Page 115 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 4 of 7 Original Research

TABLE 1: Changes in pre- and post-training assessment items.
Item Pre-training Post-training p†
(n = 401) (n = 405)
n % n %
Aware of link between violence and HIV risk amongst key populations 235 58.60 302 74.60 0.03
Aware how stigma affecting key populations limits access to effective healthcare 276 68.80 338 83.50 < 0.001
Aware that unfair treatment and discrimination by healthcare workers towards key populations are barriers to key populations 286 71.30 355 87.70 < 0.001
accessing health services
Aware that key populations may not access health services because of fear of judgement by healthcare workers 305 76.10 340 84.00 0.005
Aware that key populations may not access health services because of concerns of being refused services by healthcare workers 184 45.90 277 68.40 < 0.001
Aware that key populations may not access health services because of concerns of being abused by healthcare workers 202 50.40 273 67.40 < 0.001
Believe that selling sex is immoral or strongly immoral 238 59.40 136 33.60 < 0.001
Believe that using an illegal substance is immoral or strongly immoral 311 77.60 242 59.80 < 0.001
Believe that using an illegal substance is not immoral 90 22.40 163 40.20 < 0.001
Believe that having sex with someone of the same sex is immoral or strongly immoral 229 57.10 130 32.10 < 0.001
Believe that having sex with someone of the same sex is not immoral 172 42.90 275 67.90 < 0.001
Strongly feel comfortable providing health services for SW 121 30.20 160 39.50 0.005
Strongly feel comfortable providing health services for PWUD 101 25.20 156 38.50 < 0.001
Strongly feel comfortable providing health services for MSM 111 27.70 172 42.50 < 0.001
†, Indicates intergroup improvement in post-training compared to pre-training.

themes and an a priori coding scheme were developed to In addition, 56% (n = 219) of healthcare workers also strongly
structure the analysis, and coded data were reviewed to felt that they would be able to address discrimination against
determine final themes and outcomes. Comparisons were sex workers, MSM and PWUD in their facilities. Self-reported
drawn between the baseline and follow-up evaluation moralising and prejudicial attitudes related to selling sex,
activities per facility, and between facilities. using drugs and same-sex sex were also reduced as a result of
the training.
Ethical consideration
Qualitative findings
Approval for the research and permission to access the
healthcare staff and facilities were granted by the Free State In the interviews conducted three months after the training
and North-West Provincial Departments of Health. Ethical intervention was implemented, there were marked contrasts
approval was also granted by the University of Cape Town’s between opinions expressed by healthcare workers in the
Human Subjects Research Ethics Committee. 7 intervention group who received training as compared with
those in the non-intervention group who did not receive any
Findings training. Judgmental views towards key populations, for

Quantitative findings from pre- and example, moralising attitudes towards sex work, were voiced
by healthcare workers in the non-intervention group:
post- training questionnaires
‘Selling one’s body is not fine … if someone sells their body in
Results from the 401 pre- and 405 post-training assessment town we feel that they are just doing it deliberately. It’s not right
questionnaires are shown in Table 1. Awareness of the … We feel that the person should not be a part of us [society]
psychosocial vulnerabilities of key populations, such as because they sell their body.’ (Non-intervention group)
violence, stigma and lack of access to healthcare, increased
between pre- and post-training assessments. For example, Prejudicial statements about PWUD were also made by a
awareness of unfair treatment and discrimination towards healthcare worker in the non-intervention group:
sex workers, MSM and PWUD by staff at health facilities ‘People who use drugs … after they smoke the drugs they
increased to 88% after the training (n = 355), compared to 71% become crazy, they start to steal, they start to harass us and mug
beforehand (n = 286). After the training, 75% (n = 302) of us.’ (Non-intervention group)
respondents were aware that sex workers, MSM and PWUD
are more likely to be exposed to violence than the general A healthcare worker from the group who did not receive the
community, compared to 59% (n = 235) prior to training. training described their own lack of skills and knowledge,
After the training, 83.5% of trainees (n = 338) agreed that this and perceived capacity to provide services to sex workers
training increased their awareness of how stigma affecting and MSM, and shared the view that training would be
sex workers, MSM and PWUD can limit their access to beneficial:
effective healthcare, compared to 69% (n = 276) prior to the ‘Men who have sex with men? … I don’t know about those …
training. In the post-training assessments, 67% (n = 273) of Sex work is illegal in South Africa … they [sex workers] don’t
trainees felt that it was important for their health services to speak [disclose that they are sex workers to healthcare workers]. They
be friendly towards and supportive of sex workers, MSM might come [to the clinic] but you can’t know and can’t ask them
and PWUD, compared to 50% (n = 202) prior to the training. … you can’t ask them where they work … [there is a need for
training on how to deal with sex workers].’ (Non-intervention
7.Human Subjects Research Ethics Committee Reference number: 390/2013. group)

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