Page 113 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 2 of 7 Original Research

and moralising views towards sex work, sex between people competencies towards serving MSM patients. 29,30 Evaluations
of the same sex, homosexuality and drug use are frequently of stigma reduction or sensitisation training programmes for
expressed within South African communities, and more healthcare workers addressing MSM, transgender or hijra
specifically by individuals working in the healthcare setting, and sex worker populations in India and Bangladesh found
warranting specific attention and address. 6,8,15,16 Public sector substantial positive effects of such training; trained
healthcare providers receive scant professional training to healthcare workers were more likely to exhibit positive, kind,
support key populations, as highlighted by a review of respectful and non-judgemental attitudes towards key
undergraduate training at one of South Africa’s medical populations. 28,31 Local and regional qualitative research
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schools. As such, healthcare workers lack the appropriate evidence on the effects of sensitisation training for healthcare
skills or knowledge necessary to be adequately equipped to workers comes from interventions focusing on MSM.
24
provide these much needed services. 5,6,18 Published data on the outcomes of similar sensitisation
training addressing the needs of PWUD and sex workers
In response, South African advocates, service providers and were not available at the time of writing.
researchers have identified the need for increased healthcare
worker awareness of the issues affecting key populations, Early key population training efforts in South Africa utilised
particularly in the context of HIV, and the need to build diverse training methodologies to reach healthcare workers
capacity to provide evidence-based, competent and with both sensitisation and medical competency training;
appropriate health services. 6,17,19,20 In the light of discrimination however, the training typically focused on individual
by service providers being identified as a major barrier to population groups. In 2013, several organisations
1
accessing health services, sensitisation training for healthcare collaborated to develop the ‘Integrated Key Populations
workers about key populations has been recommended to Sensitivity Training Programme for Healthcare Workers in
reduce stigmatising attitudes and behaviours towards clients, South Africa’ in partnership with the South African National
and thus reduce HIV transmission and incidence rates in Department of Health and the South African National AIDS
South Africa. The South African National Strategic Plan for Council to consolidate sensitisation training across
21
HIV, TB and STIs (2017–2022) states the objective to: population groups and improve training efficiency.
[i]nvest in expanding training and sensitisation programmes to
reduce stigma: Programmes [to] … protect those affected by HIV The training intervention
against discrimination and violence and to support access to HIV
prevention, treatment, care and support. In addition, human In 2013, ‘Healthcare Provision for MSM, Sex Workers, and
rights and ethics training will be provided for healthcare PWUD: An Introductory Manual for Healthcare Workers in
providers … [and] will strengthen the Batho Pele principles. 22 South Africa’ was developed. 32,2 The manual was developed
with the intention of improving healthcare workers’
For the purposes of this article, we use the word ‘sensitisation’ knowledge and awareness of health and related issues
to refer to the process of increasing knowledge of an issue to affecting key populations, and included topics relating to
instil empathy, nurture a ‘sensitive’ disposition shaped by social norms and values; human sexuality and sexual
increased awareness, and modify negative attitudes and behaviour; the legal and rights context, socio-structural
behaviour, with the intention of reducing discrimination and marginalisation and prejudice; and interventions to foster
inequality. 23,24 Sensitisation training can challenge negative an enabling healthcare environment. Notably, this training
beliefs and shift attitudes through providing factual programme did not focus on clinical skills for health service
information, enable individuals to engage emotionally and provision to key populations (beyond sexual history taking
reflect upon and examine their personal attitudes and and awareness raising).
beliefs, and encourage positive behavioural intentions
through role plays and practical exercises. 25,26 Evidence from The ‘Integrated Key Populations Sensitivity Training
a European context indicates that reductions in structural Programme for Healthcare Workers in South Africa’ (key
discrimination and homo-negativity require a multilevel populations’ sensitisation training) was a one-day
intervention approach, one component of which is enabling sensitisation training programme for healthcare workers
changes in attitudes and practices amongst individuals, utilising the training manual, in conjunction with a facilitation
groups and institutions. Sensitisation-type training have guide. A total of 405 healthcare workers (inclusive of nurses,
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been shown to have the potential for effecting change at each counsellors, social workers and managers) received the
of these levels, shifting attitudes of individual participants sensitisation training between October 2013 and July 2014
directly and positively, and changing normative professional across five South African provinces: Eastern Cape, Free State,
practice amongst health workers. 27 KwaZulu-Natal, Limpopo and the Northern Cape.
The training was conducted by facilitators with prior key
Sensitisation training for healthcare workers has been shown population experience, who also received a comprehensive
to be effective in reducing judgemental and discriminatory
attitudes towards marginalised groups. A mixed-method 1.Examples include MSM Trainings by Anova Health Institute/Health4Men/ICAP
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South Africa; MSM/Sex Worker/PWUD Trainings by Desmond Tutu HIV Foundation;
quantitative and qualitative assessment conducted over a LGBT Trainings by OUT LGBT Well-Being.
two-year period in Kenya found an overall positive effect of 2.Available at: https://www.researchgate.net/publication/261078875_Health_Care_
Provision_for_Men_who_have_Sex_with_Men_Sex_Workers_and_People_who_
sensitisation training for healthcare workers on attitudes and Use_Drugs_-_An_Introductory_Manual_for_Health_Care_Workers_in_South_Africa.
http://www.sajhivmed.org.za 106 Open Access