Page 116 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 5 of 7 Original Research

A variety of differences between trained and non-trained [to the health facility] they must feel welcome. They must be like
healthcare workers later emerged in the follow-up interviews, any other patient, we must treat them equally. When a person
specifically regarding their judgemental attitudes towards comes here to share their problems they must not be scared to
key populations; these are presented below. say that I am a sex worker because they are afraid of how I will
react, what I will say to them and if I will judge them. If they say
I am a sex worker, I must not even react, I must listen to their
Respondents who received the training intervention felt that story and understand what their problem is … it’s alright
the training had addressed their previously judgemental because they are also people, we don’t have to isolate them in
attitudes by increasing their knowledge and understanding society, we must treat them like all the other people.’ (Intervention
of various psychosocial and health issues pertaining to key group, post-training)
populations. The comment below illustrates a shift away
from homo-prejudicial attitudes: The way in which the sensitisation training worked to
‘Now I can welcome them [key populations patients] properly. challenge prejudicial views and beliefs, combined with the
Because I used to think that they are just naughty before the provision of information about key populations and their
training. I found out that they are not naughty, at times as a risks and vulnerabilities, resulted in self-reported attitude
woman you get feelings for other women and as a man you get shifts on the part of the healthcare workers, as well as
feelings for other men … I can welcome them because now increased introspection on personally held judgemental
I know what the problem is. They did not choose … I have views:
learned … not to discriminate them, to end stigma, social stigma.’
(Intervention group, post-training) ‘[After the training] I also know where I stand … the training
opened my eyes so that I could introspect … I noticed that my
Intervention recipients provided further examples of how attitude has changed towards those people [key populations] …
they perceived the training to have improved their [before] I would see them [key populations] but I didn’t understand
knowledge, specifically in their ability to conduct sexual and them. The training opened my eyes and my attitude has
risk behaviour history taking. Trained healthcare workers changed.’ (Intervention group, post-training)
described their perceptions of their own capacity to ask
appropriate and relevant questions to key populations Discussion
patients to provide them with effective care: Findings from this evaluation of South Africa’s first integrated
‘When a sex worker comes to test [for HIV] at the clinic I know sex worker, MSM and PWUD sensitisation programme for
what sort of questions to ask.’ (Intervention group, post-training) healthcare workers demonstrate that training interventions of
this nature can be successful in enabling healthcare workers
Those healthcare workers who received training to better understand the social marginalisation and
demonstrated an improved understanding and increased discrimination experienced by these groups, creating space
compassion for the challenges, hostility and violence facing for them to assess and reflect on engrained social norms that
key populations in society: inform discriminatory and judgemental attitudes towards
‘These people [key populations] feel rejected because we don’t these key populations and their behaviour. Knowledge
treat them like people.’ (Intervention group, post-training) pertaining to key factors that contribute to poor health
outcomes amongst key populations were improved amongst
‘There are problems, you find that sex workers are beaten and
sometimes they are not paid … When they go and report at the healthcare workers who received the training. Specifically,
police station they tell them off and laugh at them … I have this evaluation suggests that the sensitisation training
learned a lot about key populations.’ (Intervention group, improved healthcare workers’ awareness of factors that
post-training) increase the vulnerability of key populations to HIV infection,
including psychosocial issues such as stigma and violence,
Respondents voiced opinions that the training had enabled barriers towards accessing health services, and the
them to understand the social marginalisation and consequences of unfair treatment and discrimination by
discrimination experienced by key populations: healthcare staff. Findings also indicate that the training
‘I noticed since I went for the [training] course … I found that we intervention resulted in a shift in attitudes, expressed through
stigmatise them [key populations], we don’t treat them well … A an increased empathy for key populations, and a reduction in
man who has sex with man is ridiculed in society for dating negative and discriminatory moral-based judgements of sex
another man, that is stigma … social stigma … I learned a lot workers, MSM and PWUD and their behaviours. Healthcare
from the training.’ (Intervention group, post-training) workers who received the training also self-reported increased
comfort and capability in providing appropriate health
Some of the trained healthcare workers explained that services to key populations, suggesting that a sensitisation
their improved understanding and compassion was the training of this nature could help to improve the ability of
result of reflecting on and confronting their own prejudicial healthcare workers to provide sensitive and appropriate
attitudes during the training, a necessary step to be able to health services to stigmatised and marginalised populations.
provide services to key population clients in a sensitive,
compassionate, and humane manner: The limited data on similar sensitisation-type training
‘After we went for the training [we realised] that … we must treat programmes that exist support and are congruent with the
them [key populations] like this [sensitively]. When they come here findings of this study, suggesting that sensitisation training

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