| 1. |
- Agardh, Charlotte, et al.
(författare)
-
Using pharmacists and drugstore workers as sexual healthcare givers : A qualitative study of men who have sex with men in Dar es Salaam, Tanzania
- 2017
-
Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 10:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Previous research has shown that men who have sex with men (MSM) avoid formal healthcare services because of the fear of discrimination as homosexuality is illegal and stigmatized in Tanzania. Instead, self-treatment by medications obtained directly from pharmacies or drugstores may be common when MSM experience symptoms of suspected sexually transmitted infections (STIs) related to sexual activity with men. Objective: To explore MSM’s perceptions and experiences of seeking treatment and advice from pharmacists and drugstore workers in Dar es Salaam, Tanzania, with regards to their sexual health and STI-related problems. Materials and Methods: 15 in-depth interviews were conducted with MSM with experience of seeking assistance relating to their sexual health at pharmacies and drugstores in Dar es Salaam in 2016. A qualitative manifest and latent content analysis was applied to the collected data. Results: Four themes related to different aspects of MSM’s perceptions and experiences of pharmacy care emerged from the analysis: (1) Balancing threats against need for treatment reflected informants’ struggles concerning risks and benefits of seeking assistance at pharmacies and drugstores; (2) Identifying strategies to access required services described ways of approaching a pharmacist when experiencing a sexual health problem; (3) Seeing pharmacists as a first choice of care focused on informants’ reasons for preferring contact with pharmacies/drugstores rather than formal healthcare services; and (4) Lacking reliable services at pharmacies indicated what challenges existed related to pharmacy care. Conclusions: MSM perceived the barriers for accessing assistance for STI and sexual health problems at pharmacies and drugstores as low, thereby facilitating their access to potential treatment. However, the results further revealed that MSM at times received inadequate drugs and consequently inadequate treatment. Multi-facetted approaches are needed, both among MSM and drugstore, pharmacy, and healthcare workers, to improve knowledge of MSM sexual health, STI treatment, and risks of antibiotic resistance.
|
|
| 2. |
- Larsson, Markus, et al.
(författare)
-
Stretching the boundaries : Tanzanian pharmacy workers' views and experiences of providing STI services for men who have sex with men
- 2016
-
Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:11
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore the views and experiences of providing assistance and treatment of sexually transmitted infections to same-sex practicing male clients among service providers at pharmacies and drugstores in Dar es Salaam, Tanzania. Previous research suggests that sexually transmitted infections are an increasing concern for this population. Due to stigma and discrimination, men who have sex with men face limited access to treatment, which might contribute to increased self-medication. However, limited research has been conducted on the role of the pharmaceutical service provider with regards to this population in sub-Saharan Africa. Method: In January 2016, 16 service providers at private pharmacies and drugstores with previous experience of providing services to this population were purposively selected for open-ended face-to-face interviews. The analysis was guided by the grounded theory approach. Results: The process that emerged was labelled "Stretching Boundaries for Pharmaceutical Responsibilities". This reflected informants' perceptions of themselves as being involved in a transition from having limited engagement in the care of same-sex practicing male clients to becoming regular service-providers to this group. Findings further revealed that the emotional commitment they developed for clients through this process led to a transgression of provider-client boundaries, which undermined objective decision-making when clients lacked prescription. Financial interests also emerged as an underlying motivation for providing incomplete or inaccurate drug dosages. Conclusions: Further studies are required to better address incentives related to unregulated sale of drugs. Inter-professional networks between pharmacy and healthcare workers could support the development of targeted treatment for men who have sex with men and other key populations.
|
|
| 3. |
- Ross, Michael W, et al.
(författare)
-
Addressing the Healthcare Needs of African Men who have Sex with Men: Barriers to Healthcare and Promoting HIV and STI Treatment in Sub-Saharan Africa.
- 2021
-
Ingår i: East African Journal of Health and Science. - : East African Nature and Science Organization. - 2707-3912 .- 2707-3920. ; 3:1, s. 59-77
-
Tidskriftsartikel (refereegranskat)abstract
- Barriers to healthcare for men who have sex with men (MSM) in sub-Saharan Africa (SSA) are rooted in stigma and discrimination against MSM fuelled by the criminalization of homosexuality. These barriers are influenced by factors involving MSM and the healthcare workers (HCWs). MSM are uncomfortable disclosing their identities and conceal symptoms of sexually transmitted infections (STIs), especially those in areas associated with homosexual behaviour to avoid stigmatization. MSM experience ill-treatment and abuse by HCWs and have concerns regarding HCWs maintaining confidentiality and privacy. This forces MSM to seek care from pharmacies/drugstores or resort to self-treatment, which may not be effective. This, coupled with increased HIV- and STI-risk behaviours resulting from depression and internalized homophobia, result in further spread of STIs. Further, barriers in HIV testing lead to exclusion of MSM from treatment cascades. Insufficient sexuality training of HCWs leads to discrimination or denial of treatment for MSM, particularly in government-run clinics. The criminalization of homosexuality deters HCWs from offering treatment to MSM. The prevailing discriminatory environment that accompanies the criminalization of homosexuality forces HCWs to don the role of moral and legal enforcers, making them the perpetrators of forced anal examinations that continue to be prevalent in SSA. Nevertheless, there is evidence to show HCWs in SSA recognize their lack of training in sexuality and have welcomed educational opportunities to better understand the healthcare needs of MSM. Pilot educational interventions for HCWs in SSA have been received enthusiastically, and have resulted in significant changes in HCW knowledge and attitudes and dealing with MSMs with STIs. This work reviews existing literature on barriers to STI-related healthcare for MSM in SSA. By drawing parallels to barriers that were overcome in the HIV epidemic in the 1980s, suitable solutions focusing on HCW education are suggested.
|
|
| 4. |
- Ross, Michael W., et al.
(författare)
-
Electronic Media Access and Use for Sexuality and Sexual Health Education Among Men Who Have Sex With Men in Four Cities in Tanzania
- 2018
-
Ingår i: International Journal of Sexual Health. - : Informa UK Limited. - 1931-7611 .- 1931-762X. ; 30:3, s. 264-270
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Electronic media use is an important avenue for reaching stigmatized populations. We examined Internet access and use of sexually related electronic media among men who have sex with men (MSM) in 4 cities in Tanzania. Methods: A questionnaire was administered to 231 MSM in Dar es Salaam, Mwanza, Arusha, and Tanga regarding electronic media type, times of use, type of use and frequency of use of sexually-related media. Results: Mean age was 25.7 years, and 52% had completed high school. Half had access to the internet through personal electronic devices, a further quarter had access through work, 10% through friends’ devices, and only 2% had no access to the internet. Most frequently used electronic devices were personal computer followed by work smartphone, with work computer a close third. These patterns were consistent for both seeking other men for sex and finding sexual health information. All respondents had accessed sexual material electronically at some time. Substantial logged-in time was reported each week seeking/chatting with potential sexual partners (median = 48 hr), looking at “porn” (median = 24 hr), and searching for health information (median = 7 hr). Over 98% indicated that they would use an anonymous/confidential online service for HIV and sexually transmitted infection testing. The majority (79%) had found sexual partners throughout the Internet in the last 24 hours, and 52% sought sexual health education online 2–3 times per week. Peak search time was evenings, increasing during weekends. Discussion: For Tanzanian MSM in cities, sexual electronic media use is high and includes work devices. Sexual health information seeking, and openness to electronic counseling and testing was almost universal. Electronic sites for sexual health access should be explored and evaluated.
|
|
| 5. |
- Ross, Michael W, et al.
(författare)
-
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.
- 2015
-
Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9880 .- 1654-9716. ; 8
-
Tidskriftsartikel (refereegranskat)abstract
- We present a model for developing health services for men who have sex with men (MSM) in sub-Saharan Africa and other places where MSM are heavily stigmatized and marginalized. The processes of the SPEND model include Safe treatment for sexually transmissible infections (STIs) and HIV; Pharmacy sites for treatment of STIs in countries where pharmacies and drug stores are the source of medical advice and treatment; Education in sexual health issues for health professionals to reduce discrimination against MSM patients; Navigation for patients who have HIV and are rejected or discriminated against for treatment; and Discrimination reduction through educating potential leaders in tertiary education in issues of human sexuality. Supporting empirical evidence from qualitative and quantitative studies is summarized, and barriers to implementation are discussed. Health care for MSM is one of the casualties of anti-homosexual social and legal climates. There is no amnesty for MSM in health care settings, where the stigma and discrimination that they face in the rest of society is replicated. Such conditions, however, make it necessary to consider ways of providing access to health care for MSM, especially where rates of HIV and STIs in MSM populations are high, and stigma and discrimination encourages high proportions of MSM to marry. This in itself enhances the status of MSM as an important bridge population for STIs including HIV. Where anti-homosexual laws encourage, or are believed to encourage, the reporting of MSM to authorities, health care may be seen as an agent of authority rather than an agency for care.
|
|
| 6. |
- Öhman, Joakim, et al.
(författare)
-
'Fighting an uphill battle' : a qualitative study of the challenges encountered by pharmacy workers when providing services to men who have sex with men in Dar es Salaam, Tanzania
- 2020
-
Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 13:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Previous research suggests that Tanzanian MSM might prefer consulting pharmacies and drugstores, rather than public healthcare services, when in need of STI medicines and treatment. Yet, few studies have explored the experiences of providing services to MSM clients among those working at pharmacies and drugstores and examined what challenges they encounter in providing these services. OBJECTIVE: To gain increased knowledge and understanding of the perceived challenges encountered by pharmacists and drugstore workers when providing STI services to MSM clients in Dar es Salaam, Tanzania. METHOD: In early 2016, 16 semi-structured interviews were conducted with persons working at private pharmacies and drugstores in Dar es Salaam. Data were interpreted through qualitative content analysis. RESULTS: The overarching theme that emerged was labelled 'Fighting an uphill battle', which reflected the challenges pharmacy workers experienced during interactions with MSM clients, and in particular service provision. Pharmacy workers tried to act upon the best of their knowledge to meet the needs of clients, given their understanding of risks and obstacles that MSM faced. Yet, the lack of educational and professional preparedness and insufficient financial and human resources, regarded as necessary to meet the needs of a stigmatised client group, formed barriers for effective service delivery. CONCLUSIONS: In order to support pharmacists and drug-store workers in Tanzania to address perceived challenges for service delivery to MSM clients, systematic and continuous training on MSM's sexual health is required. Furthermore, inter-professional cooperation that harnesses provider involvement from all tiers in the healthcare system is essential to offer complementary services to ensure proper STI care and treatment. Thus, interventions that focus on inter-professional communication and interaction between pharmacists and physicians could have a positive impact on timely referrals of suspected STI cases among marginalised populations.
|
|
