Fact Sheet: Unlocking Health Services for MSM and Transgender Women in San Salvador
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Author(s): Andrinopoulos K, Hembling J.
Increasing health service utilization is an important first step towards reducing health disparities for men who have sex with men (MSM) and transgender women (TW). This research brief provides descriptive information on health seeking behavior for MSM and TW in San Salvador. Data on disclosure of sexual orientation to a healthcare provider is also presented since this has been shown to increase quality of care in other contexts. A sample of 670 participants (506 MSM and 164 TW) was recruited using respondent driven sampling (RDS) and completed a survey. Statistical analysis included frequency calculations, chi-squared tests of association, and multivariate logistic regression with the application of appropriate weighting techniques for RDS. Results show that health service utilization was more common among participants who had health insurance and a regular facility or provider. Concerns related to confidentiality, judgment, and comfort with the provider, were important factors influencing the decision to seek healthcare. Most participants used MINSAL (public) facilities when they need healthcare. This is particularly true for TW. However, slightly more than half report a preference for private services. Disclosure of sexual orientation to a healthcare provider was more common among TW compared to MSM. It was also more common among participants with access to a healthcare provider supportive of MSM and TW, and participants who used MINSAL (public) versus private services. Alarmingly, disclosure of sexual orientation to a healthcare provider was associated with a higher level of perceived provider discrimination by the participant, suggesting that disclosure in this context may lead to a worse rather than better experience when seeking health services. There was also no difference in HIV service use (measured by HIV testing history), among participants who had disclosed their sexual orientation to a healthcare provider. Based on the findings, it is recommended that additional activities be implemented to mitigate the stigma and discrimination experienced by MSM and TW in the wider society and the health system. Given the level of service use and preference across types of health facilities, it is necessary to address barriers in the public sector (MINSAL/ISSS) while concurrently supporting access to private health services.
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