Reducing Stigma by Health Providers
By Geoffrey Njenga
Nairobi,Kenya – It was a bright Wednesday morning; the sky was clear and the sun was slowly baking the grounds of Kenyatta University which was dotted with tents from different organisations. The students were marking International Condom Day on February 13th 2018. HIV services were being offered by different organisations in a bid to avert the increasing numbers of new HIV infections among youth and encourage condom use. Approximately 29% of all new HIV infections in Kenya are among adolescents and youth. Thirty percent of new HIV infections in adults are among youth below 24 years. Young women aged 15 – 24 years post the highest number of HIV infections and contribute 21% of all new infections in Kenya. Jilinde a Jhpiego led project is rolling out PrEP in Kenya as part of the combination prevention package and on this day, Jilinde was on site offering HIV testing and PrEP services.
For Elizabeth, a clinician at Mathare North Health Centre in Nairobi, this day was different than the ones she had done before as it involved students. As she was busy offering HIV testing and PrEP services a group of young men aged 19 came to the tent set up by Jilinde requesting for PrEP services. PrEP, a pill taken daily has proven to be an effective way of preventing HIV. It is used in combination with other HIV prevention strategies.
The young men were referred to Elizabeth who was more than happy to offer the services until her colleague mentioned that they are Men who have sex with Men (MSM).
For the first 10 seconds her face stuck in an incredulous expression, unblinking stare, she was desperately trying to make sense of it all, she was rendered speechless unable to comprehend what she had just been told. She sat there with the client as if paralyzed from the neck up. It was Elizabeth’s first encounter with MSM’s in her 8-year career in providing health services. “My thoughts were blocked. I dint know where to start or how to talk to the clients, since I was not prepared how to handle them. It was tough for me to handle them at first.” says Elizabeth.
The young men quickly noticed the shock in Elizabeth’s face and felt uneasy and were not willing to disclose why they were at high risk of HIV infection and in need of PrEP. “I judged them based on their sexual orientation because I did not understand why they had to be MSM at that young age”. Says Elizabeth.
Instead of focusing on offering PrEP services, Elizabeth was hard at work convincing them to reconsider their sexual orientation and asked inappropriate questions. For the young men they felt stigmatized by a health worker who should be helping them. Finally, the MSM’s were able to get the services they came for however they felt they did not receive quality services.
Many key populations who will potentially benefit from PrEP face barriers to healthcare through discrimination and stigmatisation. Healthcare providers, including clinical staff, and counsellors should be provided with the competencies to provide quality PrEP services.
Jilinde organized a PrEP sensitization training on key population sensitivity, clinical guidelines, counselling, and attitudes to promote uptake and retention of PrEP by creating a non-stigmatizing and supportive environment for key populations. Elizabeth together with other health care workers went through this training and were equipped with the knowledge, attitude, and skills to provide effective PrEP services to different people.
For Elizabeth, the training has enabled her provide better PrEP quality services and even helped her reach out to more key populations at high risk and in need of PrEP. “The training has enabled me to be better prepared and more relaxed even if it’s key population coming for services. I am confident of handling them respectfully.” says Elizabeth.
Since the incident she has offered PrEP services to an older MSM couple and was able to handle them well and follow up with them during their monthly revisits. She is now able to reach out to key populations at risk and encourage them to take up PrEP as part of combination prevention package to ensure holistic care.