limited evidence exists on the experiences, perceptions and readiness of health providers to provide HIV services to MSM and FSWs.MethodsThis analysis uses data collected from 48 key informants (health providers in public and private health facilities) as part of a larger study conducted in 12 districts of Uganda between October and December 2013. Data were collected on health providers’ experiences and readiness to provide HIV services to MSM and FSWs and their perceptions on the effect of existing legislation on HIV services provision to MSM and FSWs. Data were captured verbatim, transcribed and analyzed following a thematic framework approach.ResultsAll health providers reported that they had ever provided HIV services to FSWs and a majority of them were comfortable serving them. However, no health provider had ever served MSM. When asked if they would be willing to serve MSM, nearly three-quarters of the health providers indicated that they would be bound by the call of duty to serve them. However, some health providers reported that they “would feel very uncomfortable” handling MSM because they engage in “a culture imported into our country”. A majority of the health providers felt that they did not have adequate skills to effectively serve MSM and called for specific training to improve their clinical skills. There were mixed reactions as to whether existing criminal laws would affect MSM or FSWs access to HIV services but there was agreement that access to HIV services, under the existing laws, would be more constrained for MSM than FSWs since society “does not blame FSWs [as much as it does] with MSM”.ConclusionA majority of the health providers were generally comfortable serving FSWs but there were strong homophobic tendencies towards MSM. A majority of the health providers lacked skills in how to handle MSM. Interventions aimed at improving health providers’ skills in handling MSM while minimizing the negative attitude towards them are urgently needed.
Highlights
Access to Human Immunodeficiency Virus (HIV) services among men who have sex with men (MSM) and female sex workers (FSWs) remains suboptimal globally
Forty eight (48) district-level key informants were interviewed for this study from 12 districts representing different HIV prevalence zones and known hotspots for MSM and FSWs
Most of the health providers indicated that they were comfortable serving FSWs a few of them expressed some level of discomfort
Summary
Access to HIV services among men who have sex with men (MSM) and female sex workers (FSWs) remains suboptimal globally. By the close of 2016, 70% of people living with HIV knew their HIV status; 77% of people living with HIV who knew their HIV status were accessing antiretroviral therapy, while 82% of people accessing treatment had suppressed viral loads [1] Despite this level of progress, HIV infections remain much higher among some population sub-groups than in the general population, including gay and other men who have sex with men (MSM) and female sex workers (FSWs). Despite the high levels of HIV prevalence among MSM and FSWs, the coverage of appropriate HIV prevention, care and treatment programs for these key populations remains sub-optimal globally [8,9,10,11]. Only 31.2% of MSM [10] and 37.9% of FSWs [11] have been linked to HIV care, presenting a missed opportunity for harnessing the preventive benefits of antiretroviral therapy in reducing HIV transmission in these high-risk populations
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