Medical Services for Vulnerable Groups: Expectations of MSMs and SWs in Moscow and Orenburg region (Russia)
The Institute of Inservice Training for Lecturers in Arts and Social Studies Lomonosov Moscow state University Moscow, Russia
MSMs and SWs with IDUes have the maximum behavioral risk indicators at this (mainly concentrated) stage of the HIV epidemic development in the Russian Federation.
In April-May of 2008 the author conducted the qualitative research among MSMs and SWs in 3 Russian cities (Moscow, Orenburg, Orsk) . The main research goal was to study the target population attitudes of towards services, interventions and referral systems. The methods: semi-structured focus group, mini-group discussion, in-depth interview, questionnaire. 20 MSMs and 20 street SWs took part in the research.
The research has confirmed that MSMs, SWs have low motivation to testing and treatment in connection with STI and a HIV-infection. One of the main reason: the «official» medicine personnel have no enough counseling skills, including doctor-patient communication and counseling in risk reduction and behavioral change.
What characteristics should have clinics that the target population come there? What is the difference of MSMs, SWs expectations toward medical services in Moscow and Orenburg region?
The respondents expectations consist of two groups: primary and additional. The primary expectations are equal for both groups (the medical personnel? well intentioned/tolerant attitude, professionalism; anonymity/confidentiality). But the rating depends on region. In Moscow the main are tolerance and professionalism. For smaller cities more important is anonymity.
The lists of additional expectations are different for MSMs and SWs. Also Moscow lists are wider. For street SWs is very important the affordable prices (for Orenburg region ? free). Moscow SWs add: doctors? understanding of their employment context ; comfortable clinics location; efficiency of service. For MSMs: safety, understanding aspects of this group/sub-groups. Moscow respondents add comfort and variety of services.
Thus, today?s basic barriers for Russian MSMs and SWs t?ward medical services are: not enough personnel?s tolerant attitudes, insufficient professionalism, uncertainty in anonymity observance.