Attitude shifts and knowledge gains: Evaluating men who have sex with men sensitisation training for healthcare workers in the Western Cape, South Africa

Abstract

BackgroundMen who have sex with men (MSM) in South Africa experience discrimination from healthcare workers (HCWs), impeding health service access.ObjectivesTo evaluate the outcomes of an MSM sensitisation training programme for HCWs implemented in the Western Cape province (South Africa).MethodsA training programme was developed to equip HCWs with the knowledge, awareness and skills required to provide non-discriminatory, non-judgemental and appropriate services to MSM. Overall, 592 HCWs were trained between February 2010 and May 2012. Trainees completed self-administered pre- and post-training questionnaires assessing changes in knowledge. Two-sample t-tests for proportion were used to assess changes in specific answers and the Wilcoxon rank-sum test for overall knowledge scores. Qualitative data came from anonymous post-training evaluation forms completed by all trainees, in combination with four focus group discussions (n = 28) conducted six months after their training.ResultsFourteen per cent of trainees had received previous training to counsel clients around penile–anal intercourse, and 16% had previously received training around sexual health issues affecting MSM. There was a statistically significant improvement in overall knowledge scores (80% – 87%, p < 0.0001), specifically around penile–anal intercourse, substance use and depression after the training. Reductions in negative attitudes towards MSM and increased ability for HCWs to provide non-discriminatory care were reported as a result of the training.ConclusionMSM sensitisation training for HCWs is an effective intervention to increase awareness on issues pertaining to MSM and how to engage around them, reduce discriminatory attitudes and enable the provision of non-judgemental and appropriate services by HCWs.

‘We must treat them like all the other people’: Evaluating the Integrated Key Populations Sensitivity Training Programme for Healthcare Workers in South Africa

“…For the purposes of this article, we use the word ‘sensitisation’ to refer to the process of increasing knowledge of an issue to instil empathy, nurture a ‘sensitive’ disposition shaped by increased awareness, and modify negative attitudes and behaviour, with the intention of reducing discrimination and inequality. 23,24 Sensitisation training can challenge negative beliefs and shift attitudes through providing factual information, enable individuals to engage emotionally and reflect upon and examine their personal attitudes and beliefs, and encourage positive behavioural intentions through role plays and practical exercises. 25,26 Evidence from a European context indicates that reductions in structural discrimination and homo-negativity require a multilevel intervention approach, one component of which is enabling changes in attitudes and practices amongst individuals, groups and institutions.…”

“…28,31 Local and regional qualitative research evidence on the effects of sensitisation training for healthcare workers comes from interventions focusing on MSM. 24 Published data on the outcomes of similar sensitisation training addressing the needs of PWUD and sex workers were not available at the time of writing.…”

Stigma and healthcare access among men who have sex with men and transgender women who have sex with men in Senegal

“… 35 – 38 Provider education interventions throughout SSA have been found to significantly improve sexual health knowledge regarding MSM and reduce discriminatory and homophobic fallacies among providers. 39 , 40 Providers also reported that educational training programs helped raise awareness of psychosocial vulnerabilities in relation to discrimination and sexual behavior stigma within medical settings, 41 , 42 as well as social and behavioral risks of HIV among MSM. 42 However, there is variation noted in the impact of these types of trainings, with a common finding being an immediate improvement in self-reported acceptability of sexual and gender minorities by clinical providers that decays over time.…”

Healthcare worker training to improve quality of care for sexual and gender minority people in sub‐Saharan Africa: learning from efforts in Uganda

“…Evaluation of the initiative is currently underway, including data collection on processes of training and capacity building, outcomes related to programmatic and service improvements, impact on HIV‐related clinical outcomes and qualitative interviews to further elucidate facilitators of and barriers to implementation. While results from Uganda are forthcoming, previous evaluations of SGM health‐focused training programmes in sub‐Saharan Africa offer encouragement: healthcare worker trainings in both Kenya and South Africa on sexual health needs of MSM were associated with increases in the necessary knowledge and decreases in negative attitudes [50‐52].…”