Abstract
BackgroundIn Bangladesh, community-based and peer-led prevention interventions for human immunodeficiency virus infection are provided to key populations (KPs) by drop-in centers (DICs), which are primarily supported by external donors. This intervention approach was adopted because public healthcare facilities were reportedly insensitive to the needs and culture of KPs, particularly with regard to the provision of sexually transmitted infection (STI) services. Nonetheless, in the absence of external funding, STI services need to be integrated into public healthcare systems.MethodsA qualitative study was conducted in 2017 to understand the willingness of KPs to uptake the STI services of public healthcare facilities. Data were collected based on 34 in-depth interviews, 11 focus group discussions, and 9 key informant interviews. The social-ecological theoretical framework was used to analyze the data thematically and contextually.ResultsMost participants were either resistant or reluctant to uptake STI services from public healthcare facilities because of their previous firsthand experiences (e.g., disrespectful and judgmental attitudes and behaviors), perceived discrimination, anticipatory fear, and a lack of privacy. Very few participants who had visited these facilities to receive STI services were motivated to revisit them. Nevertheless, they emphasized their comfort in DICs over public healthcare facilities. Thus, it appears that KPs can be situated along a care-seeking continuum (i.e., resistance to complete willingness). Unless policymakers understand the context and reasons that underlie their movement along this continuum, it would be difficult to encourage KPs to access STI services from public healthcare facilities.ConclusionKPs’ willingness to uptake the STI services of public healthcare facilities depends not only on individual and community experiences but also on the nexus between socio-structural factors and health inequalities. Community mobilization and training about the needs and culture of KPs for healthcare professionals are essential. Therefore, addressal of a wide range of structural factors is required to motivate KPs into seeking STI services from public healthcare facilities.
Highlights
Human immunodeficiency virus (HIV) infection is still considered to be an alarming public health burden in low-and lower-middle income countries (LMIC)
Very few participants who had visited these facilities to receive sexually transmitted infection (STI) services were motivated to revisit them. They emphasized their comfort in drop-in centers (DICs) over public healthcare facilities
The results from the last serological surveillance of 2016 that was conducted among people who inject drugs (PWID) in the city of Dhaka showed that 22% of the sampled male PWID and 5% of the sampled females who inject drugs(FWID) were HIV positive [5]
Summary
Human immunodeficiency virus (HIV) infection is still considered to be an alarming public health burden in low-and lower-middle income countries (LMIC). It is ranked as the 17th leading cause of death in South Asia [1, 2]. In Bangladesh, community-based and peer-led prevention interventions for human immunodeficiency virus infection are provided to key populations (KPs) by drop-in centers (DICs), which are primarily supported by external donors. This intervention approach was adopted because public healthcare facilities were reportedly insensitive to the needs and culture of KPs, with regard to the provision of sexually transmitted infection (STI) services. In the absence of external funding, STI services need to be integrated into public healthcare systems
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