A 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

doi:10.1002/jia2.25597

. 2020 Oct;23 Suppl 6(Suppl 6):e25597.

doi: 10.1002/jia2.25597.

A 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

Elise M van der Elst^{1

2}, Rita Mudza³, Justus M Onguso⁴, Leonard Kiirika⁵, Bernadette Kombo¹, Nassim Jahangir⁶, Susan M Graham⁷, Don Operario⁸, Eduard J Sanders^{1

2

9}

Affiliations

¹ Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.
² Department of Global Health, Academic Medical Centre, University of Amsterdam, the Netherlands.
³ Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
⁴ Institute for Biotechnology Research, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
⁵ Department of Horticulture and Food Security, School of Agriculture and Environmental Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
⁶ Ministry of Health, Kilifi County, Kenya.
⁷ Departments of Medicine, Global Health, and Epidemiology, University of Washington, Seattle, WA, USA.
⁸ Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA.
⁹ Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.

PMID: 33000906
PMCID: PMC7527756
DOI: 10.1002/jia2.25597

A 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

Elise M van der Elst et al. J Int AIDS Soc. 2020 Oct.

. 2020 Oct;23 Suppl 6(Suppl 6):e25597.

doi: 10.1002/jia2.25597.

Authors

Elise M van der Elst^{1

2}, Rita Mudza³, Justus M Onguso⁴, Leonard Kiirika⁵, Bernadette Kombo¹, Nassim Jahangir⁶, Susan M Graham⁷, Don Operario⁸, Eduard J Sanders^{1

2

9}

Affiliations

¹ Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.
² Department of Global Health, Academic Medical Centre, University of Amsterdam, the Netherlands.
³ Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
⁴ Institute for Biotechnology Research, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
⁵ Department of Horticulture and Food Security, School of Agriculture and Environmental Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
⁶ Ministry of Health, Kilifi County, Kenya.
⁷ Departments of Medicine, Global Health, and Epidemiology, University of Washington, Seattle, WA, USA.
⁸ Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA.
⁹ Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.

PMID: 33000906
PMCID: PMC7527756
DOI: 10.1002/jia2.25597

Abstract

Introduction: 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.

Keywords: HIV healthcare services; Kenya; MSM; decentralization; health equity.

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References

1. UNAIDS . Eastern and Southern Africa UNAIDS data UNAIDS data. 2019. [cited 2020 Aug 10]. Available from: https://www.unaids.org/sites/default/files/media_asset/2019‐UNAIDS‐data_...
1. Sanders EJ, Graham SM, Okuku HS, van der Elst EM, Muhaari A, Davies A, et al. HIV‐1 infection in high risk men who have sex with men in Mombasa, Kenya. AIDS. 2007;21(18):2513–20. - PubMed
1. Sanders EJ, Okuku HS, Smith AD, Mwangome M, Wahome E, Fegan G, et al. High HIV‐1 incidence, correlates of HIV‐1 acquisition, and high viral loads following seroconversion among MSM. AIDS. 2013;27(3):437–46 - PMC - PubMed
1. Wahome E, Graham SM, Thiong'o AN, Khamisi M, Oduor TH, Gichuru E, et al. HIV‐1 incidence, PrEP uptake, and adherence among Kenyan MSM. Conference on Retroviruses and Opportunistic Infections. Boston, MA; 2020.
1. Nduva GM, Hassan AS, Nazziwa J, Graham SM, Esbjornsson J, Sanders EJ. HIV‐1 transmission patterns within and between risk groups in coastal Kenya. Sci Rep. 2020;10(1):6775. - PMC - PubMed

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[1] UNAIDS . Eastern and Southern Africa UNAIDS data UNAIDS data. 2019. [cited 2020 Aug 10]. Available from: https://www.unaids.org/sites/default/files/media_asset/2019‐UNAIDS‐data_...

[2] UNAIDS . Eastern and Southern Africa UNAIDS data UNAIDS data. 2019. [cited 2020 Aug 10]. Available from: https://www.unaids.org/sites/default/files/media_asset/2019‐UNAIDS‐data_...

[3] Sanders EJ, Graham SM, Okuku HS, van der Elst EM, Muhaari A, Davies A, et al. HIV‐1 infection in high risk men who have sex with men in Mombasa, Kenya. AIDS. 2007;21(18):2513–20. - PubMed

[4] Sanders EJ, Graham SM, Okuku HS, van der Elst EM, Muhaari A, Davies A, et al. HIV‐1 infection in high risk men who have sex with men in Mombasa, Kenya. AIDS. 2007;21(18):2513–20. - PubMed

[5] Sanders EJ, Okuku HS, Smith AD, Mwangome M, Wahome E, Fegan G, et al. High HIV‐1 incidence, correlates of HIV‐1 acquisition, and high viral loads following seroconversion among MSM. AIDS. 2013;27(3):437–46 - PMC - PubMed

[6] Sanders EJ, Okuku HS, Smith AD, Mwangome M, Wahome E, Fegan G, et al. High HIV‐1 incidence, correlates of HIV‐1 acquisition, and high viral loads following seroconversion among MSM. AIDS. 2013;27(3):437–46 - PMC - PubMed

[7] Wahome E, Graham SM, Thiong'o AN, Khamisi M, Oduor TH, Gichuru E, et al. HIV‐1 incidence, PrEP uptake, and adherence among Kenyan MSM. Conference on Retroviruses and Opportunistic Infections. Boston, MA; 2020.

[8] Wahome E, Graham SM, Thiong'o AN, Khamisi M, Oduor TH, Gichuru E, et al. HIV‐1 incidence, PrEP uptake, and adherence among Kenyan MSM. Conference on Retroviruses and Opportunistic Infections. Boston, MA; 2020.

[9] Nduva GM, Hassan AS, Nazziwa J, Graham SM, Esbjornsson J, Sanders EJ. HIV‐1 transmission patterns within and between risk groups in coastal Kenya. Sci Rep. 2020;10(1):6775. - PMC - PubMed

[10] Nduva GM, Hassan AS, Nazziwa J, Graham SM, Esbjornsson J, Sanders EJ. HIV‐1 transmission patterns within and between risk groups in coastal Kenya. Sci Rep. 2020;10(1):6775. - PMC - PubMed

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A 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

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A 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

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