Abstract
Introduction Men who have sex with men (MSM) in Kenya are at high risk for HIV and may experience prejudiced treatment in health settings due to stigma. An on-line computer-facilitated MSM sensitivity programme was conducted to educate healthcare workers (HCWs) about the health issues and needs of MSM patients. Methods Seventy-four HCWs from 49 ART-providing health facilities in the Kenyan Coast were recruited through purposive sampling to undergo a two-day MSM sensitivity training. We conducted eight focus group discussions (FGDs) with programme participants prior to and three months after completing the training programme. Discussions aimed to characterize HCWs’ challenges in serving MSM patients and impacts of programme participation on HCWs’ personal attitudes and professional capacities. Results Before participating in the training programme, HCWs described secondary stigma, lack of professional education about MSM, and personal and social prejudices as barriers to serving MSM clients. After completing the programme, HCWs expressed greater acknowledgement of MSM patients in their clinics, endorsed the need to treat MSM patients with high professional standards and demonstrated sophisticated awareness of the social and behavioural risks for HIV among MSM. Conclusions Findings provide support for this approach to improving health services for MSM patients. Further efforts are needed to broaden the reach of this training in other areas, address identified barriers to HCW participation and evaluate programme effects on patient and HCW outcomes using rigorous methodology. 10.7448/IAS.16.4.18741 © 2013 Elst E M et al; licensee International AIDS Society Received 21 May 2013; Revised 6 September 2013; Accepted 25 September 2013; Published 2 December 2013 Corresponding author: Elise M van der Elst, Centre for Geographic Medicine Research (Coast) (KEMRI CGMRC), Kenya Medical Research Institute, P.O. Box 230, Kilifi, Kenya. Tel: +254 41 7522063, +254 41 7522535. (Evanderelst@kemri-wellcome.org)
Highlights
Healthcare workers (HCWs) in Africa typically receive little or no training in the healthcare needs of men who have sex with men (MSM), limiting the effectiveness and reach of population-based human T-lymphotropic retroviruses type III (HIV) control measures among this group
Specific and accurate knowledge relevant to the management of behavioural and clinical risks for MSM clients prior to training was poor. Whilst this may not be surprising in the face of longstanding neglect of Kenyan MSM within HIV policy and resource allocation and a lack of attention to MSM within medical, nursing and HIV counselling training in Kenya, it draws focus to the challenge of maintaining and extending the professional competence of the existing HIV workforce to match the epidemiological realities of the Kenyan HIV epidemic Á especially since the National AIDS & Sexually Transmitted Diseases Control Programme (NASCOP) requires Kenyan healthcare workers (HCWs) to document the number and category of MSM using HIV services
The training, which combined self-directed and facilitated group learning, increased health worker knowledge and reduced homophobic attitudes up to three months after training. Scaling up such interventions offers a straightforward response to the immediate need to support HCWs in offering accessible and informed services to address the largely sexual health needs among MSM in Kenya
Summary
Healthcare workers (HCWs) in Africa typically receive little or no training in the healthcare needs of men who have sex with men (MSM), limiting the effectiveness and reach of population-based HIV control measures among this group. Conclusions: Scaling up MSM sensitivity training for African HCWs is likely to be a timely, effective and practical means to improve relevant sexual health knowledge and reduce personal homophobic sentiment among HCWs involved in HIV prevention, testing and care in sub-Saharan Africa. Sub-Saharan Africa has a very high burden of HIV-1 infection, of which a substantial proportion occurs among populations reporting high-risk sexual behaviour such as transactional sex and anal intercourse [1] Such populations suffer from stigma and rejection, and they have been neglected by many HIV prevention and care programmes [2]. Conclusions: Intersectionality provides a framework for understanding the experiences of dual stigma and discrimination faced by MSM living with HIV in Swaziland and highlights how programmes and policies should consider the specific needs of this population when designing HIV prevention, care and treatment services. Addressing multiple levels of HIV risk, including structural factors, may help to ensure that programmes have sufficient coverage to impact this HIV epidemic among MSM
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