Personal, interpersonal and structural challenges to accessing HIV testing, treatment and care services among female sex workers, men who have sex with men and transgenders in Karnataka state, South India
Personal, interpersonal and structural challenges to accessing HIV testing, treatment and care services among female sex workers, men who have sex with men and transgenders in Karnataka state, South India
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DOI：
10.1136/jech-2011-200475
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发表时间：
2012-10-01
影响因子：
6.3
通讯作者：
Moses, Stephen
中科院分区：
文献类型：
--
作者：
Beattie, Tara S. H.;Bhattacharjee, Parinita;Moses, Stephen
背景尽管高危人群中艾滋病毒感染率很高，但在2008年之前，卡纳塔克邦艾滋病毒检测、治疗和护理服务的利用率相对较低。方法于2008年3月和4月在卡纳塔克邦6个区的女性性工作者、男男性行为者和变性者以及项目同伴教育者中开展焦点小组讨论。结果共进行了26次焦点小组讨论，涉及302名参与者。参与者对艾滋病毒和艾滋病毒自愿咨询和检测(VCT)服务有很好的了解，但对其他艾滋病毒服务的认识较低。对艾滋病毒检测结果呈阳性的心理影响的恐惧，以及被看到获得艾滋病毒服务的感知后果，是艾滋病毒服务利用的关键个人和人际障碍。政府医疗服务机构以前的歧视经历，加上自愿咨询服务工作人员的歧视性态度和行为，是那些没有接受艾滋病毒检测的人接受自愿咨询服务的关键结构性障碍。在使用政府管理的预防亲子传播和抗逆转录病毒治疗服务的人中，恶劣的物理设施、漫长的等待时间、缺乏可用的治疗、需要行贿才能接受治疗以及医护人员的歧视性态度构成了额外的结构性障碍。结论建议将一些艾滋病毒护理服务纳入现有的针对弱势人群的计划，并提高政府设施的服务质量，以帮助克服服务利用的多重障碍。增加对艾滋病毒检测、治疗和护理服务的接受是提高艾滋病毒感染者的生活质量和寿命的关键。
Background Despite high HIV prevalence rates among most-at-risk groups, utilisation of HIV testing, treatment and care services was relatively low in Karnataka prior to 2008. The authors aimed to understand the barriers to and identify potential solutions for improving HIV service utilisation.Methods Focus group discussions were carried out among homogeneous groups of female sex workers, men who have sex with men and transgenders, and programme peer educators in six districts across Karnataka in March and April 2008.Results 26 focus group discussions were conducted, involving 302 participants. Participants had good knowledge about HIV and HIV voluntary counselling and testing (VCT) services, but awareness of other HIV services was low. The fear of the psychological impact of a positive HIV test result and the perceived repercussions of being seen accessing HIV services were key personal and interpersonal barriers to HIV service utilisation. Previous experiences of discrimination at government healthcare services, coupled with discriminatory attitudes and behaviours by VCT staff, were key structural barriers to VCT service uptake among those who had not been HIV tested. Among those who had used government-managed prevention of parent to child transmission and antiretroviral treatment services, poor physical facilities, long waiting times, lack of available treatment, the need to give bribes to receive care and discriminatory attitudes of healthcare staff presented additional structural barriers.Conclusions Embedding some HIV care services within existing programmes for vulnerable populations, as well as improving service quality at government facilities, are suggested to help overcome the multiple barriers to service utilisation. Increasing the uptake of HIV testing, treatment and care services is key to improving the quality and longevity of the lives of HIV-infected individuals.