Accessing HIV services in Botswana: perspectives of men who have sex with men and other stakeholders.

BACKGROUND: Men who have sex with men (MSM) represent an increasing number of new HIV infections in Botswana. Many in Botswana still hold discriminatory views against people who engage in same-sex practices. While it is well documented that stigma and discrimination undermine efforts to prevent HIV, the literature about the perception and experiences of discrimination against MSM in accessing HIV services in Botswana is scant. OBJECTIVE(S): In this study, we sought to explore the perception and experiences of discrimination against MSM to improve access to HIV services and reduce discrimination against this marginalised population. METHODS: We employed a descriptive qualitative design using purposive sampling to recruit 20 MSM and 12 stakeholders (six policy-makers and six service providers) involved in implementing HIV/AIDS interventions in Botswana. We conducted semi-structured interviews with participants. All data were audio-recorded, transcribed, translated into English and analysed using thematic analysis. RESULTS: The findings of this study show that MSM experience discrimination at the policy, healthcare system and community levels, which undermines their ability to seek HIV services. The participants reported that MSM are excluded from HIV policies and targeted HIV services. They reported a scarcity of trained personnel, poor access to HIV information, condoms, lack of treatment services targeted at MSM and negative attitudes directed towards MSM by service providers and other users. The participants also reported that they are excluded from community interventions and experience negative attitudes from community and family members. CONCLUSION: Discrimination against MSM undermines the ability of HIV interventions to address MSM sexual health needs. The findings indicate the importance of enabling MSM to overcome discrimination to seek HIV services. Also, there is a need to further explore discrimination against MSM by service providers within the healthcare settings and ways to improve their understanding of male same-sex practices.

Beyond Access: Can a School Health Initiative Facilitate Healthcare Services Utilisation for School-Going Children?

Accessing quality healthcare services is critical to addressing the different health challenges confronting school-going children, especially those in low-resource communities. However, the evidence of access to services is utilisation and not the mere availability of such services. This study explored caregivers' descriptions of the factors influencing the access and utilisation of quality healthcare services for school-going children and their perceptions of the services provided through the integrated school health programme in South Africa. Qualitative interviews were conducted with 17 caregivers of school-going children in three low-resource communities of KwaZulu-Natal province. The data was analysed using thematic analysis, and the themes were clustered using components of the Aday and Andersen framework for access. Despite the efforts to expand the coverage and range of services provided through the Integrated School Health Programme (ISHP), we identified various factors that undermine the overall aim of the ISHP. Financial constraints, distance to health facilities, poor communication and information dissemination systems, low literacy levels, healthcare workers' negative attitudes, and long waiting periods at the referral sites constitute barriers to service utilisation. Specific attention should be paid to improving the communication system between the school-health team and the caregivers, providing support for transportation, improving the attitude of the clinic staff, and providing follow-up services for children referred for further screening and treatment.

Acceptability and accessibility of HIV testing and treatment among men who have sex with men in Botswana.

Background: Although HIV testing and treatment are the cornerstones of a comprehensive prevention strategy, their acceptability and accessibility are complex within the healthcare system.Methods: We used Aday and Andersen's conceptual framework of access to healthcare services to explore factors influencing acceptability and accessibility of HIV testing and treatment among men who have sex with men (MSM) in Botswana. A qualitative descriptive study was conducted, using purposive sampling to recruit 20 MSM. Semi-structured interviews were conducted in Setswana and English. All data were audio-recorded, transcribed, translated into English, where necessary, and analysed using thematic analysis.Findings: This study found that acceptance of HIV testing and treatment was largely positive among MSM. Motivators were the expansion of HIV services, free healthcare services and the perceived risk of contracting HIV. Although perceptions of accessibility to HIV testing and treatment were positive, there were some concerns about privacy and confidentiality, perceived barriers and fear of positive diagnosis, making MSM reluctant to access HIV testing and treatment.Conclusion: This study highlights the need for novel approaches to increase the acceptability and accessibility of HIV testing and treatment. Barriers to accessing HIV services should be addressed to achieve satisfactory health outcomes, and sustainable HIV prevention barriers to accessing HIV should be addressed among MSM.

Defining, conceptualising and operationalising community empowerment: a scoping review protocol.

INTRODUCTION: Community empowerment is a core concept in health promotion theory and practice. Several authors have defined and conceptualised the term differently. However, we did not find any synthesis of the various definitions of, and meanings attached to, community empowerment and the various conceptualisations, operationalisations, and the indicators for measuring community empowerment in the health promotion literature. The aim of this scoping review is to characterise and synthesise various definitions, conceptualisations, operationalisations and indicators for measuring community empowerment in the literature. METHODS AND ANALYSIS: This scoping review will follow scoping review methods outlined by Arksey and O'Malley. We will identify relevant studies from 1986 onwards, written in any language, conducted anywhere in the world, and published in PubMed, PsycINFO, CINAHL, Web of Science and Medline. Two reviewers will independently screen titles, abstracts and full-text articles, after which they will carry out data extraction and analysis. We will develop a numerical and narrative synthesis of the definitions, conceptualisations, operationalisations and measurements of community empowerment in relation to health promotion and/health outcomes. ETHICS AND DISSEMINATION: This scoping review does not require ethics approval, as we will only include information from previously conducted studies and we will not involve human participants.

Stakeholders' perceptions of child and adolescent mental health services in a South African district: a qualitative study.

BACKGROUND: In order to develop a district child and adolescent mental health (CAMH) plan, it is vital to engage with a range of stakeholders involved in providing CAMH services, given the complexities associated with delivering such services. Hence this study sought to explore multisectoral dynamics in providing CAMH care in one resource-constrained South African district as a case study, towards informing the development of a model for district mental health plan and generating lessons for mental health systems strengthening to support CAMH services using the Health Systems Dynamics (HSD) framework. HSD provides a suitable structure for analysing interactions between different elements within the health system and other sectors. METHODS: Purposive sampling of 60 key informants was conducted to obtain an in-depth understanding of various stakeholders' experiences and perceptions of the available CAMH services in the district. The participants include stakeholders from the Departments of Health (DoH), Basic Education (DBE), community-based/non-governmental organizations and caregivers of children receiving CAMH care. The data was categorized according to the elements of the HSD framework. RESULTS: The HSD framework helped in identifying the components of the health systems that are necessary for CAMH service delivery. At a district level, the shortage of human resources, un-coordinated CAMH management system, lack of intersectoral collaboration and the low priority given to the CAMH system negatively impacts on the service providers' experiences of providing CAMH services. Services users' experiences of access to available CAMH services was negatively impacted by financial restrictions, low mental health literacy and stigmatization. Nevertheless, the study participants perceived the available CAMH specialists to be competent and dedicated to delivering quality services but will benefit from systems strengthening initiatives that can expand the workforce and equip non-specialists with the required skills, resources and adequate coordination. CONCLUSIONS: The need to develop the capacity of all the involved stakeholders in relation to CAMH services was imperative in the district. The need to create a mental health outreach team and equip teachers and caregivers with skills required to promote mental wellbeing, promptly identify CAMH conditions, refer appropriately and adhere to a management regimen was emphasized.

How do HIV/AIDS policies address access to HIV services among men who have sex with men in Botswana?

The study assessed Botswana government policies related to HIV/AIDS and international policy documents that were adopted to address the HIV epidemic. Studies have indicated that HIV surveillance among men who have sex with men (MSM) is poor and that they are disproportionally affected by HIV. A document analysis method was employed to assess the Botswana government and international HIV/AIDS policy documents adopted in the country to determine how they address MSM issues such as access to HIV testing and treatment. A qualitative assessment of documents revealed that many international policies do have provisions specifically addressing access to HIV testing and treatment for MSM, while most of the Botswana government HIV/AIDS policies do not address issues relating to HIV testing and treatment among MSM. The results suggest that the health needs of MSM should be taken into consideration by policymakers to implement targeted health care services. Failure to do so could lead to further alienation of MSM from the healthcare services continuum and increases in HIV infection.