2. Factors Contributing To Delay In Key Populations Seeking Health Services: A Qualitative Study In Ghana By
Abdulai Marijanatu
Quaye Silas, Kenu Ernest, Baddoo A. Nyonuku, Chandi G. Margaretta, Danso A. Kenneth & Ayisi Addo Stephen
Thursday
10th May, 2018

3. Outline Background Objective Methodology Results Conclusion
Recommendations

4. Background-1
Men who have sex with men (MSM) and female sex workers (FSM) are key populations (KP) with higher risks of STI and HIV infection
Delays and inappropriate health seeking behaviours by KPs for STI and HIV services may result in lower or adverse health outcomes
Identifying factors that hinder health seeking among KPs will significantly help in programming

5. Study Objective General Objective
To qualitatively assess client-level barriers and facilitators to HIV testing, enrolment, and retention in HIV care and treatment among FSW and MSM in the Greater Accra and Kumasi metropolitan areas
Specific Objective
To identify factors that contribute to delays in health seeking behaviours among KPs in two major cities in Ghana (Accra and Kumasi)

6. Methods 1/2
Study Type
Qualitative method using descriptive phenomenology approach
FGDs – 24
IDI - 90
Target population
FSW
MSM
NGOs providing KP services
GHS staff providing HIV Related services
Sampling method
Purposive method was used to recruit participants

7. Methods- 2/2 Recruitment and Eligibility
Peer educators, NGO and GHS staff, and word-of-mouth through other study participants
Potential KP participants were those who self-identified as either FSW or MSM, were 18 years or older and had consented to participate in the study
Data collection and Analysis
All interviews were conducted using an interview guide
Recorded interviews was transcribed verbatim
NVivo 11 was used to analyse the data

8. RESULTS

9. Background characteristics of the participants in the qualitative study
FGDs
( N=198)
Percentage(%)
IDI
(N=90)
 Percentage(%)
Sex
Male 97
49.0 47
52.2
Female
101
51.0 43
47.8
Age
129
65.2 37
41.1
28-39 51
25.8 26
28.9
38-49 15
7.6 11
12.2
48-59 3
1.5 6
6.7
Marital Status
Single
160
80.8 53
58.9
Married 29
14.6 20
22.2
Cohabiting
0.0
Divorced 9
4.5 17
18.9
Education
No education 2
2.2
Primary 39
19.7 7
7.8
JHS/SSS 91
46.0 36
40.0
Vocational
Tertiary 50
25.3

10. Reasons given by KPs for delaying Health Seeking
Reasons given by MSM
Uncomfortable with a doctor who was caring for me
Afraid and shy of myself
Was asked to bring my partner which I couldn’t do
Prefer herbal medicine
Taking so many drugs is tiring
Reasons given by FSW
Lack of money
Shy to disclose HIV status
Afraid of stigmatization
The illness makes you very weak
Prefer to go to work
Due to laziness
Fear of being told of a problem
Don’t want to miss a client
Illness not serious
They frown at you in the hospital
Discrimination at the hospital

11. Reasons Given by Service Providers
Lack of money to run some laboratory investigations e.g CD4,BUE&Cr
Resort to herbal medications
Resort to spiritual interventions
Lack of time especially the FSW
Distance
Most feel healed after a few months of starting ARVs

12. Quotes from KPs on why they delay in seeking Health
“The laboratory investigations like CD4 count, liver function test are too expensive ” – (MSM, Accra).
“How they talk about it scares us so we don’t go for health Care” – (MSM, Kumasi).
“Some of the nurses the moment they know you are MSM, they will start preaching you that how can a man sleep with a fellow man, are you not a Christian? – (MSM, Accra).
“I delayed because of the side effect of the medication” – (FSW, Kumasi).

13. Quotes from KPs on why they delay in seeking Health
“Many drink and smoke marijuana so they don’t remember HIV care enrolment” – FSW Kumasi
“Sometimes you are spoken to harshly by the nurses so that put you off from going for treatment” MSM, Accra
“Some delay in going for medical appointments because of long queues.”- FSW Kumasi
“Some people believe that once you get the disease, you are going to die so there is no need for care”- (MSM, Kumasi).

14. Quotes from IDI Interviews from Service Providers
“Because of the stigma attached to KP’s, most of them don’t want to come in at the clinical hours, they prefer to come in at odd hours and we overstay to handle such cases as they will normally come in after everyone is gone” (Service Provider- Kumasi)
“Some of the clients after few months of starting ARVs, they feel they look better so they resort to spiritual remedies and are eventually brought back in critical conditions”(Service Provider- Accra)
“I have an FSW client who is always defaulting her reason is simple I don’t want to miss a client when I visit the hospital”(Service Provider-NGO)

15. Conclusions and Recommendations
Factors such as misconception about HIV transmission, stigma and discrimination by service providers, and financial constraints were identified as the major factors that cause delays in health seeking among FSW and MSM
Recommendations
It is important that GHS put in measures to ensure privacy and confidentiality in the delivery of HIV services at its facilities to enhance compliance to care by KPs
The GHS should collaborate with policy makers so as to include the cost of laboratory investigations for PLHIV in the NHIS package.

16. Acknowledgements Ghana Health Service/NACP CDC MICDAK WAPCAS
Dr Ernest Kenu
Margaretta Gloria Chandi
Mr. Daniel Kwablah
Mrs. Comfort Asamoah
Dr. Celia woodfill
Trista Bingham
Ijeoma Ugonna
Mr. Silas Quaye
Dr. Akosua Baddoo
Ms. Marijanatu Abdulai
Ms. Victoria Dafeamekpor
Mr. Francis Frimpong