Amsterdam 2015
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| Abstract #2359 - Strengthening HIV service provision | ||||
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Session: 44.1: Strengthening HIV service provision (Parallel) on Thursday @ 16.30-18.00 in C202 Chaired by Simon Gregson, Michael Evangeli Authors: Presenting Author: Prof Patrick Sullivan - Emory University, United States |
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| Additional Authors: | ||||
| Aim: South African public sector health services have provided limited specific HIV prevention, treatment, and care services for men who have sex with men (MSM). Additionally, limited research has focused on HIV prevention programs for MSM. Against this background, the Sibanye Methods of Prevention Packages Program (MP3) study was conducted in order to develop and test the feasibility and acceptability of a combination package of biomedical, behavioural and community-level HIV prevention interventions and services for MSM in Port Elizabeth and Cape Town, South Africa. This is a multi-stage study whose formative component included qualitative interviews with Health Service Providers (HSP). The objective of this paper is to understand the perceived challenges of HSP in delivering HIV-related health care services to MSM in Port Elizabeth, South Africa. | ||||
| Method / Issue: Nine focus groups were conducted, with a total of 51 HSP recruited from several clinics in Port Elizabeth and Cape Town, South Africa. Focus group moderators used visual aids to facilitate discussion, with charts of topics serving to initiate conversations on different aspects of HIV clinical and prevention service provision to MSM. In this exercise, each participant verbally self-rated their comfort level and sufficiency of training on a 1-5 scale, with group discussion formed around these ratings. We explored domains such as attitudes towards current HIV services, structural barriers to service provision, and attitudes towards the proposed enhanced HIV prevention services for MSM. Initial analysis of results is based on ed interviewer notes, key quotations and quantitative self-reports. | ||||
| Results / Comments: Most of the HSP were of mixed ethnic origin (26/51) or African (23/51), with the the remainder (2/51) white. Self-reported sexual orientation was predominantly heterosexual (47/49). Most HSP had never provided MSM patients with condom compatible lubricants (CCL) (47/51) similarly, most had not been involved with HIV pre-exposure prophylaxis (PrEP) provision (45/51). HSP ascribed their limited experience with these methods to a combination of structural barriers (such as the unavailability of CCL and PrEP) and limited knowledge. For instance, only 2/51 HSP reported ever receiving training regarding service provision to sexual minority populations. HSPs also noted the lack of clinical guidelines in place for service provision to MSM. Many identified the lack of training and guidelines as negatively impacting their comfort level with MSM patients as they expressed not knowing what questions to ask the men. This also impacted their decisions to offer certain services such as condoms, VCT and HIV education over other biomedical interventions. Religious beliefs held by some HSP also affected service provision, with some identifying a perceived conflict of interests between their religious beliefs and roles as healthcare providers. | ||||
| Discussion: There is need to improve HIV-related services offered to MSM. yet HSPs are faced with challenges to providing such services. Many studies have focused on uptake of prevention services, our work is novel but this is novel as it looks at determinants of provision and highlights modifiable barriers. It is vital to build capacity of HSPs, including enhanced structural support through training and guidelines creation and dissemination. | ||||
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