Providing HIV Care: Lessons from the Field for Nurses and Healthcare Practitioners by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030712952
Publisher: Springer International Publishing

What can nurses do to address this and make sure the care and support provided for affected people is equitable and inclusive?

7.3.2.2 The Impact

Structural factors therefore directly impact on the well-being of key populations and their access to health services. For example, in many countries where sex work is criminalised, sex workers are exposed to to harassment by law enforcement [51]. Anti-prostitution legislation encourages violence towards sex workers which can include verbal, physical and sexual abuse; mandatory HIV testing; public ‘naming and shaming’ in media; forced evictions; and extortion [52]. Increased risk of violence can put sex workers at greater risk of HIV and other sexually transmitted infections (STI), but they also often face barriers accessing sexual and reproductive health services [3].

Drug users (including injecting drug users) are especially vulnerable, and this is one of the most heavily criminalised communities, a known factor affecting HIV prevention [53]. People who use drugs face unnecessary incarceration for victimless non-violent offenses, police brutality, and widespread violations to their right to health, including failure to provide adequate drug dependence treatment [54]. This can lead to marginalisation and social exclusion, pushing people away from jobs, education, and other health and social services. Crucially, the access of drug users to HIV prevention services—such as needle exchange and testing—can be affected by lack of policy initiatives, or even interest, in addressing the needs of this group. Women who use drugs can be especially affected when attempting to access sexual and reproductive health services, facing a ‘double stigma’, especially from policies largely being designed for and by men [55].

Men who have sex with men face stigma and discrimination in countries where same-sex relationships are criminalised [56], forcing them to hide their identities and avoid places they expect to be stigmatised, which can include health services. In Vietnam, for example, MSM experience stigma, are affected by poverty, and a lack MSM-friendly services [11]. Where there is specific legislation prohibiting sex between men—in some countries punishable by death—HIV responses are hampered by daily experiences of homophobia, discrimination, violence, and criminalisation. These can have severe and damaging effects on the physical and mental health of MSM and limit their access to and use of vital services [57].

Transgender people are amongst the most brutalized of all marginalised communities, with some countries outlawing transgender men and women altogether. They are at risk of being excluded and marginalised, not completing their education, and resorting to sex work for income. The risk of HIV faced by transgender people is high compared with other populations [58], and HIV response programmes often miss this group due to misclassification of transgender people as MSM or female sex workers [59], or structural stigma.Banished from her home, Serina was forced to fend for herself and found a job as a bartender in a different town. Here she was able to present as a woman, and this was how the community knew her. Still, Serina’s situation presented several challenges. Men in the bar often made advances towards her, but she knew this could put her in danger.

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