Impediments in access to quality STI care services by the MSM and TG communities

The post below available at SEA AIDS e- forum(slightly modified) is in response to a recent consultation report from the September 2008 meeting of the World Health Organization (WHO) and its United Nations (UN) partners in Geneva. The report speaks to the urgent need to address the emerging and remerging HIV and STI epidemics among MSM and transgender people.

Access the full report here:

Read the executive summary of the report, to which the posting below responds, here:]

Dear Friends,

The biggest hurdle in the delivery of quality sexually transmitted infection (STI) services to the men who have sex with men (MSM) and transgender (TG) communities is the mindset and attitude of most of the service providers.

This observation is based on my programmatic and personal experiences as a STI/HIV programme manager for nearly a decade and my earlier role as a service provider in the STI division of the All India Institute of Medical Sciences (AIIMS) in New Delhi for a couple of years.

This reality compelled us in areas of our operations to partner with preferred private providers to build their capacity through structured modular trainings to facilitate management of STIs in targeted interventions for the MSM/TG and other most at risk populations.

These activities are not just another option but an absolute must to ensure effective STI service delivery outside the formal public health infrastructure and governmental hospital/health centers accessed by very few.

In an assessment of ICT (integrated counselling and testing ) services of a very large centre affiliated to a teaching hospital in a state in South India, I came across the situation where the counseling, testing and STI care services were never accessed by the TG population who were staying in large numbers at a stone's throw distance.

The focused group discussions (FGDs) with the local TG population established beyond doubts TG not accessing the available health services was directly related to the ridicule and the stigmatizing and discriminatory demeanour of the personnel/service providers experienced by TG in the past.

Qualified venereogists have been observed to just examine the genitalia of a male/female patient with no effort to consider the oral/anal involvement, perhaps denying the existence of alternate sexual practices and thereby wishing them away. Such a judgmental approach affects the quality and reach of the much needed services for prevention, care, support and treatment of STI/HIV.

Stigma, discrimination and the denial of appropriate services will add to the burden with major untoward consequences.

We have to promote and protect the rights of the clients and ensure stigma-free delivery of services.

The cited study further corroborates the observations at the grassroots and strengthens the evidence necessitating building of a case for provision and equitable access of non-judgmental and non-stigmatizing quality services.

Let us continue our ongoing endeavours for ensuring the same.

Best wishes,

Dr.Rajesh Gopal

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