"You are wasting our drugs": health service barriers to HIV treatment for sex workers in Zimbabwe.
"You are wasting our drugs": health service barriers to HIV treatment for sex workers in Zimbabwe.
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DOI：
10.1186/1471-2458-13-698
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发表时间：
2013-07-31
影响因子：
4.5
通讯作者：
Cowan F
中科院分区：
文献类型：
--
作者：
Mtetwa S;Busza J;Chidiya S;Mungofa S;Cowan F
尽管性工作者受到艾滋病毒的影响不成比例，但他们仍然被扩大获得抗逆转录病毒治疗的努力所忽视。在津巴布韦，尽管存在针对女性性工作者的服务，但不到一半的被诊断患有艾滋病毒的妇女接受了转诊评估和抗逆转录病毒治疗的启动;只有14%的人接受了一次以上的预约。我们进行了一项定性研究，以探讨不出勤和高流失率的原因。在哈拉雷进行了三次焦点小组讨论，由“有声音的姐妹篇”方案将艾滋病毒阳性工作者转介到一家公共艾滋病毒诊所进行抗逆转录病毒治疗资格筛查和登记。焦点小组探讨了性工作者寻求护理的经验和看法，重点是如何管理艾滋病毒与性工作者特有的挑战相互作用。FGD成绩单进行了分析，通过确定新出现的和反复出现的主题，特别是与卫生服务的相互作用，以及这些如何影响艾滋病毒治疗的吸收和保留在护理决策。社工们强调了供应方面的障碍，比如被卫生工作者贬低和羞辱，这反映了围绕他们工作的更广泛的社会耻辱。性工作者特别容易在卫生保健环境中被识别和轻视。需求方面的障碍也很突出，包括相互竞争的时间承诺以及运输和某些治疗的成本，反映了社会工作者被边缘化的社会经济地位。改善社会工作者获得治疗的机会对于他们自身的健康、方案公平性和公共卫生利益至关重要。致力于减少艾滋病毒护理中的工作人员流失的方案需要积极主动地解决公共服务的质量和环境问题。通过专门培训提高卫生工作者的敏感性，将性工作者友好诊所的转诊系统完善为国家系统，并为性工作者提供集体组织改善治疗和权利的机会，可能有助于减轻性工作者目前面临的治疗启动和关注障碍。
Although disproportionately affected by HIV, sex workers (SWs) remain neglected by efforts to expand access to antiretroviral treatment (ART). In Zimbabwe, despite the existence of well-attended services targeted to female SWs, fewer than half of women diagnosed with HIV took up referrals for assessment and ART initiation; just 14% attended more than one appointment. We conducted a qualitative study to explore the reasons for non-attendance and the high rate of attrition. Three focus group discussions (FGD) were conducted in Harare with HIV-positive SWs referred from the ‘Sisters with a Voice’ programme to a public HIV clinic for ART eligibility screening and enrolment. Focus groups explored SWs’ experiences and perceptions of seeking care, with a focus on how managing HIV interacted with challenges specific to being a sex worker. FGD transcripts were analyzed by identifying emerging and recurring themes that were specifically related to interactions with health services and how these affected decision-making around HIV treatment uptake and retention in care. SWs emphasised supply-side barriers, such as being demeaned and humiliated by health workers, reflecting broader social stigma surrounding their work. Sex workers were particularly sensitive to being identified and belittled within the health care environment. Demand-side barriers also featured, including competing time commitments and costs of transport and some treatment, reflecting SWs’ marginalised socio-economic position. Improving treatment access for SWs is critical for their own health, programme equity, and public health benefit. Programmes working to reduce SW attrition from HIV care need to proactively address the quality and environment of public services. Sensitising health workers through specialised training, refining referral systems from sex-worker friendly clinics into the national system, and providing opportunities for SW to collectively organise for improved treatment and rights might help alleviate the barriers to treatment initiation and attention currently faced by SW.
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影响因子：
4.9
作者：
Dlamini, Priscilla S.;Wantland, Dean;Holzemer, William L.
通讯作者：
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影响因子：
56.3
作者：
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通讯作者：
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影响因子：
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作者：
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Moses, Stephen
DOI：
10.1177/154510970200100203
发表时间：
2002-01-01
期刊：
Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002)
影响因子：
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作者：
Cameron, D William
通讯作者：
Cameron, D William
DOI：
10.1111/j.1753-6405.2010.00594.x
发表时间：
2010-10-01
影响因子：
3.5
作者：
Harcourt, Christine;O'Connor, Jody;Donovan, Basil
通讯作者：
Donovan, Basil