Open AccessA more responsive, multi‐pronged strategy is needed to strengthen HIV healthcare for men who have sex with men in a decentralized health system: qualitative insights of a case study in the Kenyan coast
Author(s) -
Elst Elise M,
Mudza Rita,
Onguso Justus M,
Kiirika Leonard,
Kombo Bernadette,
Jahangir Nassim,
Graham Susan M,
Operario Don,
Sanders Eduard J
Publication year - 2020
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1002/jia2.25597
Subject(s) - men who have sex with men , focus group , health care , medicine , thematic analysis , qualitative research , government (linguistics) , reproductive health , family medicine , nursing , environmental health , human immunodeficiency virus (hiv) , political science , population , business , sociology , social science , linguistics , philosophy , syphilis , marketing , law
HIV healthcare services for men who have sex with men (MSM) in Kenya have not been openly provided because of persistent stigma and lack of healthcare capacity within Kenya’s decentralized health sector. Building on an evaluation of a developed online MSM sensitivity training programme offered to East and South African healthcare providers, this study assessed views and responses to strengthen HIV healthcare services for MSM in Kenya. Methods The study was conducted between January and July 2017 in Kilifi County, coastal Kenya. Seventeen policymakers participated in an in‐depth interview and 59 stakeholders, who were purposively selected from three key groups (i.e. healthcare providers, implementing partners and members of MSM‐led community‐based organizations) took part in eight focus group discussions. Discussions aimed to understand gaps in service provision to MSM from different perspectives, to identify potential misconceptions, and to explore opportunities to improve MSM HIV healthcare services. Interviews and focus group discussions were recorded, transcribed verbatim and analysed using Braun and Clarke’s thematic analysis. Results Participants’ responses revealed that all key groups navigated diverse challenges related to MSM HIV health services. Specific challenges included priority‐setting by county government staff; preparedness of leadership and management on MSM HIV issues at the facility level; data reporting at the implementation level and advocacy for MSM health equity. Strong power inequities were observed between policy leadership, healthcare providers and MSM, with MSM feeling blamed for their sexual orientation. MSM agency, as expressed in their actions to access HIV services, was significantly constrained by county context, but can potentially be improved by political will, professional support and a human rights approach. Conclusions To strengthen HIV healthcare for MSM within a decentralized Kenyan health system, a more responsive, multi‐pronged strategy adaptable and relevant to MSM’s healthcare needs is required. Continued engagement with policy leadership, collaboration with health facilities, and partnerships with different community stakeholders are critical to improve HIV healthcare services for MSM.