Help-seeking and challenges faced by transwomen following exposure to gender-based violence; a qualitative study in the Greater Kampala Metropolitan Area, Uganda

Abstract

Background The high prevalence of gender-based violence (GBV) among transwomen is a human rights and public health challenge. Nonetheless, there is limited evidence of sources of GBV support services and the challenges faced by transwomen while help-seeking, especially in transphobic settings like Uganda. This study explored the sources of GBV support services and the challenges faced by transwomen in the Greater Kampala Metropolitan Area during help-seeking. Methods A qualitative study design involving 60 transwomen and 10 key informants was conducted. Respondents were recruited using snowball sampling. An in-depth interview (IDI), and a focus group discussion guide were used to collect data from 20 IDI respondents and six focus group discussants. Each focus group discussion averaged six participants. A key informant interview guide was used for key informant interviews. Data were transcribed verbatim and analysed following a thematic framework, informed by the socio-ecological model. Data were organised into themes and subthemes using NVivo 12.0. Results The sources of support following exposure to GBV included key population-friendly healthcare facilities and civil society organisations (CSOs), and friends and family. Friends and family provided emotional support while key population-friendly healthcare facilities offered medical services including HIV post-exposure prophylaxis. Key population CSOs provided shelter, nutritional support, and legal advice to GBV victims. Lack of recognition of transgender identity; long distances to healthcare facilities; discrimination by healthcare providers and CSO staff, inappropriate questioning of the trans-gender identity by police officers and healthcare providers, and the lack of trans-competent healthcare providers and legal personnel hindered help-seeking following exposure to GBV. Conclusion The immediate sources of GBV support services included key population-friendly healthcare facilities and CSOs, police, and friends and family. However, a significant number of transwomen did not report incidences of GBV. Transwomen were discriminated against at some key population healthcare facilities and CSOs, and police, which hindered help-seeking following exposure to GBV. This study highlights the need to tackle internalized stigma and discrimination against transwomen at the existing sources of GBV support. There is also a need to train law enforcers and legal personnel on the right to access healthcare among transwomen in Uganda.

Understanding the effect of gender-based violence on uptake and utilisation of HIV prevention, treatment, and care services among transgender women: a qualitative study in the greater Kampala metropolitan area, Uganda

“…A participatory qualitative approach of data collection was used. A narrative qualitative inquiry was used, the details of which are provided in our earlier publication [ 16 ]. This study was conducted in GKMA.…”

“…For each KI, we asked how GBV independently affected access to and utilisation of HIV testing, disclosure of HIV status, enrolment and retention in care, and adherence to ART. We also asked about help-seeking following exposure to GBV, as reported in our earlier publication [ 16 ]. FGDs were used to obtain perspectives on GBV experiences and how they affect access to and utilisation of HIV prevention, care, and treatment services among transwomen communities.…”

“…Data on GBV especially in low and middle-income countries are limited. Recent evidence however, indicates that GBV among transwomen is highly prevalent, frequent, often severe, and gravely under-reported [ 1 , 15 , 16 ]. GBV refers to violence perpetrated against an individual based on their gender or gender identity and can be physical, sexual, economic, emotional/ psychological in nature [ 1 , 17 ].…”

“…GBV among transwomen is often perpetrated by a variety of actors, ranging from intimate partners, friends, family, and community members, to representatives of the state (e.g., law enforcement officials and health care providers), on the basis of stigmatization of gender non-conformity, gender expression or identity, and perceived sexual orientation [ 1 , 12 , 16 , 21 ]. Furthermore, transwomen’s economic vulnerabilities, including dependence on their intimate partners and engagement in sex work for survival amidst economic discrimination make them more vulnerable to GBV [ 22 , 23 ].…”

“…Individual factors include one’s demographics, attitudes, beliefs and behaviours; relationships include the influence of friends and social networks on one’s behaviour; the community includes settings such as healthcare facilities, where social relationships occur or are constructed; and society includes social and cultural norms, and policies that create a climate for violence to occur [ 28 ]. The socio-ecological model has previously been used to understand help-seeking following exposure to GBV among transwomen in GKMA [ 16 ], and elsewhere to understand GBV experiences of the transgender populations [ 30 – 33 ]. Our findings can be used by policy makers to design interventions targeted at reducing the impact of GBV on the uptake and utilisation of HIV prevention, treatment and care services across socio-ecological scales.…”