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Citation Information

Type Thesis or Dissertation - Master of Health Management
Title Utilization on HIV services among men-who-have-sex-with men in Nairobi County, Kenya.
Author(s)
Publication (Day/Month/Year) 2016
Abstract
The new constitution promulgated in 2010 clearly state every Kenyan without
discrimination is entitled to the highest attainable quality of health care, which is not
reflected with the current challenges men-who-have-sex with- men continue to face in the
sexual health service utilization. Kenya struggles in its response to this ongoing crisis
amongst MSM in many areas including disease prevention, treatment, and HIV related
stigma, prejudice, and discrimination. Currently little information is reported on MSM
health services utilization. The wider spread of STIs including HIV beyond the MSM
community is real hence need for urgent intervention. Therefore, the overall aim of this
study was to assess HIV services utilization among MSM in Njiru Sub-County, Nairobi
County. This study used a descriptive cross-sectional study design employing both
quantitative and qualitative methods of data collection. Snowballing sampling technique
was used to sample 149 respondents who participated in this study while purposive
sampling design was used to select and interview 15 key informants. Descriptive, chisquare
and binary regression was used to analyze quantitative data from study survey
using SPSS while qualitative data from key informants was analyzed thematically using
Nvivo. On utilization, findings revealed that 86% of MSM had sought HIV services
within the last 6 months. Self-reported HIV prevalence rate among MSM was 53%. On
patterns of utilization, NGOs programs and outreaches were the most preferred centers
due to their user-friendliness. In relation to knowledge, 86% of MSM had correct
knowledge on HIV transmission and prevention. There was a statistically significant
relationship between access to health information on transmission and prevention of
HIV/AIDs (p=0.001) and utilization of HIV services. In terms of sexual behavior, 67%
of the MSM had engaged in unprotected sex with about 63% of MSM engaging in sex for
a pay. There was a statistically significant relationship between exposure to unprotected
sex (p=0.010), regular use of condoms during sex (p=0.05), involvement in sex for a pay
(p=0.021) and utilization of HIV services. In relation to health system factors, about 50%
of MSM had experienced stigma, discrimination and dismissive attitude from health staff
when seeking HIV services. There was a statistically significant relationship between
denial of services based on sexual orientation (p=0.001), mistreatment by health staff
(p=0.043), experience of discrimination at service delivery points (p=0.025),
discrimination by community members (p=0.025), awareness of anti-same sex laws
(p=0.004), privacy and confidentiality (p=0.022), friendliness of health staff (p=0.001),
access to adequate HIV/AIDs information (p=0.036), perceived quality of HIV services
(0.032) and utilization of HIV services. In conclusion, there was a high HIV prevalence
rate among MSM partly due to their risky sexual behaviours. There is a high risk of
vertical and horizontal HIV transmission among the group due to existence of multiple
male and female sexual partners. Currently, MSM are facing increasing stigma,
discrimination and dismissive attitude which limit their ability to demand and utilize HIV
services. Therefore, there is need to enhance programs which advocate and promote safe
sexual behaviours among MSM, reduce stigma and discrimination of MSM to enhance
their willingness to use HIV services

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