Stigma and healthcare access among men who have sex with men and transgender women who have sex with men in Senegal

Dibble, Kate E.; Baral, Stefan; Beymer, Matthew R; Stahlman, Shauna; Lyons, Carrie; Olawore, Oluwasolape; Ndour, Cheikh Tidiane; Nunez, Gnilane Turpin; Touré-Kâne, Coumba; Diouf, Nafissatou Leye; Diouf, Daouda; Dramé, Fatou Maria; Mboup, Souleymane; Murray, Sarah

doi:10.1177/20503121211069276

Cited by 6 publications

(6 citation statements)

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“…Fourteen articles13 68–80 were partially intersectional stigma studies incorporating an intersectional approach to some elements of the analysis or presentation of their findings. We also identified 10 articles81–90 that studied multiple stigmas in a non-intersectional manner and 142 articles4 13 16–18 21 51 52 91–224 that studied one stigma in one population of SGM or studied one stigma in each of multiple populations (eg, SSSAB stigma only among MSM and transgender stigma only among TGW). A summary of each intersectional stigma study (n=21) appears in online supplemental file 2 and a summary of each non-intersectional stigma study (n=152) appears in online supplemental file 3.…”

Section: Resultsmentioning

confidence: 99%

Scoping review of HIV-related intersectional stigma among sexual and gender minorities in sub-Saharan Africa

Dada,

Abu-Ba’are,

Turner

et al. 2024

BMJ Open

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ObjectivesSexual and gender minority (SGM) populations in sub-Saharan Africa (SSA) are disproportionately impacted by HIV and often face multiple HIV-related stigmas. Addressing these stigmas could reduce SGM HIV vulnerability but little is known about how the stigmas operate and intersect. Intersectional stigma offers a lens for understanding the experiences of stigmatised populations and refers to the synergistic negative health effects of various systems of oppression on individuals with multiple stigmatised identities, behaviours or conditions. This review aims to (1) assess how often and in what ways an intersectional lens is applied in HIV-related stigma research on SGM populations in SSA and (2) understand how intersectional stigma impacts HIV risk in these populations.DesignScoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews.Data sourcesPublic health and regional databases were searched in 2020 and 2022.Eligibility criteriaArticles in French and English on HIV-related stigma and HIV outcomes among men who have sex with men, women who have sex with women and/or transgender individuals in SSA.Data extraction and synthesisArticles were screened and extracted twice and categorised by use of an intersectional approach. Study designs and stigma types were described quantitatively and findings on intersectional stigma were thematically analysed.ResultsOf 173 articles on HIV-related stigma among SGM in SSA included in this review, 21 articles (12%) applied an intersectional lens. The most common intersectional stigmas investigated were HIV and same-sex attraction/behaviour stigma and HIV, same-sex attraction/behaviour and gender non-conformity stigma. Intersectional stigma drivers, facilitators and manifestations were identified across individual, interpersonal, institutional and societal socioecological levels. Intersectional stigma impacts HIV vulnerability by reducing HIV prevention and treatment service uptake, worsening mental health and increasing exposure to HIV risk factors.ConclusionIntersectional approaches are gaining traction in stigma research among SGM in SSA. Future research should prioritise quantitative and mixed methods investigations, diverse populations and intervention evaluation.

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Section: Resultsmentioning

confidence: 99%

Scoping review of HIV-related intersectional stigma among sexual and gender minorities in sub-Saharan Africa

Dada,

Abu-Ba’are,

Turner

et al. 2024

BMJ Open

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“…Nine studies discussed barriers to the uptake and adherence of healthcare services [ 28 , 39 , 41 – 43 , 50 – 53 ]. Respondents frequently reported two significant barriers to PrEP uptake and adherence: daily dosing patterns and human immunodeficiency virus (HIV)-related stigma [ 38 , 41 , 52 ].…”

Section: Resultsmentioning

confidence: 99%

“…Four studies discussed individualized stigma as a barrier to healthcare access and utilization [ 28 , 43 , 54 , 55 ]. TGD women highlighted emotions of shame and low self-esteem that influenced their health-seeking behaviours, with some participants expressing concern about being unwelcomed by HCPs [ 28 , 54 ].…”

Section: Resultsmentioning

confidence: 99%

“…Thirty-six of the studies included in this research discussed healthcare-related stigma as a barrier, in addition to individualized stigma [ 2 , 4 , 26 – 32 , 34 , 36 , 37 , 39 , 43 , 44 , 46 – 67 ]. HCP attitudes were frequently reported as a key barrier to healthcare access and utilization by TGD people, with some participants reporting that they did not receive the same level of care as cisgender patients [ 28 ].…”

Section: Resultsmentioning

confidence: 99%

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Healthcare access and barriers to utilization among transgender and gender diverse people in Africa: a systematic review

Jessani,

Berry-Moreau,

Parmar

et al. 2024

BMC Global Public Health

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Background Transgender and gender diverse (TGD) people face significant challenges in accessing timely, culturally competent, and adequate healthcare due to structural and systemic barriers, yet there is a lack of research exploring the access and utilization of healthcare services within African TGD communities. To address this gap, this systematic review explored: (1) barriers to accessing healthcare services and gender-affirming hormone therapy (GAHT) faced by TGD people, (2) demographic and societal factors correlated with the utilization of healthcare services and GAHT, (3) common healthcare and support services utilized by TGD people, and (4) patterns of accessing healthcare services and GAHT within TGD communities. Methods A systematic literature search was conducted in PubMed, Embase, and Scopus in September 2023. Eligible studies included peer-reviewed original research, reports, and summaries published in the English language assessing health service accessibility and utilization of TGD people in Africa between January 2016 and December 2023. Results From 2072 potentially relevant articles, 159 were assessed for eligibility following duplicate removal, and 49 were included for analysis. Forty-five articles addressed barriers to accessing healthcare services and GAHT, seven focused on demographic and societal factors correlated with the utilization of healthcare services and GAHT, 16 covered common healthcare and support services utilized by TGD people, and seven examined patterns of accessing healthcare services and GAHT. Findings suggested a limited availability of health services, inadequate knowledge of TGD healthcare needs among healthcare providers, a lack of recognition of TGD people in healthcare settings, healthcare-related stigma, and financial constraints within African TGD communities. An absence of studies conducted in Northern and Central Africa was identified. Conclusions TGD people in Africa encounter significant barriers when seeking healthcare services, leading to disparity in the utilization of healthcare and resulting in a disproportionate burden of health risks. The implications of these barriers highlight the urgent need for more high-quality evidence to promote health equity for African TGD people. Trial registration PROSPERO CRD42024532405.

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“…Our findings are similar to observations in several sub-Saharan African countries that young MSM and TG people are especially vulnerable to HRVs. 6 , 12 , 13 , 14 , 15 , 16 …”

Section: Discussionmentioning

confidence: 99%

Human rights violations among men who have sex with men and transgender people in South Africa

Chimatira

Jebese-Mfenqe

Chikwanda

et al. 2023

Southern African Journal of HIV Medicine

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Background: Men who have sex with men (MSM) and transgender (TG) people face human rights violations (HRVs) which impact their access to critical interventions for HIV prevention, treatment, and related services.Objectives: This study describes how Beyond Zero, a not-for-profit organisation in South Africa built an HRV reporting system and discusses data on the HRVs experienced by MSM and TG people who accessed HIV prevention services between 01 January 2021 and 31 December 2021.Method: This was a cross-sectional study using secondary analysis of programmatic data routinely collected as part of HIV prevention programmes for MSM and TG in 10 rural districts of South Africa.Results: A total of 249 individuals reported having experienced HRVs. Of these, 113 (54.6%) were physical violations, 145 (58.2%) were psychosocial harassment, 15 (18.3%) were experienced within the workplace, and 59 (23.7%) were experienced at a healthcare or social services institution. Overall, 77% of the physical violations and 70.4% of the psychosocial violations occurred in the home and local community settings; 76.1% of the perpetrators of physical violence and 79.3% of the perpetrators of psychosocial harassment were known. Most incidents of physical violence (80.5%) and psychosocial harassment (92.4%) were not reported due to fear of homophobic or transphobic violence.Conclusion: Our findings demonstrate the feasibility of documenting HRVs among MSM and TG people within HIV prevention programmes. Men who have sex with men and TG people should be systematically screened for HRVs and linked to legal or other services.Contribution: Our findings present data on the nature of HRVs in 10 districts outside of the large urban centres where research documenting the lived experiences of MSM, TG people and other key populations is traditionally conducted in South Africa. Such data contribute to addressing the gap in the literature on the needs of MSM and TG people in South Africa caused by the delayed inclusion of rural MSM and TG people in research.

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Stigma and healthcare access among men who have sex with men and transgender women who have sex with men in Senegal

Cited by 6 publications

References 58 publications

Scoping review of HIV-related intersectional stigma among sexual and gender minorities in sub-Saharan Africa

Scoping review of HIV-related intersectional stigma among sexual and gender minorities in sub-Saharan Africa

Healthcare access and barriers to utilization among transgender and gender diverse people in Africa: a systematic review

Human rights violations among men who have sex with men and transgender people in South Africa

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