Barriers and Facilitators of Sexually Transmitted Infection Control in Maasai Communities: A Qualitative Systematic Review

Abstract

Sexually transmitted infections (STIs) continue to have a large impact on global health, with Africa being disproportionately affected. The Maasai people of Kenya and Tanzania are a disadvantaged community in terms of health outcomes, with multiple aspects of their traditional culture putting them at increased risk of STIs. Despite this, comprehensive reviews of the available data are lacking in the literature regarding the extent to which the Maasai are impacted by these infections and the most appropriate methods of STI control. To address this publication gap, this systematic review analysed qualitative data in order to identify the barriers and facilitators of STI control in Maasai communities. Thematic analysis was utilised to study mixed methods and qualitative studies conducted in various communities across Maasailand. The results were grouped into key themes and further discussed in terms of their applicability to the Maasai as a whole. Major barriers to STI control included multiple concurrent sexual partners, low STI knowledge and high levels of gender inequality in Maasai society. These factors were found to increase the risk of exposure to STIs, in addition to impacting the uptake of health services such as testing and treatment. Common facilitators included reverence towards elders within the community, formal education services and female empowerment. These results emphasise the extent to which Maasai social structures differ to that of sedentary society in surrounding areas. Therefore it is imperative that STI control interventions utilise an evidence based approach to ensure their effectiveness. The inclusion of community elders, female empowerment and increased access to education should be core aspects of future STI control programs which target Maasai communities. Further research should aim to gather widespread quantitative data regarding STI levels in the Maasai in addition to longitudinal study of the impact of culturally congruent intervention implementation. Through increased investment in the inclusion of Maasai in country wide STI control, progress can be made towards decreasing the current health disparities which exist in this disadvantaged population.