Abstract
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. 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.ConclusionsIndividual, 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.
Highlights
Trans-women sex workers bear the greatest brunt of human immunodeficiency virus (HIV) and other sexually transmitted infections (STI)
The low education status, social exclusion [14] and lack of empowerment that are prevalent among the trans-women sex workers make it difficult for them to negotiate for HIV prevention strategies such as the correct and consistent use of condoms [12, 15,16,17]
This study revealed that discrimination of the transwomen by some healthcare providers in both general and key population-friendly healthcare facilities, and straight patients barred them from accessing HIV/STI prevention and care services
Summary
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. They remain underserved and continue to grapple with access to and utilisation of HIV/STI prevention services. The risk of HIV infection is 49 times higher among the trans-women compared to the general population [2]. The high prevalence of STIs and HIV among the trans-women sex workers could be linked to the absence of a conducive environment for accessing prevention, care, and treatment services [12, 13]. There is evidence that social, cultural and policy issues such as internalized stigma and violence, limited access to non-stigmatizing healthcare services, inaccurate perceptions of self and partners’ risk escalate STI/HIV acquisition among the trans-women sex workers [14]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
