Healthcare Workers’ Experiences and Challenges in Managing Gender-Based Violence Among HIV-Positive Women Living in Southern, Tanzania: A Qualitative Study

Abstract

Leila S Matoy,1– 3 Felista S Tarimo,2,4 Efraim M Kosia,2 Josephine J Mkunda,2 Maja Weisser,1,3,5– 7 Sally Mtenga8 1Interventions and Clinical Trials, Ifakara Health Institute, Morogoro, Tanzania; 2The Nelson Mandela, African Institution of Science and Technology, Tengeru, Arusha, Tanzania; 3Chronic Diseases Clinic of Ifakara, St. Francis Referral Hospital, Morogoro, Tanzania; 4Environmental Health and Ecological Sciences, Ifakara Health Institute, Dar-es-Salaam, Tanzania; 5Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, 4031, Switzerland; 6University of Basel, Basel, 4002, Switzerland; 7Swiss Tropical and Public Health Institute, Allschwil, 4123, Switzerland; 8Health System Impact Evaluation and Policy, Ifakara Health Institute, Dar-es-Salaam, TanzaniaCorrespondence: Leila S Matoy, Ifakara Health Institute, P.O. Box 53, off Mlabani Passage, Ifakara, Morogoro, Tanzania, Tel [phone], Email [email protected]: Healthcare workers (HCW) play an important role in managing women living with HIV (WLHIV) with gender-based violence (GBV) experience, but little is known about their experience in screening and managing GBV among WLHIV. This study explored the perceptions and experience of the HCWs on screening and managing GBV cases among WLHIV.Patients and Methods: We performed a descriptive phenomenological qualitative study to elicit the views and experience of HCW on GBV screening and management for WLHIV. The study was conducted in the semi-urban setting in Morogoro Region, Tanzania. Ten in-depth interviews (IDIs) were administered to HCW selected purposefully based on their roles at an HIV care and treatment center. Data were transcribed using patterns matching study aim and then merged into relevant themes for analysis and interpretation. NVIVO software version 12 was used for data coding and analysis.Results: We found that HCW experienced multiple challenges in GBV screening and management, including limited capacity for GBV screening and management; inadequate training on assessment and handling GBV cases, limited resources (time, GBV guidelines and screening tools), inadequate GBV referral and monitoring systems; referral forms for GBV survivors to social support centers and follow-up mechanisms to trace survivors, mental aspects; HCWs’ fear of being stressed by listening to women’s’ GBV traumatic experiences, HCWs’ fear of causing problems to the women’s families and HCW biased notions on women disclosure of GBV; the believes that women will not report their GBV experiences.Conclusion: We identified context-specific challenges preventing HCW to deliver optimal services of GBV to WLHIV, stressing the necessity to strengthen HCW capacity and resources for GBV services and to integrate psychosocial services into HIV care. Policy and programs should be developed to support GBV screening and management for WLHIV.Keywords: healthcare provider, intimate partner violence, women living with HIV, gender-based violence

Keywords

• healthcare provider
• intimate partner violence
• women living with hiv
• gender-based violence