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

Abstract

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