Exploring access to HIV-related services and programmatic gaps for Men having Sex with Men (MSM) in rural India- a qualitative study.

Autor: Bangar S; Epidemiology Division, ICMR-National AIDS Research Institute, Pune, India., Mohan U; Upgraded Department of Community Medicine and Public Health, King George's Medical University, Lucknow, India., Kumar S; Department of Community & Family Medicine, All India Institute of Medical Sciences, Bhopal, India., Mahapatra A; Epidemiology Division, ICMR-Regional Medical Research Center, Bhubaneswar, India., Singh SK; Upgraded Department of Community Medicine and Public Health, King George's Medical University, Lucknow, India., Kohli R; Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, India., Verma A; Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, India., Katendra TL; Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, India., Rahane G; Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, India., Shewale SP; Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, India., Yenbhar N; Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, India., Verma V; National AIDS Control Organization, New Delhi, India., Saravanamurthy P; FHI 360, Linkages-India, New Delhi, India., George B; FHI 360, Linkages-India, New Delhi, India., Kushwaha BS; National AIDS Control Organization, New Delhi, India., Das C; National AIDS Control Organization, New Delhi, India., Rajan S; National AIDS Control Organization, New Delhi, India., Sahay S; Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, India.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2023 May 04; Vol. 18 (5), pp. e0284901. Date of Electronic Publication: 2023 May 04 (Print Publication: 2023).
DOI: 10.1371/journal.pone.0284901
Abstrakt: Background: Despite the Link Worker Scheme to address the HIV risk and vulnerabilities in rural areas, reaching out to unreached men having sex with men (MSM) remains a challenge in rural India. This study explored issues around health care access and programmatic gaps among MSM in rural settings of India.
Methods: We conducted eight Focused Group Discussions (FGDs), 20 Key Informant Interviews (KIIs), and 20 In-Depth Interviews (IDIs) in four rural sites in Maharashtra, Odisha, Madhya Pradesh, and Uttar Pradesh between November 2018 and September 2019. The data in the local language were audio-recorded, transcribed, and translated. Data were analyzed in NVivo version 11.0 software using the grounded theory approach.
Results: Primary barriers to health care access were lack of knowledge, myths and misconceptions, not having faith in the quality of services, program invisibility in a rural setting, and anticipated stigma at government health facilities. Government-targeted intervention services did not seem to be optimally advertised in rural areas as MSM showed a lack of information about it. Those who knew reported not accessing the available government facilities due to lack of ambient services, fear of the stigma transforming into fear of breach of confidentiality. One MSM from Odisha expressed, "…they get fear to go to the hospital because they know that hospital will not maintain confidentiality because they are local people. If society will know about them, then family life will be disturbed" [OR-R-KI-04]. Participants expressed the desire for services similar to those provided by the Accredited Social Health Activists (ASHA), frontline health workers for MSM.
Conclusion: Programme invisibility emerges as the most critical issue for rural and young MSM. Adolescent and panthis emerged as Hidden MSM and they need focused attention from the programme. The need for village-level workers such as ASHA specifically for the MSM population emerged. MSM-friendly health clinics would help to improve healthcare access in rural MSMs under Sexual and Reproductive Health Care.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2023 Bangar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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