Health services we can trust: how same-sex attracted men in Dar Es Salaam, Tanzania would like their HIV healthcare to be organised

Abstract

Drawing on qualitative research in Dar es Salaam, Tanzania, this article explores how men who engage in sex with other men perceive their interactions with healthcare providers, and how they would prefer healthcare services to be organised and delivered. The paper describes the strengths and weaknesses men associate with private and public healthcare; the advantages and disadvantages they associate with dedicated clinics for sexual minority persons; what they conceive of as good healthcare services; and how they would characterise a good healthcare worker. The paper also presents recommendations made by study participants. These include the view that health services for same-sex attracted men should be developed and delivered in collaboration with such men themselves; that health workers should receive training on the medical needs as well as the overall circumstances of same-sex attracted men; and that there should be mechanisms that make healthcare available to poorer community members. We analyse men's views and recommendations in the light of theoretical work on trust and discuss the ways in which same sex attracted men look for signs that healthcare workers and healthcare services are trustworthy.

Not a Problem at All or Excluded by Oneself, Doctors and the Law? Healthcare Workers’ Perspectives on Access to HIV-Related Healthcare among Same-Sex Attracted Men in Tanzania

“…(As part of this research project, we also carried out research among same-sex attracted men themselves. Findings from this part of our work have been reported elsewhere 31 and will not be further discussed in this paper.)…”

“…Among the proposals put forward was that the general public should be encouraged to report men who have sex with other men to the authorities so that they could be corrected and/or punished. 42 Even when the central government distanced itself from this proposal, 31 it remained a topic that emerged in discussions between many of the healthcare workers who took part in this study. Some even wondered what might happen to themselves if they were provided services to same-sex attracted men, as also reported is a recent study by Sadgrove.…”

“…While there has been a dearth of studies focusing on how cost may act to block same-sex attracted men from care in Sub-Sahara Africa, a study from Malawi 32 pointed out that cost was a main barrier there, and that most MSM lacked health insurance. There has been limited research into the role costs play for access to care among same-sex attracted men in Tanzania, but in our own recent study among members of this population, 31 costs were portrayed as a major obstacle for reaching and utilizing healthcare services among poor same-sex attracted men.…”

“… 6 , 24 , 30 , 31 In our own recent study among same-sex attracted men in Dar es Salaam, some men said they would prefer to be served by healthcare workers who are themselves MSM since they would not be expected to stigmatize or discriminate, and because they would be expected to understand the healthcare needs and lived circumstances of men who have sex with men. 31 …”

The role of cultural safety and ethical space within postcolonial healthcare for Maasai in Tanzania

“…[90][91][92] In a study of a hard to reach community in Tanzania, men who engage in sex with other men, trustworthy health services were those that employed people from their community, have friendly staff and provide training to health workers on the lived realities of same-sex attracted men. 93 Maasai respondents did not articulate the issues of (mis)trust or unsafe spaces but in many instances identify other reasons for inadequate services such as an increased population and lack of resources. This may be due to a strong sense of hope.…”