I need the same care even if am gay: nuancing household arms-length care services for the bed-ridden marginalized persons

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Muyunga T., Sebulime G., Matovu Mohammed, Jacqueline K., Kyaruzi J., Grace B., Masuliya F.
BACKGROUND: Identity, sexuality and HIV status affect level of care, form basis of disproportionate access to HIV services.
OBJECTIVE: We did an analysis of access to care among key populations in Uganda by factoring in the household support issues such as: bathing the bed-ridden, checking nutrition, nursing-care, ARV-refills and conversation between March 2011-Jan 2012.
DESIGN: Through collecting narratives from HIV+ve respondents who were also bed-ridden in the past 12 months and using these nursing-care procedures to prompt responses: bathing the bed-ridden, checking nutrition, nursing-care, ARV-refills and conversation.
 SETTING: 102 respondents formed basis of our report and included 20 men in discordant relations, 30 youth females living with HIV, 20 youth males living with HIV, 03 WSW, 09 women in discordant relations, 12 MSM, 05 sex-workers and 03 substance users
RESPONDENTS: All respondents had a history of having been bed-ridden in the past 12 months.
INTERVENTION: Continuity of care at household level by home-based care givers is possible but affected by taboos.
MAIN OUTCOME MEASUREMENT: Key affected populations receive care disproportionately due to identity, sexuality and status.
RESULTS: Women in discordant relations, youth females living with HIV, MSM, sex-workers and substance users preferred an ARV-provider facility away from their home-village, were not active in the positives support club activities, recalled patronizing and derogatory conversations. Youth males living with HIV and men in discordant relations were active in formal positives support clubs and were provided with care perceived as very good by care-givers.
LIMITATIONS: Most respondents frequently interfaced with interviewers through known networks.
CONCLUSIONS: Even while bed-ridden key affected persons are provided care services disproportionately.              


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