Top

Published in:

Open Access 01-12-2021 | Care | Research article

Cultural and clinical challenges in sexual health care provision to men who have sex with men in Tanzania: a qualitative study of health professionals’ experiences and health students’ perspectives

Authors: Lucy R. Mgopa, B. R. Simon Rosser, Michael W. Ross, Gift Gadiel Lukumay, Inari Mohammed, Agnes F. Massae, Sebalda Leshabari, Ever Mkonyi, Stella Emmanuel Mushy, Dorkasi L. Mwakawanga, Maria Trent, James Wadley, Zobeida E. Bonilla

Published in: BMC Public Health | Issue 1/2021

Abstract

Background

Health care providers across sub-Saharan Africa continue to face challenges while delivering sexual health care services. We explored the experiences, views and challenges of health care professionals and health students across different disciplines in Tanzania, towards delivery of sexual health services to men who have sex with men.

Methods

Utilizing a qualitative approach, we recruited 121 health care professionals (providers) and students from the fields of midwifery, nursing and medicine in Dar es Salaam, Tanzania. We conducted 18 focus groups discussions, stratified by profession and experience, to investigate clinical management and challenges while addressing a case of an adult male presenting with rectal gonorrhea.

Results

Findings indicated this case as extremely sensitive, clinical management involved establishing rapport and consent, medical care from history taking to treatment, and referral to other specialties. However, the illegal status of homosexuality in Tanzania was a primary concern to participants, this triggered the clinical care of this case scenario as challenging. There were uncertainties whether or not that such a case should be reported to the authorities.

Conclusion

Findings from this study revealed a need for training health students in Tanzania to address sexual health issues including accurate information on homosexuality, reporting requirements and clinical management in the legal and socio-cultural context of the African continent.

Delivering quality health services. a global imperative for universal health coverage. Geneva: World Health Organization, Organization for Economic Co-operation and Development, and The World Bank; 2018.

Sexual health and its linkages to reproductive health. An operational approach. Geneva: World Health Organization; 2017.

Centers for Disease Control and Prevention (US). Division of Reproductive Health. In: Reproductive health: major milestones; 2010s. [cited 2011 Dec 12]. Available from: URL: http://www.cdc.gov /reproductive health/drh/Timeline.htm.

Ford JV, Barnes R, Rompalo A, Hook EW 3rd. Sexual Health Training and Education in the U.S. Public Health Rep. 2013;128(Suppl 1 (Suppl 1)):96–101. https://doi.org/10.1177/00333549131282S111.CrossRefPubMedPubMedCentral

Developing sexual health programmes. A framework for action. Geneva: World Health Organization; 2017.

Key populations. Targeted approaches to an AIDS – free generation: USAID; 2019. www.usaid.gov/global-health/health-areas/hiv-and-aids/technical-areas/key-populations

Duorado I, Crosland Guimaräes M, Damacena G, Magno L, et al. Sex work stigma and non-disclosure to health care providers: data from a large RDS study among FSW in Brazil. BMC Int Health Hum Rights. 2019;19(1):8. https://doi.org/10.1186/s12914-019-0193-7.CrossRef

Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. World Health Organization (2014). http://www.who.int/hiv/pub/guidelines/keypopulations

Evens E, Lanham M, Santi K, Cooke J, Ridgeway K, Morales G, et al. Experiences of gender- based violence among female sex workers, men who have sex with men and transgender women in Latin America and the Caribbean: a qualitative study to inform HIV programming. BMC Int Health Hum Rights. 2019;19(1):9. https://doi.org/10.1186/s12914-019-0187-5.CrossRefPubMedPubMedCentral

10.

Report on global sexually transmitted infection surveillance, 2018. Geneva: World Health Organization; 2018.

11.

Rowley J, Vander Hoorn S, Korenromp E, Low N, Unemo M, Abu-Raddad LJ, et al. Global and regional estimates of the prevalence and incidence of four curable sexually transmitted infections in 2016: WHO Bulletin; 2019. https://www.who.int/bulletin/online_first/BLT.18.228486.pd

12.

Kirkcaldy RD, Weston E, Segurado AC, Hughes G. Epidemiology of gonorrhea: a global perspective. Sex Health. 2019;16(5):401–11. https://doi.org/10.1071/SH19061.

13.

Joint United Nations Programme on HIV/AIDS. UNAIDS (2018).

14.

Beyrer C, Baral SD, Griensven FV, Goodreau SM, Chariyalertsak S, Wirtz AL. Global epidemiology of HIV infection in men who have sex with men. Lancet. 2012;380(9839):367–77. https://doi.org/10.1016/S0140-6736(12)60821-6.CrossRefPubMedPubMedCentral

15.

Ross MW, Nyoni J, Ahaneku HO, Mbwambo J, McClelland RC, McCurdy SA. High HIV seroprevalence, rectal STIs and risky sexual behavior in men who have sex with men in Dar es Salaam and Tanga, Tanzania. BMJ Open. 2014;4(8):4e006175. https://doi.org/10.1136/bmjopen-2014-006175, High HIV seroprevalence, rectal STIs and risky sexual behaviour in men who have sex with men in Dar es Salaam and Tanga, Tanzania.CrossRef

16.

Mmbaga EJ, Moen K, Makyao N, Mpembeni R, Leshabari MT. HIV and STI among men who have sex with men in Dodoma municipality, Tanzania: a cross-sectional study. Sex Transm Infect (2017); 0:1–6. Doi:https://doi.org/10.1136/sextrans-2016-052770, 93, 5.

17.

Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. World Health Organization;2013.

18.

HIV and Young Men who have sex with men: A Technical Brief: World Health Organization; 2015.

19.

Kaighobadi F, Collier K, Reddy V, Lane T, Sandfort T. Sexual violence experiences among black gay, bisexual and other men who have sex with men and transgender women in South African townships: contributing factors and implications for health. S Afr J Psychol. 2019. https://doi.org/10.1177/0081246319859449.

20.

Miltz AR, Lampe FC, Bacchus LJ, McCormack S, Dunn D, White E, et al. Intimate partner violence, depression and sexual behavior among gay, bisexual and other men who have sex with men in the PROUD trial. BMC Public Health. 2019;19(1):431. https://doi.org/10.1186/s12889-019-6757-6.CrossRefPubMedPubMedCentral

21.

Mgopa L, Mbwambo J, Likindikoki S, Pallangyo P. Violence and depression among men who have sex with men in Tanzania. BMC Psychiatry. 2017;17(1):296. https://doi.org/10.1186/s12888-017-1456-2.CrossRefPubMedPubMedCentral

22.

Anderson AA, Ross MW, Nyoni JE, McCurdy SA. High prevalence of stigma -related abuse among a sample of men who have sex with men in Tanzania: Implications for HIV prevention. AIDS Care. 2015;27(1):63–70. https://doi.org/10.1080/09540121.2014.951597.CrossRefPubMed

23.

Ross M, Nyoni J, Larsson M, Mbwambo J, Agardh A, Kashiha J, et al. Health care in a homophobic climate: the SPEND model for providing sexual health services to men who have sex with men where their health and human rights are compromised. Glob Health Action. 2015;8(1):26096. https://doi.org/10.3402/gha.v8.26096.CrossRefPubMed

24.

Ochonye B, Foyalan M, Fatusi A, Bello B, Ajidagba B, Emmanuel G, et al. Sexual practices, sexual behaviours and HIV risk profile of key populations in Nigeria. BMC Public Health. 2019;19(1):1210. https://doi.org/10.1186/s12889-019-7553-z.CrossRefPubMedPubMedCentral

25.

Lane T, Mogale T, Struthers H, McIntyre J, Kegeles S. “They see you as a different thing”: the experiences of men who have sex with men with health Care Workers in South African Township Communities. Sex Transm Infect. 2008;84(6):430–3. https://doi.org/10.1136/sti.2008.031567.CrossRefPubMedPubMedCentral

26.

Tsang Yuk-ha E, Qiao S, Wilkinson JS, Fung Lai-chu A, Lipeleke F, Li X. Multilayered stigma and vulnerabilities for HIV infection and transmission: a qualitative study on male sex Workers in Zimbwabwe. Am J Mens Health. 2019;13(1):1–11. https://doi.org/10.1177/1557988318823883.CrossRef

27.

Magesa D, Mtui L, Abdul M, Kayange A, Chiduo R, Leshabari M, et al. Barriers to men who have sex with men attending HIV related health services in Dar es Salaam, Tanzania. Tanzania J Health Res. 2014;16:2. https://doi.org/10.4314/thrb.v16i2.8.CrossRef

28.

Zahn R, Grosso A, Scheibe A, Bekker LG, Katende S, Dausab F, et al. Human rights violations among men who have sex with men in southern Africa: comparison between legal contexts. PLoS One. 2016;11(1):e0147156. https://doi.org/10.1371/journal.pone.0147156.CrossRefPubMedPubMedCentral

29.

Semugoma P, Nemande S, Baral SD. The Irony of Homophobia in Africa. Lancet (2012); 380(9839):312–314. doi: https://doi.org/10.1016/S0140-6736(12)60901-5.

30.

MMbaga E, Leyna G, Leshabari M, TersbØl, Lange T, Makyao N, et al. Effectiveness of health care workers and peer engagement in promoting access to health services among population at higher risk for HIV in Tanzania (KPHEALTH): Study protocol for a quasi-experimental trial. BMC Health Serv Res. 2019;19:801. https://doi.org/10.1186/s12913-019-4675-z.CrossRefPubMedPubMedCentral

31.

Nyblade L, Mbote D, Barker C, Morla J, Mwai D, Oneko T, et al. Impact of Stigma on Utilization of Health Services among Sex Workers in Kenya. Washington, DC: Futures Group, Health Policy Project; 2015. https://www.researchgate.net/publications/28418156

32.

Moen K, Aggleton P, Leshabari MT, Middleton AL. Same – Sex Practicing Men in Tanzania from 1860 to 2010. Arch Sex Behav. 2014. https://doi.org/10.1007/s10508-014-0286-2.

33.

Meek J, Dunnett K, Brittain D. The role of the HCA in sexual health services: British Journal of Health Care Assistants, vol. 8; 2014. p. 10. https://doi.org/10.12968/bjha.2014.8.10.489.CrossRef

34.

Müller A, Röhrs S, Hoffman-Wanderer Y, Moult K. “You have to make a judgement call”. – Morals, judgements and the provision of quality sexual and reproductive health services for adolescents in South Africa: Social Science and Medicine; 2016. https://doi.org/10.1016/j.socscimed.2015.11.048.CrossRef

35.

Ross MW, Leshabari S, Rosser BRS, Trent M, Mgopa L, Wadley J, et al. Evaluation of an assessment instrument for a sexual health curriculum for nurses and midwifery students in Tanzania: the sexual health education for professionals scale(SHEPS). Appl Nurs Res. 2018;40:152–6. https://doi.org/10.1016/j.apnr.2018.01.005.CrossRefPubMed

36.

Alli F, Maharaj P, Vawda M. Interpersonal relations between health care workers and young clients: Barriers to accessing sexual and reproductive health care. J Community Health. 2013;38(1):150–5. https://doi.org/10.1007/s10900-012-9595-3.CrossRefPubMed

37.

United Nations Department of Economic and Social Affairs. World population prospects 2019: Highlights2020 [cited 2020 July 26]. Available from: https://www.un.org/development/desa/publications/world-population-prospects-2019-highlights.html.

38.

Matovu J, Musinguzi G, Kiguli J, Nuwaha F, Mujisha G, Musinguzi J, et al. Health providers’ experiences, perceptions and readiness to provide HIV services to men who have sex with men and female sex workers in Uganda- a qualitative study. BMC Infect Dis. 2019;19(1):214. https://doi.org/10.1186/s12879-019-3713-0.CrossRefPubMedPubMedCentral

39.

Duby Z, Scheibe A, Nkosi B. “We must treat them like all the other people”: Evaluating the Integrated Key Populations Sensitivity Training Programme for Healthcare Workers in South Africa. South Afr J HIV Med. 2019;v20i1:909. https://doi.org/10.4102/sajhivmed.CrossRef

40.

Fay H, Baral SD, Trapence G, Motimedi F, Umar E, Lipinge S, et al. Stigma, health care access, and HIV knowledge among men who have sex with men in Malawi, Namibia and Botswana. AIDS Behav. 2010;15(6):1088–97. https://doi.org/10.1007/s10461-010-9861-2.CrossRef

41.

King R, Sebyala Z, Ogwal M, Aluzimbi G, Apondi R, Reynolds S, et al. How men who have sex with men experience HIV health Services in Kampala. Uganda BMJ Global Health. 2020;5(4). https://doi.org/10.1136/bmjgh-2019-001901.

42.

Shangani S, Naanyu V, Operario D, Genberg B. Stigma and Healthcare – Seeking Practices of Men Who Have Sex with Men in Western Kenya: A Mixed -Methods Approach for Scale Validation. AIDS Patient Care STDs. 2018;32(11). https://doi.org/10.1089/apc.2018.0101.

43.

Kapanda L, Jumbe V, Izugbara C, Muula AS. Healthcare providers’ attitudes towards care for men who have sex with men (MSM) in Malawi. BMC Health Serv Res. 2019;19(1):316. https://doi.org/10.1186/s12913-019-4104-3.CrossRefPubMedPubMedCentral

44.

Eluwa GI, Adebajo SB, Eluwa T, Ogbanufe O, Ilesanmi O, Nzelu C. Rising HIV prevalence among men who have sex with men in Nigeria: a trend analysis. BMC Public Health. 2019;19(1):1201. https://doi.org/10.1186/s12889-019-7540-4.CrossRefPubMedPubMedCentral

45.

Fisher C, Fried A, Macapagal K, Mustanski B. Patient- provider communication barriers and facilitators to HIV and STI preventive Services for Adolescent MSM. AIDS Behav. 2018;22(10):3417–28. https://doi.org/10.1007/s10461-018-2081-x.CrossRefPubMedPubMedCentral

46.

Rebe K, De Swardt G, Struthers H, McIntyre J. Towards ‘men who have sex with men-appropriate’ health services in South Africa. S Afr J HIV Med. 2013;14(2):52–7. https://doi.org/10.7196/SAJHIVMED.841.CrossRef

47.

Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Admin Pol Ment Health. 2015;42(5):533–44. https://doi.org/10.1007/s10488-013-0528-y.CrossRef

48.

Exavery A, Lutambi AM, Wilson N, Mubyazi GM, Pemba S, Mbaruku G. Gender-based distributional skewness of the United Republic of Tanzania’s health workforce cadres: a cross-sectional health facility survey. Hum Resour Health. 2013;11(1):28. https://doi.org/10.1186/1478-4491-11-28.CrossRefPubMedPubMedCentral

49.

Saldaña J. The coding manual for qualitative researchers: Sage Publications Ltd; 2009.

50.

Howarth AR, Day S, Greene L, Ward H. “They made me feel comfortable”: a comparison of methods to measure patient experience in a sexual health clinic. BMC Health Serv Res. 2017;17(1):325. https://doi.org/10.1186/s12913-017-2264-6, “They made me feel comfortable”: a comparison of methods to measure patient experience in a sexual health clinic.

51.

Van der Elst EM, Gichuru E, Omar A, Kanungi J, Duby Z, Midoun M, et al. Experiences of Kenyan healthcare workers providing services to men who have sex with men: qualitative findings from a sensitivity training programme. J Int AIDS Soc. 2013;16(4suppl 3):18741. https://doi.org/10.7448/IAS.16.4.18741.

52.

Wanyeze RK, Musinguzi G, Matovu JK, Kiguli J, Nuwaha F, Mujisha G, et al. “If You Tell People That You Had Sex with a Fellow Man, It is Hard to Be Helped and Treated”: Barriers and Opportunities for Increasing Access to HIV Services among Men Who Have Sex with Men in Uganda. PLoS One. 2016;11(1):e0147714. https://doi.org/10.1371/journal.pone.0147714.CrossRef

53.

Taegtmeyer M, Davies A, Mwangome M, Van der Elst EM, Graham SM, Price MA, et al. Challenges in Providing Counselling to MSM in Highly Stigmatized Contexts: Results of a Qualitative Study from Kenya. PLoS One. 2013;8(6):e64527. https://doi.org/10.1371/journal.pone.0064527.CrossRefPubMedPubMedCentral

54.

Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. World Health Organization. 2016 update.

55.

Rispel LC, Metcalf CA, Cloete A, Moorman J, Reddy V. You become afraid to tell them that you are gay: Health service utilization by men who have sex with men in South African cities. J Public Health Policy. 2011:S137–51.

56.

Rosser BRS, Mgopa L, Leshabari S, Ross MW, Gadiel Lukumay G, Massae A, et al. Legal and ethical considerations in delivery of sexual health care in Tanzania. Afr J Health Nurs Midwifery. 2020;3(7):84–102.

57.

Kushwaha S, Lalani Y, Maina G, Ogunbanjo A, Wilton L, Agyarko PT, et al. “But the moment they find out that you are MSM…”a qualitative investigation of HIV prevention experiences among men who have sex with men(MSM) in Ghana’s health care system. BMC Public Health. 2017;17(1):770. https://doi.org/10.1186/s12889-017-4799-1.CrossRefPubMedPubMedCentral

Title: Cultural and clinical challenges in sexual health care provision to men who have sex with men in Tanzania: a qualitative study of health professionals’ experiences and health students’ perspectives
Authors: Lucy R. Mgopa
B. R. Simon Rosser
Michael W. Ross
Gift Gadiel Lukumay
Inari Mohammed
Agnes F. Massae
Sebalda Leshabari
Ever Mkonyi
Stella Emmanuel Mushy
Dorkasi L. Mwakawanga
Maria Trent
James Wadley
Zobeida E. Bonilla
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Care
Human Immunodeficiency Virus
Published in: BMC Public Health / Issue 1/2021
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-021-10696-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cultural and clinical challenges in sexual health care provision to men who have sex with men in Tanzania: a qualitative study of health professionals’ experiences and health students’ perspectives

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

How can the public health impact of vaccination be estimated?

Do they really wash their hands? Prevalence estimates for personal hygiene behaviour during the COVID-19 pandemic based on indirect questions

Long-term effectiveness of elderly health care voucher scheme strategies: a system dynamics simulation analysis

Housing First Combined with Suicide Treatment Education and Prevention (HOME + STEP): study protocol for a randomized controlled trial

Prevalence and risk factors of self-reported wrist and hand symptoms and clinically confirmed carpal tunnel syndrome among office workers in China: a cross-sectional study

Effect of different resumption strategies to flatten the potential COVID-19 outbreaks amid society reopens: a modeling study in China