A comparative appraisal of access and quality of sexual and reproductive health services for gays and lesbians in Bulawayo (Zimbabwe) and Pretoria (South Africa)

This study investigated the extent to which gays and lesbians access quality sexual and reproductive health (SRH) services in Pretoria and Bulawayo. The study also examines the facilitators and barriers for accessing the same services. Theoretically, the study was grounded in the Health Belief Model (Hochbaum, 1958, modified by Rosenstock, 1974 and Siddiqui, 2016). To answer the research questions, a mixed methods approach was applied involving both qualitative and quantitative data collection methods. A total of 30 key informant interviews, eight focus group discussions and 387 questionnaires were administered using purposive, time location and snowball sampling approaches in the two cities. The study found that the most commonly available sexual and reproductive health (SRH) services were contraceptive services, sexually transmitted infections (STI) services and Human immunodeficiency syndrome (HIV) services. The services were provided at public health facilities, drop-in centres and through outreach activities operated by Civil Society Organizations (CSOs). The least available services that gays and lesbians required as part of a comprehensive package were access to information, education and communications (IEC) materials and mental health and psychosocial support services (MHPSS). Several service providers were not adhering to the World Health Organization (WHO) guidelines for provision of comprehensive services for key populations including gays and lesbians. Critical gaps noted included the absence of key populations-only service hours, lack of options for clinicians to attend to them, presence of a stigma and discrimination free environment and provision of comprehensive package of services under one roof. Most of the referral facilities had limited drugs, equipment and supplies for cancer screening and they had no HIV prevention, sex change, in-vitro fertilization, and sterilization services and procedures. The quality of physical facilities and SRH services in both cities did not meet the expectations of gays and lesbians, acting as a barrier to their health seeking behaviour. Stigma and discrimination from healthcare workers was a huge barrier affecting access across all public health facilities. The acts of stigmatisation and discrimination affected the perceptions that gays and lesbians had regarding the quality of the services and compromised access of the same. In view of these health system challenges, the study recommends that there is need for public authorities in both cities to address the bottlenecks and barriers affecting access to SRH services and products such as lubricants, affordable quality condoms, dental dams and latex gloves while reinforcing the facilitating factors promoting access. Healthcare workers need further training on how to provide comprehensive services for gays and lesbians according to the WHO guidelines. Public health authorities in Bulawayo and Pretoria should build upon the identified factors which facilitated the access to SRH services and use of products such as condoms and lubricants. These factors require strengthening of community-based organizations and networks that work directly with gays and lesbians in both Bulawayo and Pretoria.Thesis (PhD) -- Faculty of Social Sciences and Humanities, 202

A comparative appraisal of access and quality of sexual and reproductive health services for gays and lesbians in Bulawayo (Zimbabwe) and Pretoria (South Africa)

This study investigated the extent to which gays and lesbians access quality sexual and reproductive health (SRH) services in Pretoria and Bulawayo. The study also examines the facilitators and barriers for accessing the same services. Theoretically, the study was grounded in the Health Belief Model (Hochbaum, 1958, modified by Rosenstock, 1974 and Siddiqui, 2016). To answer the research questions, a mixed methods approach was applied involving both qualitative and quantitative data collection methods. A total of 30 key informant interviews, eight focus group discussions and 387 questionnaires were administered using purposive, time location and snowball sampling approaches in the two cities. The study found that the most commonly available sexual and reproductive health (SRH) services were contraceptive services, sexually transmitted infections (STI) services and Human immunodeficiency syndrome (HIV) services. The services were provided at public health facilities, drop-in centres and through outreach activities operated by Civil Society Organizations (CSOs). The least available services that gays and lesbians required as part of a comprehensive package were access to information, education and communications (IEC) materials and mental health and psychosocial support services (MHPSS). Several service providers were not adhering to the World Health Organization (WHO) guidelines for provision of comprehensive services for key populations including gays and lesbians. Critical gaps noted included the absence of key populations-only service hours, lack of options for clinicians to attend to them, presence of a stigma and discrimination free environment and provision of comprehensive package of services under one roof. Most of the referral facilities had limited drugs, equipment and supplies for cancer screening and they had no HIV prevention, sex change, in-vitro fertilization, and sterilization services and procedures. The quality of physical facilities and SRH services in both cities did not meet the expectations of gays and lesbians, acting as a barrier to their health seeking behaviour. Stigma and discrimination from healthcare workers was a huge barrier affecting access across all public health facilities. The acts of stigmatisation and discrimination affected the perceptions that gays and lesbians had regarding the quality of the services and compromised access of the same. In view of these health system challenges, the study recommends that there is need for public authorities in both cities to address the bottlenecks and barriers affecting access to SRH services and products such as lubricants, affordable quality condoms, dental dams and latex gloves while reinforcing the facilitating factors promoting access. Healthcare workers need further training on how to provide comprehensive services for gays and lesbians according to the WHO guidelines. Public health authorities in Bulawayo and Pretoria should build upon the identified factors which facilitated the access to SRH services and use of products such as condoms and lubricants. These factors require strengthening of community-based organizations and networks that work directly with gays and lesbians in both Bulawayo and Pretoria.Thesis (PhD) -- Faculty of Social Sciences and Humanities, 202

Zimbabwe (2013): Qualitative Segmentation Study on Cervical Cancer Screening Behaviors among Women aged 30 Years and above in Zimbabwe

The PSI Zimbabwe program seeks to promote cervical cancer screening behaviours through planning and implementation of screening programs at community level. Cervical cancer screening is a generally new service. Thus, raising knowledge and awareness, communicating the benefits and improving the availability of services is important to increase demand and uptake of services. However, very little is known about the existing barriers and facilitating factors. This study a imed to help answer numerous questions around the creation of appropriate communications for increased uptake of the promoted behaviour. Through this qualitative investigation, PSI/Zimbabwe sought to gain an in-depth understanding of knowledge levels on cervical cancer screening. The results of this study will inform a communication strategy that seeks to create awareness of the health problem and thereafter shape marketing plans for demand creation. An exclusively qualitative approach using in-depth interviews was adopted among women aged 30 - 49 years and women living with HIV of any age above 18 years. Twenty females over 30 years of age, and those of any age above 18 years if HIV positive, were purposively selected to participate in the study. Ten (10) of them had been previously screened using Visual inspection using acetic acid (VIA) at least once and ten (10) had never been screened before. Three (3) of those ever screened were HIV positive. Participants were drawn from Harare, Bulawayo, Chiredzi and Mazowe. Trained moderators/interviewers were involved in the recruitment study participants. Data analysis used the nine codes of the qualitative segmentation framework. Outputs of the study included a frequency intensity chart, code summaries and the dashboard

Zimbabwe(2012): Qualitative Segmentation Study on Water Treatment Behavior in Zimbabwe using WaterGuard among Caregivers aged 15-49 years in Zimbabwe

The Hygiene Promotion and Home-Based Water Treatment program in Zimbabwe carries out mass media and interpersonal hygiene behavior change communications in order to increase correct and consistent point of use water treatment among among Caregivers aged 15-49 years in rural and urban Zimbabwe. The study also seek to increase correct and consistent hygienic practices among target population (hand washing and stool disposal). Designing the concept for a social marketing activity requires familiarity with the target audience and the context in which behavior change takes place. The purpose of this qualitative study was to provide information that can be used to inform PSI/Zimbabwe’s Hygiene Promotion and Home-based Water Treatment interventions, particu larly in the development of messages, and campaign personality for point of use water treatment using WaterGuard. A photo narrative approach, including in-depth interviews, was used to collect data from Twenty four caregivers (4 Males and 20 Females) that were purposively selected to participate in the study

Zim (2013): VMMC Pretest February Campaign among women and men aged 15-49 years in Zimbabwe.

PSI intends to run some mass media campaigns to increase knowledge of male circumcision and motivate men to access the service. The campaign will also target female partners to encourage them to persuade their partners to go for male circumcision so that they are protected from cervical cancer. PSI would like to pre-test the campaign adverts before rolling them out. Main Research objectives (Pre-test) 1.Examine audience comprehension of messages contained in executions. In particular, examine understanding and meaning to the target audience. 2.Explore audience likes/dislikes of the execution 3.Evaluate emotional reaction to the message. 4.Evaluate the credibility, relevance, and appropriateness of executions content and messages to target audience. 5.Determine audience's preferred message and suggest any necessary changes. 6.Determine if the message will persuade the target audience to go for circumcision Target Audience and Geography -15 - 18 year old males residing in rural and urban areas (Harare, Mashonaland East & Masvingo). -19 - 25 year old males and females residing in rural and urban areas (Harare, Mashonaland East & Masvingo). -26 - 35 year old males and females residing in rural and urban areas (Harare, Mashonaland East & Masvingo). The respondents will first conduct an individual assessment of the adverts and then participate in a group discussion to discuss their ratings

Zimbabwe (2013): TRaC Study Evaluating Knowledge on Hygiene Promotion and Point-of-use Water Treatment Behaviors amongst Population Aged 15 - 59 years, in Zimbabwe. Round [3].

PSI/Z conducted a cross sectional population based survey in December 2013. The main objectives of this study were to answer the following Monitoring: What are the levels in the practice of key behaviors (water treatment, hand washing and stool disposal practices), risk, OAM constructs, and exposure to PSI/Zimbabwe activities? and Evaluation: Is exposure to PSI/Zimbabwe activities leading to changes in OAM, risk, water treatment behaviors? The study population for this survey included men and wo men ages 15-59 years in rural and urban Zimbabwe. A total of 2294 respondents were recruited for this study. Participants were recruited by trained interviewers through door to door visits. The study sample was selected in two stages. In the first stage, enumeration areas (EAs) were randomly selected using probability proportionate to size. EAs are geographic areas used for sampling purposes. In the second stage, households within the selected EAs were selected using simple random sampling. In households where more than one eligible respondent was available, a respondent was randomly selected using the Kish grid method. A structured questionnaire was used to collect data on practice of the key behaviors. Data were analysed using SPSS (Versions 20 and 21) and a separate module for Coarsened Exact Matching (CEM) and results were presented in PSI dashboard format. The analysis involved descriptive statistics for key program indicators using unianova, to examine trends over time. Results of this study will be used to develop interventions and communications for the Zimbabwe Hygiene Promotion and Home-based Water Treatment program

Zimbabwe (2011): Qualitative Segmentation Study on Male Circumcision among men aged 15-49 in Zimbabwe

PSI Zimbabwe began operating in Zimbabwe in 1996 with a social marketing program for male condoms. To date PSI's portfolio has grown to include a range of HIV services, products and behavior change communications. HIV products include male and female condoms, a range of family planning products, malaria insecticide treated nets and water treatment products. Communications range from behavior change to demand creation for products and services. HIV services delivery include HIV testing and counseling; Post-test Services; and male circumcision. Male circumcision is a recently introduced service by PSI Zimbabwe. The platform recently got funding for scaling up male circumcision services for the next 5 years. PSI/Z seeks to create demand for this service among men in Zimbabwe and plans to undertake research on the existing beliefs, attitudes a nd understanding of male circumcision prior to designing and implementing a male circumcision promotion campaign. The current 5 year program seeks to circumcise about 250,000 men. Between January and February 2011 PSI conducted a FoQus for QS study to gather information in the above-mentioned areas. A photonarrative approach, including in-depth interviews, was used to collect data. This method was chosen for its ease of use and the richness of data produced when photos accompany narratives. Photos allowed study participants to choose what to photograph and, as a result, produced data that is driven by what is important to members of the target audience. Photo narratives allow study participants to describe their experiences both verbally and visually, presenting another means by which to understand their lives. These methods allow researchers (and marketers) to make an emotional connection with the target audience. Storytelling is a fundamental human way of relaying information, so data collection feels more natural to both moderators and participants

Zimbabwe (2013): Qualitative Segmentation Study on Family Planning among women and men aged 18-49 years in Zimbabwe

The PSI Zimbabwe program seeks to promote the use of long-acting reversible contraceptive methods as a means of reducing unintended pregnancies in the country. However, very little is known about the barriers and facilitating factors towards the uptake of long-acting and permanent family planning methods. Against this backdrop, the purpose of this study was to examine factors that motivate and or inhibit women to use long term methods of family planning. In addition the study seeks to profile users of these methods so as to effectively target women in Zimbabwe. Thi s is a qualitative study with in-depth interviews among adult men and women 15 to 49 years. Both users and non-users of family planning methods were purposively selected in urban and rural Zimbabwe to participate in this study

Zimbabwe (2014): Qualitative Segmentation Study on Condom Use among Women and Men Aged 15-49 Years in Zimbabwe.

PSI/Zimbabwe is implementing a Multi-year USAID and DFID funded HIV prevention program targeting sexually active Zimbabwean men and women ages 15-49 years. The program goal is to reduce HIV incidence and the impact of HIV and AIDS on Zimbabweans. The aim of this study was to identify motivators and barriers to consistent condom use among adults 15 to 49 years: Specifically, the study objectives were to: Identify factors explaining consistent condoms use; Build one or more profiles that portray the characteristics of condom users and non-users; Identify current strategies used by men and women to overcome obstacles to correct and consistent condom use; Describe how to get information to target audience; Describe men and women past experiences with condom use and alternative behaviours; Understand how men and women perceive adopters and non-adopters of condom use behaviour. This study was conducted among men and women age 15- 49 years residing in both rural and urban areas in Zimbabwe. Twenty four (24) respondents were purposively selected to participate in the study, eight (8) being men and sixteen (16) being women. An exclusively qualitative approach using in-depth interviews was used to collect data in one on one audio recorded qualitative interview. Trained moderators/interviewers recruited study participants, in collaboration with PSI care and Protector Plus (PP) sales agents who would use their records to identify potential participants

Zimbabwe 2013: TRaC Study Evaluating Knowledge on HIV, Family Planning and Voluntary Medical Male Circumcision amongst Population Aged 15 - 49 years, in Zimbabwe

PSI/Z conducted a cross sectional population based survey in (February and March 2013). Male and female respondents aged 15-49 years were randomly sampled from households in both urban and rural areas. The study sample was selected in two stages. In the first stage, enumeration areas (EAs) were randomly selected using probability proportionate to size . EAs are geographic areas used for sampling purposes. In the second stage, households within the selected EAs were selected using simple random sampling. In households where more than one eligible respondent was available, a respondent was randomly selected using the Kish grid method.The main objective of this study is to add to the body of knowledge on HIV, Family Planning, and Voluntary Medical Male Circumcision. Analysis was performed using SPSS version 16 and results presented in PSI Dashboard format. This TRaC will provide evidence for monitoring and evaluating implementation of PSI Zimbabwe's HIV prevention and risk reduction program, Family Planning (FP) and also segmentation for the Voluntary Medical Male Circumcision (VMMC) interventions. This information will be used to develop interventions and communications for the interventions