The 130th Annual Meeting of APHA

Abstract #44813

Lorie L Broomhall, PhD¹, Jennifer Liku, MA², O. Habil², Z. Omongo², and R Okawa². (1) Health Services Research, Family Health International, PO Box 13950, Research Triangle Park, NC 27713, 919.544.7040, lbroomhall@fhi.org, (2) Family Planning and Reproductive Health Program, Family Health International, The Chancery 2nd Floor, Valley Road, PO Box 38835, Nairobi, Kenya

A clear link exists between STI status and HIV vulnerability. Despite high rates of HIV in western Kenya, condom promotion by STI service providers is poor and condom use among STI patients is low. This qualitative study sought to 1) explain the synergetic dynamics of risk, service provision and disease that hamper effective condom promotion and perpetuate risky sexual behavior, and 2) identify leverage points within the service delivery system where interventions will be most effective. Fifteen formal and informal STI service venues - hospitals, clinics, and pharmacies in each f two districts - Kisumu and Siaya - were selected for intensive investigation. Fifty-five licensed and unlicensed providers such as clinicians, healers and herbalists, and 46 STI patients were interviewed. Focus groups (12) were conducted with high-risk groups including youth, bicycle transporters and commercial sex workers.

Findings showed that the formal and informal sectors of Kenyan medicine constitute a single system with feedback loops between the two sectors. Ineffective STI services “push” clients from the formal sector and “pull” them towards the informal sector where they are even less likely to receive adequate treatment and condom counseling, thus perpetuating their HIV susceptibility. STI clients’ reasons for avoiding public facilities included lack of confidentiality; long waits for service, cost and frequent stockouts. Clients reported seeking alternative treatment from herbalists, pharmacy clerks, or self-medicating. Data suggest that strengthening clinical supervision and increasing the STI drug stabilizing the STI drug supply could be critical leverage points to improve condom promotion and use.

Learning Objectives: Learning Objectives

At the conclusion of the session, the participant (learner) in this session will be able to
• articulate the systems approach to health services research, and
• discuss how qualitative research methods can be used to investigate health promotion and health seeking behaviors.

Keywords: STD Prevention, International Reproductive Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.