Cultural and clinical challenges in sexual health care provision to men who have sex with men in Tanzania: a qualitative study of health professionals’ experiences and health students’ perspectives

Abstract

Background Health care providers across sub-Saharan Africa continue to face challenges while delivering sexual health care services. We explored the experiences, views and challenges of health care professionals and health students across different disciplines in Tanzania, towards delivery of sexual health services to men who have sex with men. Methods Utilizing a qualitative approach, we recruited 121 health care professionals (providers) and students from the fields of midwifery, nursing and medicine in Dar es Salaam, Tanzania. We conducted 18 focus groups discussions, stratified by profession and experience, to investigate clinical management and challenges while addressing a case of an adult male presenting with rectal gonorrhea. Results Findings indicated this case as extremely sensitive, clinical management involved establishing rapport and consent, medical care from history taking to treatment, and referral to other specialties. However, the illegal status of homosexuality in Tanzania was a primary concern to participants, this triggered the clinical care of this case scenario as challenging. There were uncertainties whether or not that such a case should be reported to the authorities. Conclusion Findings from this study revealed a need for training health students in Tanzania to address sexual health issues including accurate information on homosexuality, reporting requirements and clinical management in the legal and socio-cultural context of the African continent.

“We must help them despite who they are…”: Healthcare providers’ attitudes and perspectives on care for tertiary student men who have sex with men in Nairobi, Kenya

“…Though some HCPs demonstrated knowledge and ability to address the health needs of TSMSM (such as anal STIs), other HCPs indicated they had never "heard of anal STIs in college". The lack of pre-service training on the health needs of non-heterosexual individuals and how to respond to these needs was reported in the current study, and has also been observed in other studies in Kenya, Uganda and Tanzania (47)(48)(49). Evidence from Kenya and South Africa suggests that sensitization and training reduces homo-prejudice and improves knowledge and skills of HCPs (46, [50][51][52], and should hence be considered for adoption and scale-up among HCPs in tertiary academic institution-based health facilities.…”

Tailoring a sexual health curriculum to the sexual health challenges seen by midwifery, nursing and medical providers and students in Tanzania

“…As detailed in Table 1 37 , there were 60 experienced healthcare providers, including 11 men and 49 women. Their ages ranged from 24 to 62 years, and had, on average, 15 years of clinical experience.…”

“…The methods for this study have been published elsewhere. 37 To summarise, we utilised a stratified three (profession: midwifery, nursing, medicine) by two (experience: clinicians vs students) design. The main objective was to assess and compare how providers address sexual health concerns across professions and by experience (providers vs students) in order to identify curriculum priorities.…”

Prevalence of and factors associated with anal high-risk human papillomavirus in urban Tanzanian men who have sex with men, 2011-2012

“…Details of study activities have been previously described. 14 Briefly, given the highly stigmatized and criminalized nature of homosexuality in Tanzania at the time of the study and to the present, 15 MSM were recruited using respondent-driven sampling (RDS) which provided access to MSM utilizing established networks of friends and acquaintances. Five initial respondents were contacted in Dar es Salaam and these persons referred up to 3 persons each using study coupons.…”