Breaking Down Barriers to Access to Healthcare and Men’s Sexual Health

As the HIV epidemic spreads, structural interventions designed to eliminate service barriers are urgently needed. Project ACT, an innovative multi-country advocacy demonstration project in five African and two Caribbean countries, tested an innovative solution for tackling these issues head-on.

Through the Project ACT process, MPact Global Action for Gay Men’s Health and Rights (MPact) created a collaborative partner organization in each participating country. These organizations were then provided with the chance to build their capacity and advocacy skills throughout the course of project implementation.

  1. Social Inclusion

Social inclusion is the idea that everyone has the right to be recognized, heard and taken into account in their society. This fundamental human right has been upheld in numerous international treaties.

Additionally, people should have the freedom to engage in community activities and access to the same services as others within their area. Doing so can improve wellbeing for those who are less advantaged, creating more positive interactions between members of a given group.

Social inclusion is an incredibly important concept, yet many Australians do not enjoy this right. This can lead to low self-esteem, isolation and mental health issues such as depression or anxiety.

Many times, this is caused by factors that shape people’s lives such as unemployment, age or ill health. Other reasons could include financial strain, racism or discrimination.

For instance, in countries like Australia where people tend to have lower incomes and fewer resources than elsewhere, it can be challenging for individuals to secure work or afford healthcare. These factors can have a considerable effect on an individual’s wellbeing and lead to them having less time for socialising with friends and families.

These barriers can prevent men from accessing the best healthcare and men’s sexual health possible. This leads to an increased rate of illness, lower quality of life, higher stress levels, and depression.

Many organisations are working to guarantee that everyone has the opportunity to exercise this right. This could include helping people gain employment or housing, decreasing mental illness stigma, and offering support in communities.

One common approach is consumer involvement, where individuals are given leadership roles at service agencies and encouraged to build meaningful connections with clients. This encourages them to re-engage with their communities and foster healthy connections that can promote mental health and wellbeing for themselves and those around them.

Studies have demonstrated that social inclusion can lead to improvements in overall health outcomes and reduced healthcare costs. This is likely because when individuals feel empowered to make changes in their lives, they are more motivated to take action for themselves and those around them.

  • Inclusion of Sexually Transmitted Infections (STIs)
  • Sexually transmitted infections (STIs) are a widespread and serious public health hazard in the United States; estimates suggest that one out of every five Americans has an STI at any given time. These infections may be sexually transmitted and lead to various complications like gonorrhea, chlamydia, syphilis or HIV; they have also been linked to high rates of depression, poor health outcomes and social exclusion.

    STIs can be prevented and treated effectively through a range of strategies that include sex education, screening, testing and prevention. These activities are especially crucial for adolescents and young adults as they help people recognize and manage their STIs more easily, increasing the likelihood that they will seek care or encourage a partner to do so.

    Recent recommendations from NASEM’s Committee on Prevention and Control of Sexually Transmitted Infections in the United States call for integrating STI screenings into sexual health screening programs to guarantee people are screened for all available STIs, tailored to an individual’s risk factors and sensitivity. It also calls for addressing gender/sexual orientation differences, racial disparities in STI prevalence rates, social determinants of STI risk as well as providing STI-specific services at various health care venues.

    In addition to lack of access, various barriers also prevent people from receiving and using services. These include stigma, cost, and quality concerns. Furthermore, many may feel uneasy seeking care due to their age, gender or other identifying information.

    To better understand these barriers, we conducted a survey of patients at 21 STD clinics in the United States. We asked males (n = 2251) and females (n = 2091) about their reasons for using the STD clinic, where they would seek care if not through the clinic, and their willingness to use insurance coverage for STI care.

    Results revealed that patients primarily used STD clinics for their sexual symptoms (18.9%) or screening purposes (33.3%), but they also visited because it was easy to get an appointment and costs were low. Furthermore, many visited the STD clinic because it provided expert care when other types of health care venues were either unavailable or expensive.

  • Social Stigma
  • Social stigma, or negative attitudes and beliefs about people or things, is a widespread issue in public health. It can have harmful consequences and have an extended impact on wellbeing. Stigma may affect an individual’s mental health as well as physical well-being, as well as that of those close to them such as family members or caregivers.

    People may feel less inclined to seek care for a mental health condition due to this complex issue that involves factors like poverty, race, gender, religion and social context. Addressing this complex issue is no small feat and often requires extensive resources.

    Stigma comes in many forms. Some of the most prevalent include stigma associated with mental illness, stigma associated with physical deformity and stigma associated with membership in a certain group or religion.

    Emile Durkheim coined the term “stigma” in the nineteenth century to refer to a process of labeling people or groups with certain characteristics, such as poverty or femininity. This concept was founded on the idea that stigmatized individuals do not receive recognition from their peers for other aspects of life.

    Goffman, an American sociologist, contributed to our understanding of stigma as a social construct and developed the theory of stigma wherein individuals with this condition move between two environments: discredited ones where their peers don’t recognize them and discreditable ones where peers do recognize them. The former can be controlled by the stigmatized individual in order to hide its characteristics while passing it off as normal behavior.

    The discreditable environment can be shaped by other factors such as social status, occupation or education level. These have a direct impact on how stigmatized individuals experience social stigma and its effects on their identity.

    Sexual behavior stigma can be a significant barrier for MSM when seeking healthcare and have an adverse impact on their mental health. It has been linked to poor health outcomes such as HIV-related adverse health outcomes and is frequently the cause of limited access to sexual and reproductive healthcare. Therefore, combatting sexual behavior stigma is key for improving MSM access to healthcare and improving their sexual health in general.

  • Health Inequalities
  • When researching health disparities, researchers and policy makers must take into account how those differences are constructed. For instance, the World Health Organization emphasizes race/ethnicity, place of residence, gender, religion, education level, and socioeconomic status (SES) as stratifiers that can be used to define social groups (5).

    Data interpretation and analysis should be guided by clearly defined membership categories rooted in theory, supported by prior contextual knowledge. Unfortunately, these groupings can be complex, with some members falling into multiple groups. This makes data interpretation and analysis especially challenging when dealing with large-scale population health datasets that may not easily collapse or differentiate with a consistent approach.

    Researchers must remember that some social groupings are based on absolute levels of a variable such as income, while others are constructed through ordering or continuous levels of an attribute like sex or race. Selecting the correct grouping strategy is critical since it will influence whether health inequalities can be identified in data.

    The concept of health inequalities is heavily dependent on epidemiologic concepts but also deeply embedded in social values from ethics and human rights fields. That means definitions of these terms matter – not only for their meaning but how they are used and measured by local, national, and international governments as well as nongovernmental organizations.

    One of the primary challenges in measuring and understanding social group-level health inequalities is how to distinguish between relative and absolute levels of wealth, power, and prestige that may impact health outcomes. Measures of absolute income, wealth and social status can help us identify how health inequalities occur and investigate their causal mechanisms.

    However, relative measures of SES can also be useful to investigate the role that relative positions play in creating and maintaining health disparities across social groups. As a result, research into relative levels of SES has grown alongside an expanding interest in inequality as an independent risk factor for health.

    This paper presents a three-stage approach for providing health inequity data useful for health equity policy: univariate health inequality, univariate health inequity and bivariate health inequities. Our method seeks to bridge the gap between advances in specialized disciplines and those found in policy relevant applied work; additionally it provides an operational framework that explicitly incorporates the definition of health inequity into its measurement process.

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