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Abstract
Objectives To examine experiences of key populations (lesbian, gay, bisexual, trans and intersex (LGBTI) people, men who have sex with men (MSM) and sex workers) in Zimbabwe regarding access to, and experiences of, healthcare.
Design Qualitative study using in-depth interviews and focus groups, with thematic analysis.
Participants Sixty individuals from key populations in Zimbabwe.
Setting Participants were recruited from four locations (Harare, Bulawayo, Mutare, Beitbridge/Masvingo).
Results Participants described considerable unmet needs and barriers to accessing basic healthcare due to discrimination regarding key population status, exacerbated by the sociopolitical/legal environment. Three main themes emerged: (1) key populations' illnesses were caused by their behaviour; (2) equal access to healthcare is conditional on key populations conforming to ‘sexual norms’ and (3) perceptions that healthcare workers were ill-informed about key populations, and that professionals' personal attitudes affected care delivery. Participants felt unable to discuss their key population status with healthcare workers. Their healthcare needs were expected to be met almost entirely by their own communities.
Conclusions This is one of very few studies of healthcare access beyond HIV for key populations in Africa. Discrimination towards key populations discourages early diagnosis, limits access to healthcare/treatment and increases risk of transmission of infectious diseases. Key populations experience unnecessary suffering from untreated conditions, exclusion from healthcare and extreme psychological distress. Education is needed to reduce stigma and enhance sensitive clinical interviewing skills. Clinical and public health implications of discrimination in healthcare must be addressed through evidence-based interventions for professionals, particularly in contexts with sociopolitical/legal barriers to equality.
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
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Footnotes
Handling editor Stephanie Topp.
Contributors JH conceived the study, collected and managed data. SC assisted in collecting and managing data. KB and RH provided academic scientific direction for the study (design, analysis, reporting). JH, KB and RH reviewed the coding to improve rigour and jointly drafted the manuscript. All authors agreed the final analysis and interpretation.
Funding This work was supported by the Open Society Foundations. Open access for this article was funded by King's College London.
Competing interests None declared.
Ethics approval Ethical approval for the study was obtained from the Medical Research Council of Zimbabwe (reference number MRCZ/A/1881).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.