Health care workers' perceptions and bias toward men as HIV clients in Malawi and Mozambique: A qualitative study.
Health care workers' perceptions and bias toward men as HIV clients in Malawi and Mozambique: A qualitative study.
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DOI：
10.1371/journal.pgph.0001356
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发表时间：
2023
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在整个撒哈拉以南非洲，男子在艾滋病毒服务中的代表性不足。很少有人知道卫生保健工作者（HCW）的男子作为客户的看法，这可能会直接影响所提供的护理质量，以及HCW的购买男性特定的干预措施。2016年，与马拉维和莫桑比克15家医疗机构的HCW进行了焦点小组讨论（FGD），最初是为了评估普及治疗的障碍（而不是HCW偏见）。FGD以当地语言进行，记录，翻译成英语，并转录。在这项研究中，我们专注于HCW对男性作为HIV客户的看法以及对男性的任何明确偏见，使用Atlas.ti v.8中的归纳和演绎编码，并使用恒定比较方法进行分析。包括在艾滋病毒治疗诊所工作的20名FGD和154名HCW。中位年龄为30岁，59%为女性，43%为提供者与支持人员。HCW对男性客户持有强烈的明显偏见。大多数保健工作者认为，由于男子在社会中的地位较高，他们可以很容易地获得艾滋病毒服务，而不管他们面临的设施一级的障碍。男子被轻蔑地描述为缺乏信息和难以相处的客户，他们没有进入卫生系统。由于对男性“自私”和“骄傲”本性的假设，男性在很大程度上被视为“坏客户”，导致HCW对男性护理不善的同情很少。我们的研究强调了对男性作为艾滋病毒客户的强烈明显偏见，即使性别和偏见不是数据收集的重点。因此，医护人员可能没有动力实施针对男性的干预措施或改善医护人员与男性的互动。将男子框定为问题男子个人承担不应有的责任，同时尽量减少对他们产生独特影响的体制障碍。必须立即解决地方、国家和全球对男性的偏见。
Men are underrepresented in HIV services throughout sub-Saharan Africa. Little is known about health care worker (HCW) perceptions of men as clients, which may directly affect the quality of care provided, and HCWs’ buy-in for male-specific interventions. Focus group discussions (FGDs) were conducted in 2016 with HCWs from 15 facilities across Malawi and Mozambique and were originally conducted to evaluate barriers to universal treatment (not HCW bias). FGDs were conducted in local languages, recorded, translated to English, and transcribed. For this study, we focused on HCW perceptions of men as HIV clients and any explicit bias against men, using inductive and deductive coding in Atlas.ti v.8, and analyzed using constant comparison methods. 20 FGDs with 154 HCWs working in HIV treatment clinics were included. Median age was 30 years, 59% were female, and 43% were providers versus support staff. HCWs held strong explicit bias against men as clients. Most HCWs believed men could easily navigate HIV services due to their elevated position within society, regardless of facility-level barriers faced. Men were described in pejorative terms as ill-informed and difficult clients who were absent from health systems. Men were largely seen as “bad clients” due to assumptions about men’s ‘selfish’ and ‘prideful’ nature, resulting in little HCW sympathy for men’s poor use of care. Our study highlights a strong explicit bias against men as HIV clients, even when gender and bias were not the focus of data collection. As a result, HCWs may have little motivation to implement male-specific interventions or improve provider-patient interactions with men. Framing men as problematic places undue responsibility on individual men while minimizing institutional barriers that uniquely affect them. Bias in local, national, and global discourses about men must be immediately addressed.