Stretching the Boundaries: Tanzanian Pharmacy Workers' Views and Experiences of Providing STI Services for Men Who Have Sex with Men.
OBJECTIVE
To explore the views and experiences of providing assistance and treatment of sexually transmitted infections to same-sex practicing male clients among service providers at pharmacies and drugstores in Dar es Salaam, Tanzania. Previous research suggests that sexually transmitted infections are an increasing concern for this population. Due to stigma and discrimination, men who have sex with men face limited access to treatment, which might contribute to increased self-medication. However, limited research has been conducted on the role of the pharmaceutical service provider with regards to this population in sub-Saharan Africa.


METHODS
In January 2016, 16 service providers at private pharmacies and drugstores with previous experience of providing services to this population were purposively selected for open-ended face-to-face interviews. The analysis was guided by the grounded theory approach.


RESULTS
The process that emerged was labelled "Stretching Boundaries for Pharmaceutical Responsibilities". This reflected informants' perceptions of themselves as being involved in a transition from having limited engagement in the care of same-sex practicing male clients to becoming regular service-providers to this group. Findings further revealed that the emotional commitment they developed for clients through this process led to a transgression of provider-client boundaries, which undermined objective decision-making when clients lacked prescription. Financial interests also emerged as an underlying motivation for providing incomplete or inaccurate drug dosages.


CONCLUSIONS
Further studies are required to better address incentives related to unregulated sale of drugs. Inter-professional networks between pharmacy and healthcare workers could support the development of targeted treatment for men who have sex with men and other key populations.
Division of Social Medicine and Global Health, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Markus
M
Larsson
Division of Social Medicine and Global Health, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Karen
K
Odberg Pettersson
Community Health Education Services & Advocacy (CHESA), Dar es Salaam, Tanzania.
John
J
Kashiha
Programme in Human Sexuality, Department of Family Medicine and Community Health, Medical School, University of Minnesota, Minneapolis, Minnesota, United States of America.
Michael W
MW
Ross
Division of Social Medicine and Global Health, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Anette
A
Agardh
D004645:Empathy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009042:Motivation; D010594:Pharmacies; D012749:Sexually Transmitted Diseases / Q000188:drug therapy / Q000523:psychology*; D057545:Social Stigma; D013636:Tanzania