HIV and transgender women in Kampala, Uganda – Double Jeopardy

King, Rachel; Nanteza, Justine; Sebyala, Zubayiri; Bbaale, Joy; Sande, Enos; Poteat, Tonia; Kiyingi, Herbert; Hladik, Wolfgang

doi:10.1080/13691058.2018.1506155

Cited by 32 publications

(32 citation statements)

References 23 publications

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“…Emerging data suggest that trans men face vulnerability to HIV through condomless vaginal and/or anal sex with cisgender men, having multiple sexual partners, not knowing the HIV positive or unknown HIV status of these partners and having sex while under the influence of alcohol [ 2 , 3 , 4 ]. HIV vulnerability is exacerbated by social marginalization, transphobia, violence and homophobic rape [ 5 , 6 , 7 , 8 ]. Few data are available on HIV prevalence among trans men globally.…”

Section: Introductionmentioning

confidence: 99%

“You are not a man”: a multi‐method study of trans stigma and risk of HIV and sexually transmitted infections among trans men in Uganda

et al. 2021

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Introduction Transgender (trans) men in sub‐Saharan Africa are a hidden and vulnerable population who may engage in sex work due to socio‐economic exclusion and lack of alternative employment opportunities. Little is known about HIV and sexually transmitted infection (STI) risk among trans men in this setting. We conducted a multi‐method study to characterize HIV/STI risk among trans men in Uganda. Methods Between January and October 2020, we enrolled 50 trans men into a cross‐sectional study through snowball sampling. Data were collected on socio‐demographic characteristics, sexual practices and depression. We conducted 20 qualitative interviews to explore: (1) descriptions of sexual practices that could increase HIV/STI exposure; (2) experiences of accessing public healthcare facilities; (3) perceptions of HIV or STI testing; (4) HIV and STI service delivery; and (5) drug and alcohol use. We used an inductive content analytic approach centring on descriptive category development to analyse the data. Results The median age was 25 years (interquartile range 23–28). The prevalence of HIV, syphilis and hepatitis B was 4%, 6% and 8%, respectively. We observed multiple levels of intersecting individual, interpersonal and structural stigmas. (1) Trans men reported transphobic rape motivated by interpersonal stigma that was psychologically traumatizing to the survivor. The resultant stigma and shame hindered healthcare access. (2) Structural stigma and economic vulnerability led to sex work, which increased the risk of HIV and other STIs. Sex work stigma further compounded vulnerability. (3) Individualized stigma led to fear of disclosure of gender identity and HIV status. Concealment was used as a form of stigma management. (4) Multiple levels of stigma hampered access to healthcare services. Preference for trans‐friendly care was motivated by stigma avoidance in public facilities. Overall, the lived experiences of trans men highlight the intertwined relationship between stigma and sexual health. Conclusions In this sample from Uganda, trans men experienced stigma at multiple levels, highlighting the need for gender‐sensitive healthcare delivery. Stigma reduction interventions, including provider training, non‐discrimination policies, support groups and stigma counselling, could strengthen uptake and utilization of prevention services by this marginalized population.

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Section: Introductionmentioning

confidence: 99%

“You are not a man”: a multi‐method study of trans stigma and risk of HIV and sexually transmitted infections among trans men in Uganda

et al. 2021

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“…In Sub-Saharan Africa, the HIV prevalence among the trans-women is as high as 59% [3]. Although there are no reliable national estimates for the HIV burden among the trans-women in Uganda, King, Nanteza [4] reported a prevalence as high as 20%.…”

Section: Introductionmentioning

confidence: 99%

“…Sex work, which is the main source of livelihood for majority of the trans-women [4,5], is usually associated with high-risk behaviours such as incorrect and inconsistent condom use, having sex under influence of drugs and other substances [6,7], and multiple sexual partnerships/relationships [8], which are all known to escalate the risk of HIV transmission [9,10]. Thus, trans-women sex workers, who are the focus of this study, experience higher rates of STIs including HIV compared to nontrans-women sex workers [5,11].…”

Section: Introductionmentioning

confidence: 99%

Barriers to access and utilisation of HIV/STIs prevention and care services among trans-women sex workers in the greater Kampala metropolitan area, Uganda

Ssekamatte

Isunju

Naume³

et al. 2020

BMC Infect Dis

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Background Trans-women sex workers bear the greatest brunt of HIV and other sexually transmitted infections (STI). Trans-women are 49 times more at risk of HIV infections compared to the general population. However, they remain underserved and continue to grapple with access to and utilisation of HIV/STI prevention services. This study explored barriers to access and utilisation of HIV/STI prevention services and associated coping mechanisms. Methods This exploratory qualitative study was conducted among trans-women sex workers in the Greater Kampala Metropolitan area, Uganda. A total of 22 in-depth interviews, 6 key informant interviews and 9 focus group discussions were conducted to obtain data on barriers to access and utilisation of HIV and other STI prevention and care services, and coping strategies of trans-women sex workers. Data were analysed through thematic analysis using a hybrid of inductive and deductive approaches. Results Individual level barriers to access and utilisation of HIV/STI prevention and care services included internalised stigma and low socio-economic status. Healthcare system barriers included social exclusion and lack of recognition by other key population groups; stigmatisation by some healthcare providers; breach of confidentiality by some healthcare providers; limited hours of operation of some key population-friendly healthcare facilities; discrimination by straight patients and healthcare providers; stockout of STI drugs; inadequate access to well-equipped treatment centres and high cost of drugs. At community level, transphobia hindered access and utilisation of HIV/STI prevention and care services. The coping strategies included use of substitutes such as lotions, avocado or yoghurt to cope with a lack of lubricants. Herbs were used as substitutes for STI drugs, while psychoactive substances were used to cope with stigma and discrimination, and changing the dress code to hide their preferred gender identity. Conclusions Individual, community and healthcare system barriers hindered access and utilisation of HIV/STI prevention and care services among the trans-women sex workers. There is a need to create an enabling environment in order to enhance access to and utilisation of HIV/STI prevention and care services for trans-women sex workers through sensitisation of healthcare providers, other key population groups and the community at large on the transgender identity.

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“…Sex work, which is the main source of livelihood for majority of the trans-women (4,5), is usually associated with high-risk behaviours such as incorrect and inconsistent condom use, having sex under in uence of drugs and other substance abuse (6,7), and multiple sexual partnerships/relationships (8), which are all known to escalate the risk of HIV transmission (9,10). Thus, trans-women sex workers, who are the focus of this study, experience higher rates of STIs including HIV compared to non-transwomen sex workers (5,11).…”

Section: Introductionmentioning

confidence: 99%

Barriers to access and utilisation of HIV/STIs prevention and care services among trans-women sex workers in the greater Kampala metropolitan area, Uganda.

Ssekamatte

Isunju

Muyanga³

et al. 2020

Preprint

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BackgroundTrans-women sex workers bear the greatest brunt of HIV and other sexually transmitted infections (STI). Trans-women are 49 times more at risk of HIV infections compared to the general population. However, they remain underserved and continue to grapple with access to and utilisation of HIV/STI prevention services. This study explored barriers to access and utilisation of HIV/STI prevention services and associated coping mechanisms. MethodsThis exploratory qualitative study was conducted among trans-women sex workers in the Greater Kampala Metropolitan area, Uganda. A total of 22 in-depth interviews, 6 key informant interviews and 9 focus group discussions were conducted to obtain data on barriers to access and utilisation of HIV and other STI prevention and care services, and coping strategies of trans-women sex workers. Data were analysed through thematic analysis using a hybrid of inductive and deductive approaches.ResultsIndividual level barriers to access and utilisation of HIV/STI prevention and care services included internalised stigma and low socio-economic status. Health system barriers included social exclusion and lack of recognition by other key population groups; stigmatisation by some healthcare providers; breach of confidentiality by some healthcare providers; limited hours of operation of some key population-friendly healthcare facilities; discrimination by straight patients and healthcare providers; stockout of STI drugs; inadequate access to well-equipped treatment centres and high cost of drugs. At community level, transphobia hindered access and utilisation of HIV/STI prevention and care services. The coping strategies included use of substitutes such as lotions, avocado or yoghurt to cope with a lack of lubricants. Herbs were used as substitutes for STI drugs, while psychoactive substances were used to cope with stigma and discrimination, and changing the dress code to hide their preferred gender identity. Conclusions Individual, community and health system level barriers hindered access and utilisation of HIV/STI prevention and care services among the trans-women sex workers. There is a need to create an enabling environment in order to enhance access to and utilisation of HIV/STI prevention and care services for trans-women sex workers through sensitisation of healthcare providers, other key population groups and the community at large on the transgender identity.

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HIV and transgender women in Kampala, Uganda – Double Jeopardy

Cited by 32 publications

References 23 publications

“You are not a man”: a multi‐method study of trans stigma and risk of HIV and sexually transmitted infections among trans men in Uganda

“You are not a man”: a multi‐method study of trans stigma and risk of HIV and sexually transmitted infections among trans men in Uganda

Barriers to access and utilisation of HIV/STIs prevention and care services among trans-women sex workers in the greater Kampala metropolitan area, Uganda

Barriers to access and utilisation of HIV/STIs prevention and care services among trans-women sex workers in the greater Kampala metropolitan area, Uganda.

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