Utilization of Sexually Transmitted Infection Health Care Services among Men Who Have Sex with Men in Nairobi City County, Kenya
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Date
2024-01
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Kenyatta University
Abstract
Men who engage in same-sex relationships face a higher risk of contracting sexually transmitted infections (STIs). This heightened risk is attributed to engaging in unprotected receptive anal sex and reluctance to disclose their sexual orientation and associated behaviours to healthcare workers (HCWs). This lack of disclosure complicates clinical decision-making for HCWs, hindering their ability to offer appropriate STI treatment and prevention services. To enhance MSM utilization of STI healthcare services, open communication about their high-risk practices with HCWs is essential. In turn, they can learn risk reduction measures and access STI prevention and treatment options. However, on the contrary, MSM doesn't do this due to various reasons. This study aimed to explore how MSM in Nairobi City County utilize the STI health services, focusing on MSM hotspots within the County. The research employed a cross-sectional study design incorporating both quantitative and qualitative data collection methods. A systematic sampling approach involved 404 respondents, and in-depth interviews were conducted with five key informants selected through a purposive sampling of public health facilities and MSM health provider sites. Descriptive, bivariate, and multivariate analysis was used to analyse quantitative data from the study survey using SPSS version 25 while qualitative data from key informants was analysed thematically using Nvivo version 11. Demographically, the majority of the participants were Kenyans, youth, single, and Christians. Their level of education ranged from primary to post-secondary, more than half were employed and their income ranged from Kshs <5000 to >15,000. A significant relationship was found between participants history of having ever contracted STIs (p=0.000, aOR=6.58, 95%CI 3.38-12.82). Knowledge assessment of participants revealed that 49.4% scored below 50.0%. However, participant’s knowledge score was not correlated with utilization of STI health care services. Seventy- four percent of the participants had sought sexual healthcare services within the past 12 months, with 99.0% self-reporting HIV testing. Over half (54.9%; 223) had accessed services from NGO programs and privacy they offered was correlated with utilization of STI health care services (p=0.042, aOR=1.86, 95% CI 1.02-3.37). In-depth key informant interviews highlighted health and legal system factors as the major facilitators, while health system factors, MSM individual factors, referral challenges, and political system were identified as barriers to utilizing sexual healthcare services. In conclusion, the study found low STI knowledge among participants and they sought STI healthcare services when they were infected. This is an indication that there is a need for the participants to be educated about STIs and have routine check-ups. Stigma and discrimination are the root cause of challenges faced by MSM. This emphasizes the importance of training and sensitization for all HCWs. Also, the community needs to be sensitized to avoid instances where MSM hesitate or delay to seek STI healthcare services.
Description
A Research Thesis Submitted in Partial Fulfillment of the Requirements for the Award of the Degree of Master of Public Health (Epidemiology & Disease Control) in the School of Health Sciences of Kenyatta University January 2024
Supervisors:
1. Justus O.S Osero
2. Meshack Onyambu