Access to health services for men who have sex with men and transgender women in Beira, Mozambique: A qualitative study

Abstract

Objectives HIV prevalence and incidence are higher among key populations including Men who have Sex with Men (MSM) and transgender women in low and middle income countries, when compared to the general population. Despite World Health Organisation guidelines on the provision of services to key populations recommending an evidence-based, culturally relevant and rights-based approach, uptake of HIV services in many resource-limited and rights-constrained settings remains low. Mé decins Sans Frontières (MSF) has been offering health services for MSM and transgender women in Beira, Mozambique since 2014 using a peer-educator driven model, but uptake of services has not been as high as expected. This qualitative study aimed to learn more about these key populations in Beira, their experiences of accessing MSM-and transgender-friendly services and their use of face-to-face and virtual networks, including social media, for engagement with health care. Methods In-depth interviews were carried out with MSM and transgender women who were 1) enrolled in, 2) disengaged from or 3) never engaged in MSF's programme. Purposive and snowball sampling were used to recruit the different groups of interviewees. Interviews were conducted in Portuguese, transcribed and translated into English before being coded and manually analysed using a thematic network framework. Results Nine transgender women and 18 cisgender MSM participated in the study. Interviewees ranged in age from 19 to 47 years, with a median age of 29. Three main themes emerged from the data: perceptions of stigma and discrimination, experiences of the peer-educator driven model and the use of face-to-face and virtual platforms for communication and engagement,

Stigma among transgender and gender‐diverse people accessing healthcare: A concept analysis

“…Instead, consequences of stigma such as discrimination (Arístegui et al, 2018;Gamariel et al, 2020;Lacombe-Duncan et al, 2020;Mbeda et al, 2020;Pinkston & Schierberl Scherr, 2020), stereotype (Vijay et al, 2018), violence (Ritterbusch et al, 2018), mistreatment (Pinkston & Schierberl Scherr, 2020) and prejudice (Vijay et al, 2018) were used to describe the concept of stigma. While these terminologies are related to stigma, it is essential to point out that discrimination, stereotype, violence, mistreatment and prejudice centres the attention on the actors that produce such behaviours.…”

“…While this definition comprises a comprehensive definition of access, healthcare access is defined as the use of healthcare areas among TGD people. In the sampled literature, nearly half examined stigma among TGD people accessing HIV-related services (Diehl et al, 2017;Gamariel et al, 2020;Lacombe-Duncan et al, 2020;Pinkston & Schierberl Scherr, 2020;Ritterbusch et al, 2018). However, healthcare access among TGD people also includes the use of primary and preventative care, surgical services and emergency services.…”

Comprehensive approach to HIV/AIDS testing and linkage to treatment among men who have sex with men in Curitiba, Brazil

“…The AHA team developed and implemented a communications plan to increase outreach to gay men and other MSM and encouraged service uptake through virtual tools, e.g., Facebook, Instagram, Twitter, WhatsApp, Grinder, and the AHA website. The project mapped out public venues where MSM gather to socialize [15], including bars, cafés, nightclubs, movie theaters, and public restrooms. This mapping facilitated partnerships with LGBT-friendly businesses, resulting in tailored messaging for each HTC environment and type of client.…”

Why Doesn't the Decriminalisation of Same-Sex Sexuality and Sex Work Ensure Rights? The Legality and Social Acceptance of Transgressive Sexualities in Urban Mozambique

“…Scholars suggest that this may relate to the relatively late initiation of legal repression on same-sex sexuality by the Portuguese as compared with the British, and which primarily seemed to be instituted to keep the sexual behaviour of white European males living in Mozambique in check. Findings from a few smaller-scale qualitative studies suggest the presence of contending views, following experiences of social stigma and discriminatory acts reported by LGBTI people, and also by sex workers in Mozambique (Gamariel et al, 2020;Hendriks & Rácz, 2016;Centro de Direitos Humanos, 2017). This paper explores the current legal framework and the views and positions on the affirmation of LGBTI and sex worker rights in the law among legal experts, policy makers, civil society pressure groups, and community opinion leaders, with the purpose of critically reflecting on the capacity of the law to exert influence over socially contentious issues and the processes through which certain groups in society are set apart based on their sexual identity or sexual activity.…”