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

Abstract

Background: Same-sex attracted men in Tanzania are disproportionately affected by HIV. Drawing on qualitative research, the present study explores healthcare providers’ perspectives on access to HIV-related healthcare services among same-sex attracted men. Methods: A qualitative study was carried out among healthcare workers in in the cities of Dar es Salaam and Tanga in Tanzania between August 2018 and October 2019. Fieldwork entailed qualitative interviewing, focus group discussions and participant observation. A purposive sampling strategy was used to select study participants who varied with respect to age, education level, work experience, and the type and location of the facilities they worked in. Twentyfour interviews and six focus group discussions were conducted. Results: This paper describes four different discourses that were identi􀂦ed among healthcare workers with respect to their perception of access to healthcare services for SSAM. One held that access to healthcare was not a major problem at all, another that some SSAM did not utilize healthcare services although they were available, a third that some healthcare workers prevented SSAM from gaining access to healthcare and a fourth that healthcare for gender and sexual minority persons was made di􀂨cult by structural barriers. Conclusion: Although these are four rather different takes on the prevailing circumstances with respect to healthcare access for SSAM, we suggest that they may all be ‘true’ in the sense that they grasp and highlight different aspects of the same realities.