Access barriers for Men who have Sex with Men for HIV testing and treatment in Curitiba (PR)

Cota, Vanda Lúcia; Cruz, Marly Marques da

doi:10.1590/0103-1104202112911I

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ORIGINAL ARTICLE • Saúde debate 45 (129) • Apr-Jun 2021 • https://doi.org/10.1590/0103-1104202112911I copy

Access barriers for Men who have Sex with Men for HIV testing and treatment in Curitiba (PR)

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

More than half of new HIV infections in 2018 were among key populations, including gay men and other Men who have Sex with Men (MSM). Stigma can have several behavioral consequences, adversely reflecting on the lives of individuals and can be translated into barriers to access to public health services. This paper aimed to analyze the main barriers to accessing HIV testing at a Curitiba Testing and Counseling Center and the linkage of gay men and other MSM with the health service for early HIV treatment. Primary data were collected following the qualitative method, triangulating field observations, document analysis, and interviews. The results pointed to the lack of trained professionals, difficulty receiving health services, acceptance of sexuality, fear of results, and lack of information as the main barriers to testing. Difficulty in accepting the diagnosis, prejudice, and discrimination were some barriers identified to start treatment. We can conclude that the expansion of access to guarantee the rights of those who have more difficulty entering the Unified Health System (SUS) is still a significant challenge.

KEYWORDS:
HIV; Homosexuality, Male; Health evaluation

Document	Nature of document	Number of documents analyzed	Characterization of the document’s content
Project Protocol	AHA Project official document	1	Justification for the AHA project, objectives, methodology used, participants, instruments used in data collection, and time for carrying out the research.
Minutes/aide-mémoire of meetings between the linkers and the linking coordination	Details of the issues addressed in the meetings on the linking strategy	29	Barriers encountered by users in the Basic Health Units (UBS) in Curitiba; barriers found in the COA; difficulties identified by linkers in the linking process.
Cooperation Agreement interim and annual reports	Information on the development/progress of the AHA project	5	Data from the testing and linking process, communication and information materials used, results achieved, progress and challenges of the AHA project.
User/Linker Registration Forms	Record of each contact made between the linker and the user	73	Barriers encountered by users in each process: registration at the UBS, appointment, test scheduling, medication pick-up, among others.
Supervisory visit reports	Details of the situations observed in the COA	8	Relationships between COA professionals and project professionals, service to users, and COA structure.
Project 'Agora é a Hora' (The Time is Now) evaluation report	Project implementation assessment report	1	Satisfaction survey with COA users carried out in 2016; positive and negative points of the COA from users' perspective (interviews conducted in 2016), main findings according to the critical variables of implementing the AHA project.

Categories of analysis	Questions	Informants
Barriers for MSM	What are the main barriers MSM users may encounter when looking for the COA?	All users and health professionals
Barriers for MSM	In your opinion, what is the most significant barrier to reaching MSM in Curitiba?	All users and health professionals
Testing barriers	Can you describe some of the reasons why MSM may choose not to be tested for HIV?	All users; health professionals and managers
Treatment barriers	What do you consider the main barrier for a user (MSM) diagnosed with HIV+ not to start treatment?	HIV+ users and health professionals

	Managers and COA professionals	Users
Intentional selection characteristics	COA health professionals (including superintendence, district management, and local coordination)	Took the test in the last six months at the COA
Intentional selection characteristics	Professionals hired by the AHA Project	Never took the test
Inclusion criteria	Held current position for at least six months	Self-identifies as MSM
	Held current position for at least six months	Lives in Curitiba
	Accepting to participate in the research (Informed Consent Form)	Above 18 years
		Accepted to participate in the research (Informed Consent Form)
Exclusion criteria	COA professional who does not serve the project population (e.g., doctors and administrative staff)	Does not self-declare as MSM
Exclusion criteria		Transvestite/transexual
Interviews realized	Two managers	Seven HIV+ users
	Seven professionals	Six HIV– users
	Total: 9	Total: 13

ACCESS BARRIERS
Barriers for MSM	Professionals and managers mentioned the opening hours as the main barrier for MSM in the COA, besides lack of staff
	To reach the MSM in Curitiba, professionals and managers mentioned: access, humanization, lack of trained human resources in services, prejudice
	To reach the MSM in Curitiba, users mentioned: lack of information, fear, homophobia, shame. Reagent users cited: fear, prejudice, shame
Testing barriers	Per the view of professionals and managers: prejudice, lack of access (suburbs), reception difficulty in health services, accepting sexuality, opening hours of the COA, lack of trained staff at the COA
	Users pointed out as barriers: lack of trained professionals; time to take the test; difficult access; fear of suffering prejudice; fear of exposure; fear of the result; shame
	HIV+ users cited: fear, prejudice, stigma, lack of information
Treatment barriers	The professionals mentioned: denial of the diagnosis, issue of accepting their sexuality, prejudice, religious issue, lack of financial resources (money for transportation, for example)
Treatment barriers	HIV+ users mentioned as barriers: fear of medication, side effects; lack of information, shame and when someone wants to ‘give up on life’

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E-mail: revista@saudeemdebate.org.br

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[1] Collaborators

Cota VL (0000-0002-6823-9304)^* * Orcid (Open Researcher and Contributor ID). contributed to the design, planning, analysis, interpretation of data, elaboration of the draft, critical review of the content, and approval of the final version of the manuscript. Cruz MM (0000-0002-4061-474X)^* * Orcid (Open Researcher and Contributor ID). contributed to the design and planning, critical review of the content, and approval of the final version of the manuscript.