Enhancing a survivor-centred approach to healthcare provision in Afghanistan: Understanding and addressing the barriers faced by male victims/survivors of sexual violence

Abstract

Background: Men and boys may experience sexual violence, particularly in conflict settings. However, in Afghanistan little is known about the barriers they face accessing healthcare services.

Objective: The objectives are to identify barriers to healthcare provision for male victims/survivors of sexual violence in Afghanistan and identify ways to enhance survivor-centred healthcare.

Participants and setting: Data were collected in three provinces with adult male victims/survivors of sexual violence (n = 27), healthcare providers (n = 44), and community health workers (n = 26). Boys were not interviewed due to ethical reasons; however, we include retrospective analysis where possible.

Methods: The methods include semi-structured, qualitative interviews with participants. Data were analyzed thematically according to a social ecological model of public health. The study was ethically approved by the Afghan Ministry of Public Health.

Results: Male victims/survivors of sexual violence in Afghanistan face multiple and cumulative barriers to accessing healthcare services. Stigmatization and fears of being sexually abused by healthcare providers are particularly accentuated for those victims/survivors with diverse sexual orientation, gender identity, gender expression, and sex characteristics (SOGIESC). Boy victims/survivors also face particular barriers, including healthcare providers' lack of knowledge of the evolving capacities of the child.

Conclusions: Survivor-centred healthcare response to male victims/survivors of sexual violence should address barriers at multiple levels of the social ecological model, and respond to the needs of male victims/survivors from different vulnerable groups, including boys and those with diverse SOGIESC.

Keywords: Afghanistan; Barriers to healthcare; Male victims/survivors; Sexual violence; Survivor-centred.