Utilization of HIV services among men-who-have-sex-with men in Nairobi County, Kenya.
Kiplagat, Anthony Bundi
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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, chi-square 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