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Jessani A, Berry-Moreau T, Parmar R, Athanasakos A, Prodger JL, Mujugira A. Healthcare access and barriers to utilization among transgender and gender diverse people in Africa: a systematic review. BMC GLOBAL AND PUBLIC HEALTH 2024; 2:44. [PMID: 38948028 PMCID: PMC11208260 DOI: 10.1186/s44263-024-00073-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/14/2024] [Indexed: 07/02/2024]
Abstract
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. Supplementary Information The online version contains supplementary material available at 10.1186/s44263-024-00073-2.
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Affiliation(s)
- Abbas Jessani
- Department of Dentistry, Schulich School of Medicine and Dentistry, Western University, London, ON Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON Canada
| | - Teagan Berry-Moreau
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, ON Canada
| | - Reeya Parmar
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, ON Canada
| | - Alexia Athanasakos
- Department of Dentistry, Schulich School of Medicine and Dentistry, Western University, London, ON Canada
| | - Jessica L. Prodger
- Department of Dentistry, Schulich School of Medicine and Dentistry, Western University, London, ON Canada
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, ON Canada
| | - Andrew Mujugira
- Department of Global Health, University of Washington, Seattle, WA USA
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
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Abu-Ba’are GR, Shamrock OW, Zigah EY, Ogunbajo A, Dakpui HD, Agbemedu GRK, Boyd DT, Ezechi OC, Nelson LE, Torpey K. Qualitative description of interpersonal HIV stigma and motivations for HIV testing among gays, bisexuals, and men who have sex with men in Ghana's slums-BSGH-005. PLoS One 2024; 19:e0289905. [PMID: 38837972 PMCID: PMC11152275 DOI: 10.1371/journal.pone.0289905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 05/21/2024] [Indexed: 06/07/2024] Open
Abstract
Despite significant progress in Ghana's HIV response, disparities in HIV prevalence persist among different populations. Gays, bisexuals, and other men who have sex with men (GBMSM) in the country remain vulnerable to HIV infection due to high levels of stigma and discrimination, limited access to healthcare services, and low HIV knowledge levels. While limited studies focus on HIV prevention and care in the Ghanaian GBMSM context, we did not find studies on GBMSM in slums. We, therefore, explored stigma and motivations of HIV testing among GBMSM in slums. In collaboration with our community partners, we recruited and conducted face-to-face interviews among 12 GBMSM from slums in Accra and Kumasi, Ghana. Our multiple-reviewer summative content analysis identified the following: under HIV stigma, we identified two categories, avoidance of GBMSM living with HIV and fear of testing positive for HIV. Under motivations for HIV testing, we identified three categories; HIV vulnerability, knowing one's HIV status, and positive messaging about HIV. Our findings provide valuable insights into stigma and motivations for HIV testing among GBMSM in Ghanaian slums. They also highlight the importance of targeted HIV education interventions to empower GBMSM to take responsibility for their sexual health and address the unique challenges they face accessing HIV testing services.
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Affiliation(s)
- Gamji Rabiu Abu-Ba’are
- Behavioral, Sexual and Global Health Lab, School of Nursing, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama’a Action, West Legon, Accra, Ghana
- Department of Public Health Sciences, University of Rochester, Rochester, New York, United States of America
- School of Nursing, Yale University, New Haven, Connecticut, United States of America
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Osman Wumpini Shamrock
- Behavioral, Sexual and Global Health Lab, School of Nursing, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama’a Action, West Legon, Accra, Ghana
| | - Edem Yaw Zigah
- Behavioral, Sexual and Global Health Lab, School of Nursing, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama’a Action, West Legon, Accra, Ghana
| | - Adedotun Ogunbajo
- Us Helping Us People into Living, Washington, DC, United States of America
| | - Henry Delali Dakpui
- Behavioral, Sexual and Global Health Lab, School of Nursing, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama’a Action, West Legon, Accra, Ghana
| | - George Rudolph Kofi Agbemedu
- Behavioral, Sexual and Global Health Lab, School of Nursing, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama’a Action, West Legon, Accra, Ghana
| | - Donte T. Boyd
- College of Social Work, Ohio State University, Columbus, Ohio, United States of America
| | - Oliver C. Ezechi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - LaRon E. Nelson
- School of Nursing, Yale University, New Haven, Connecticut, United States of America
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
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Beres LK, Underwood A, Le Tourneau N, Kemp CG, Kore G, Yaeger L, Li J, Aaron A, Keene C, Mallela DP, Khalifa BAA, Mody A, Schwartz SR, Baral S, Mwamba C, Sikombe K, Eshun‐Wilson I, Geng EH, Lavoie MC. Person-centred interventions to improve patient-provider relationships for HIV services in low- and middle-income countries: a systematic review. J Int AIDS Soc 2024; 27:e26258. [PMID: 38740547 PMCID: PMC11090778 DOI: 10.1002/jia2.26258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/16/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Person-centred care (PCC) has been recognized as a critical element in delivering quality and responsive health services. The patient-provider relationship, conceptualized at the core of PCC in multiple models, remains largely unexamined in HIV care. We conducted a systematic review to better understand the types of PCC interventions implemented to improve patient-provider interactions and how these interventions have improved HIV care continuum outcomes and person-reported outcomes (PROs) among people living with HIV in low- and middle-income countries. METHODS We searched databases, conference proceedings and conducted manual targeted searches to identify randomized trials and observational studies published up to January 2023. The PCC search terms were guided by the Integrative Model of Patient-Centeredness by Scholl. We included person-centred interventions aiming to enhance the patient-provider interactions. We included HIV care continuum outcomes and PROs. RESULTS We included 28 unique studies: 18 (64.3%) were quantitative, eight (28.6.%) were mixed methods and two (7.1%) were qualitative. Within PCC patient-provider interventions, we inductively identified five categories of PCC interventions: (1) providing friendly and welcoming services; (2) patient empowerment and improved communication skills (e.g. supporting patient-led skills such as health literacy and approaches when communicating with a provider); (3) improved individualized counselling and patient-centred communication (e.g. supporting provider skills such as training on motivational interviewing); (4) audit and feedback; and (5) provider sensitisation to patient experiences and identities. Among the included studies with a comparison arm and effect size reported, 62.5% reported a significant positive effect of the intervention on at least one HIV care continuum outcome, and 100% reported a positive effect of the intervention on at least one of the included PROs. DISCUSSION Among published HIV PCC interventions, there is heterogeneity in the components of PCC addressed, the actors involved and the expected outcomes. While results are also heterogeneous across clinical and PROs, there is more evidence for significant improvement in PROs. Further research is necessary to better understand the clinical implications of PCC, with fewer studies measuring linkage or long-term retention or viral suppression. CONCLUSIONS Improved understanding of PCC domains, mechanisms and consistency of measurement will advance PCC research and implementation.
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Affiliation(s)
- Laura K. Beres
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Centre for Infectious Disease Research in Zambia (CIDRZ)LusakaZambia
| | - Ashley Underwood
- Washington University in St. Louis School of MedicineSt LouisMissouriUSA
| | - Noelle Le Tourneau
- Washington University in St. Louis School of MedicineSt LouisMissouriUSA
| | | | - Gauri Kore
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Lauren Yaeger
- Washington University in St. Louis School of MedicineSt LouisMissouriUSA
| | - Jingjia Li
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Alec Aaron
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | | | | | - Aaloke Mody
- Centre for Infectious Disease Research in Zambia (CIDRZ)LusakaZambia
| | | | - Stefan Baral
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Chanda Mwamba
- Centre for Infectious Disease Research in Zambia (CIDRZ)LusakaZambia
| | | | | | - Elvin H. Geng
- Washington University in St. Louis School of MedicineSt LouisMissouriUSA
| | - Marie‐Claude C. Lavoie
- Center for International Health Education and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
- Institute of Human VirologyUniversity of Maryland School of MedicineBaltimoreMarylandUSA
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Moyo PL, Nunu WN. Exploring Barriers and Facilitators That Influence Uptake of Oral Pre-Exposure Prophylaxis Among Men Who Have Sex With Men in Bulawayo, Zimbabwe: Key Stakeholder's Perspectives. Am J Mens Health 2024; 18:15579883231223377. [PMID: 38183239 PMCID: PMC10771743 DOI: 10.1177/15579883231223377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 01/07/2024] Open
Abstract
The world has been on the path to ending HIV and AIDS as a global threat by 2030; despite these efforts, the rate of new HIV infections among men who have sex with men remains very high. This study sought to explore the perceptions of key stakeholders on the potential barriers and facilitators of pre-exposure prophylaxis use among this key population. An exploratory, descriptive (through interviews) qualitative study was conducted on 10 key informants who were purposively selected and snowballed based on their knowledge and experience toward pre-exposure prophylaxis programming among men who have sex with men. The interviews were recorded, transcribed verbatim, coded, and thematically analyzed on MAXQDA. Stated barriers were stigma, lack of information, wrong messaging around pre-exposure prophylaxis, hearing negative things about the pills, the burden of taking pills daily, negative attitudes from health care providers, non-friendly health care facilities, pre-exposure prophylaxis not being affordable, and lack of flexibility and privacy from public hospitals. Identified facilitators were correct messaging on pre-exposure prophylaxis, long-lasting injectable pre-exposure prophylaxis, improved packaging, de-stigmatization, more friendly facilities, differentiated service approach, community groups, engagement, and partnership. To address these barriers and leverage the facilitators, it is imperative to have accessible, affordable services, non-judgmental health care providers, and peer support networks to empower men who have sex with men to make informed decisions regarding their sexual and reproductive health. Continued efforts to remove barriers and promote facilitators are crucial for maximizing the potential of pre-exposure prophylaxis as an effective HIV prevention tool among this population.
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Affiliation(s)
- Perez Livias Moyo
- Department of Environmental Health, Faculty of Environmental Science, National University of Science and Technology, Bulawayo, Zimbabwe
| | - Wilfred Njabulo Nunu
- Department of Environmental Health, Faculty of Environmental Science, National University of Science and Technology, Bulawayo, Zimbabwe
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Shamrock OW, Abu-Ba'are GR, Zigah EY, Apreku A, Agbemedu GRK, Boyd DT, Adjaka G, Nelson LE. Family rejection of non-hetero sexuality-Sexual orientation and behavior anonymity among sexual minority men in slum communities-BSGH 001. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001659. [PMID: 38039264 PMCID: PMC10691700 DOI: 10.1371/journal.pgph.0001659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 11/04/2023] [Indexed: 12/03/2023]
Abstract
It can be challenging for sexual minority men (SMM) to decide whether or not to disclose their sexual orientation or behavior. The implications of this decision are significant, especially when considering how their family might react. We interviewed individuals living in slum communities (n = 12) in Accra and Kumasi, Ghana. Our study found that two factors primarily influenced the decision of SMM to disclose their sexual orientation. Firstly, SMM feared facing harm from their families and, secondly, the close ties of SMM families to religious institutions in their communities, which taught against LGBTQ+ activities in the country. These findings contribute to understanding why SMM in Ghanaian slum communities choose to keep their sexual orientation anonymous. While no single intervention is enough to address the challenges associated with coming out, participants in the study agreed that a social support intervention that provides opportunities to educate and inform their families and community on LGBTQ+ activities could help them assimilate comfortably in their communities.
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Affiliation(s)
- Osman Wumpini Shamrock
- School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
| | - Gamji Rabiu Abu-Ba'are
- School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
- Department of Public Health Sciences, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, United States of America
| | - Edem Yaw Zigah
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
| | - Amos Apreku
- Behavioral, Sexual and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - George Rudolph Kofi Agbemedu
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
| | - Donte T Boyd
- College of Social Work, Ohio State University, Columbus, Ohio, United States of America
| | | | - LaRon E Nelson
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, United States of America
- School of Nursing, Yale, Connecticut, United States of America
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Marea CX, Warren N, Glass N, Ahmed W, Pallitto CC. Advancing the measurement of knowledge, attitudes and practices of health workers who care for women and girls who have undergone female genital mutilation/ cutting (FGM/C): A qualitative exploration of expert opinion. PLoS One 2023; 18:e0284900. [PMID: 37104292 PMCID: PMC10138782 DOI: 10.1371/journal.pone.0284900] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 04/01/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Female genital mutilation or cutting (FGM/C) is a social norm driven practice associated with numerous adverse health complications. Existing assessment tools for health workers are limited by lack of a clear framework for what constitutes the critical knowledge, attitudes, and practices that impact FGM/C prevention and care. The aim of this study was to explore expert opinion of the knowledge, attitudes, and practices for FGM/C-related prevention and care that can be used to inform the development of future KAP measurement tools. METHODS We conducted 32 semi-structured individual interviews with global clinical and research experts on FGM/C from 30 countries including participants from Africa, Australia/ New Zealand, Europe, the Middle East, and North America. Interview questions explored areas of knowledge, attitudes, and practices that influence FGM/C-related prevention and care activities. We used the directed content analysis methodology for the qualitative data analysis. RESULTS We identified six categories of knowledge, six of practice, and seven of attitudes that contribute to FGM/C-related prevention and care. Areas of knowledge included: general knowledge about FGM/C; who is at risk for experiencing FGM/C; support for FGM/C; female genital anatomy/ physiology; health complications of FGM/C; management of health complications of FGM/C; ethical and legal considerations for the treatment and prevention of FGM/C, and patient-health worker communication. Areas of practice included: clinical procedures and protocols; management of complications; defibulation; other surgical procedures for FGM/C; pediatric care (including prevention); and patient-centered care. Participants described health worker attitudes that may affect how prevention and care activities are delivered and/or received including attitudes toward: the perceived benefits of FGM/C; harms of FGM/C; ethical considerations related to FGM/C medicalization, prevention, and treatment; providing care for FGM/C-affected clients; women and girls who have experienced FGM/C; communities that practice FGM/C; and affective response to FGM/C. We also present participant perspectives on the ways in which knowledge, attitudes, and practice interact impacting the type and quality of care provided to those affected by FGM/C. CONCLUSIONS This study identified specific areas of knowledge, attitudes, and practices in FGM/C prevention and care that are important to include in future evaluation metrics. Future KAP tools should be theoretically informed using the framework we present, and assessed for validity and reliability using psychometrically rigorous methods. Developers of KAP tools should consider the hypothesized relationships between knowledge, attitudes, and practices.
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Affiliation(s)
- Christina X. Marea
- Georgetown University School of Nursing, Washington, D.C., United States of America
| | - Nicole Warren
- Johns Hopkins University School of Nursing, Baltimore, MD, United States of America
| | - Nancy Glass
- Johns Hopkins University School of Nursing, Baltimore, MD, United States of America
| | - Wisal Ahmed
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Christina C. Pallitto
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Muwanguzi PA, Nabunya R, Karis VMS, Nabisere A, Nangendo J, Mujugira A. Nurses' reflections on caring for sexual and gender minorities pre-post stigma reduction training in Uganda. BMC Nurs 2023; 22:50. [PMID: 36823533 PMCID: PMC9947888 DOI: 10.1186/s12912-023-01208-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) and transgender women (TGW) have a significant HIV burden worldwide. Data from eight countries across sub-Saharan Africa found a pooled HIV prevalence of 14% among MSM and 25% among TGW. Stigma and discrimination among healthcare providers are barriers to healthcare access by these populations. We sought to explore nurses' attitudes before and after sensitivity training to reduce stigma in HIV prevention and care provision to MSM and transgender persons in Uganda. METHODS An explorative qualitative study comprising in-depth interviews. Nineteen nurses who underwent sensitivity training in caring for the vulnerable, priority and key populations in Uganda participated. We interviewed each participant before and after the stigma reduction training and analyzed the data with NVivo. RESULTS Eight (8) themes emerged from the reflections before the training, namely, 'the definition of MSM and transgender persons', 'legal concerns', 'mental illness', 'attitude in health care provision', 'personal perceptions', 'self-efficacy', 'insufficient training preparation', and 'reasons for gender or sexual orientation preference'. The post-training reflections suggested a change in knowledge and attitude. Five themes emerged for MSM: 'stigma reduction', 'sexual practices and sexuality', 'the need for tailored health approaches', 'MSM and the law' and 'corrected misconceptions'. For transmen, 'reproductive health needs', 'social needs', 'safety needs', 'Gender identity recognition' and 'reduced stigma, discrimination, and barriers to care'. Finally, the reflections on their attitudes towards transwomen were on five topics; Gender affirming care', 'Healthcare provision for transwomen', 'Need for further training', 'New knowledge acquired', and 'Sexual violence'. CONCLUSION Nurses' attitudes and empathy for vulnerable and key populations improved following the training. Nursing training programs should consider incorporating sexual and gender minority (SGM) specific health training into their curricula to decrease negative attitudes. There is a need to identify best practices and conduct implementation research to provide culturally sensitive and affirming healthcare delivery in sub-Saharan Africa. Future studies should evaluate the effect of provider sensitivity training on sexual health and HIV outcomes for SGM. Furthermore, interventions targeting higher-level stigma, such as structural and policy levels, are critical because they influence interpersonal stigma reduction efforts and initiatives.
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Affiliation(s)
- Patience A. Muwanguzi
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, P. O. Box 7072, Uganda
| | - Racheal Nabunya
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, P. O. Box 7072, Uganda
| | - Victoria M. S. Karis
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, P. O. Box 7072, Uganda
| | - Allen Nabisere
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, P. O. Box 7072, Uganda
| | - Joan Nangendo
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, P.O. BOX 7072, Uganda
| | - Andrew Mujugira
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, P. O Box 22418, Uganda
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Keuroghlian AS, Keatley J, Shaikh S, Radix AE. The context, science and practice of gender-affirming care. Nat Med 2022; 28:2464-2467. [PMID: 36522607 DOI: 10.1038/s41591-022-02082-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Alex S Keuroghlian
- The Fenway Institute, Fenway Health, Boston, MA, USA. .,Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - JoAnne Keatley
- Innovative Response Globally for Transgender Women and HIV, Oakland, CA, USA
| | - Simran Shaikh
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Asa E Radix
- Callen-Lorde Community Health Center, New York, NY, USA
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Odokonyero RF, Musanje K, Mpirirwe R, Namisi CP. Promoting HIV-Related Behavioral and Social Science Research Training in Africa: A Case of Uganda. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:1381-1384. [PMID: 36388750 PMCID: PMC9664997 DOI: 10.2147/amep.s387198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
HIV/AIDS is a major contributor to morbidity and mortality in Sub-Saharan Africa (SSA). Several gaps in HIV/AIDS care persist despite advancements in bio-medical care approaches. Socio-behavioral approaches have been identified to have the capacity to plug these gaps. This calls for HIV- related behavioral and social science research (BSSR) capacity building. Adopting BSSR in HIV may provide insights into the HIV care continuum that is contextual and cost-effective and reveal the missing layer in the fight against HIV on the African continent. The Makerere University Behavioral and Social Sciences Research (Mak-BSSR) program has responded to the call to strengthen capacity in BSSR. This commentary is a call to promote, support, and sustain the collaborations needed to integrate behavioral and social science research into HIV in SSA.
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Affiliation(s)
- Raymond Felix Odokonyero
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Khamisi Musanje
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Educational, Social and Organizational Psychology, School of Psychology, College of Humanities and Social Sciences, Makerere University, Kampala, Uganda
| | - Ruth Mpirirwe
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Patrick Namisi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Dean’s Office, School of Medicine, Uganda Martyrs’ University, Mother Kevin Postgraduate School, Kampala, Uganda
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Tun W, Pulerwitz J, Shoyemi E, Fernandez A, Adeniran A, Ejiogu F, Sangowawa O, Granger K, Dirisu O, Adedimeji AA. A qualitative study of how stigma influences HIV services for transgender men and women in Nigeria. J Int AIDS Soc 2022; 25 Suppl 1:e25933. [PMID: 35818868 PMCID: PMC9274359 DOI: 10.1002/jia2.25933] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/05/2022] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Transgender men and women in Nigeria experience many barriers in accessing HIV prevention and treatment services, particularly given the environment of transphobia (including harassment, violence and discrimination) and punitive laws in the country. HIV epidemic control in Nigeria requires improving access to and quality of HIV services for key populations at high risk, including transgender men and women. We assessed how stigma influences HIV services for transgender people in Lagos, Nigeria. METHODS In-depth interviews (IDIs) and focus group discussions were conducted with transgender men (n = 13) and transgender women (n = 25); IDIs were conducted with community service organization (CSO) staff (n = 8) and healthcare providers from CSO clinics and public health facilities (n = 10) working with the transgender population in March 2021 in Lagos. Content analysis was used to identify how stigma influences transgender people's experiences with HIV services. RESULTS AND DISCUSSION Three main findings emerged. First, gender identity disclosure is challenging due to anticipated stigma experienced by transgender persons and fear of legal repercussions. Fear of being turned in to authorities was a major barrier to disclose to providers in facilities not affiliated with a transgender-inclusive clinic. Providers also reported difficulty in eliciting information about the client's gender identity. Second, respondents reported lack of sensitivity among providers about gender identity and conflation of transgender men with lesbian women and transgender women with being gay or men who have sex with men, the latter being more of a common occurrence. Transgender participants also reported feeling disrespected when providers were not sensitive to their pronoun of preference. Third, HIV services that are not transgender-inclusive and gender-affirming can reinforce stigma. Both transgender men and women spoke about experiencing stigma and being refused HIV services, especially in mainstream public health facilities, as opposed to transgender-inclusive CSO clinics. CONCLUSIONS This study highlights how stigma impedes access to appropriate HIV services for transgender men and women, which can have a negative impact along the HIV care continuum. There is a need for transgender-inclusive HIV services and competency trainings for healthcare providers so that transgender clients can receive appropriate and gender-affirming HIV services.
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Affiliation(s)
- Waimar Tun
- Social and Behavioral Science Research, Population Council, Washington, DC, USA
| | - Julie Pulerwitz
- Social and Behavioral Science Research, Population Council, Washington, DC, USA
| | | | | | | | | | | | - Krista Granger
- Social and Behavioral Science Research, Population Council, Washington, DC, USA
| | - Osasuyi Dirisu
- Policy Innovation Unit, Nigerian Economic Summit Group, Lagos, Nigeria
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Affiliation(s)
- Alex S Keuroghlian
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA. .,Massachusetts General Hospital, Boston, Massachusetts, USA. .,Harvard Medical School, Boston, Massachusetts, USA.
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Barr D, P Garnett G, Mayer KH, Morrison M. Key populations are the future of the African HIV/AIDS pandemic. J Int AIDS Soc 2021; 24 Suppl 3:e25750. [PMID: 34189865 PMCID: PMC8242978 DOI: 10.1002/jia2.25750] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
| | | | - Kenneth H Mayer
- The Fenway InstituteBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA
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