Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada.
J Int AIDS Soc. 2012 Sep 7;15(2):17392. doi: 10.7448/IAS.15.2.17392.
Lesbian, bisexual, queer and transgender (LBQT) women living with HIV have been described as invisible and understudied. Yet, social and structural contexts of violence and discrimination exacerbate the risk of HIV infection among LBQT women. The study objective was to explore challenges in daily life and experiences of accessing HIV services among HIV-positive LBQT women in Toronto, Canada.
We used a community-based qualitative approach guided by an intersectional theoretical framework. We conducted two focus groups; one focus group was conducted with HIV-positive lesbian, bisexual and queer women (n = 7) and the second with HIV-positive transgender women (n = 16). Participants were recruited using purposive sampling. Focus groups were digitally recorded and transcribed verbatim. Thematic analysis was used for analyzing data to enhance understanding of factors that influence the wellbeing of HIV-positive LBQT women.
Participant narratives revealed a trajectory of marginalization. Structural factors such as social exclusion and violence elevated the risk for HIV infection; this risk was exacerbated by inadequate HIV prevention information. Participants described multiple barriers to HIV care and support, including pervasive HIV-related stigma, heteronormative assumptions in HIV-positive women's services and discriminatory and incompetent treatment by health professionals. Underrepresentation of LBQT women in HIV research further contributed to marginalization and exclusion. Participants expressed a willingness to participate in HIV research that would be translated into action.
Structural factors elevate HIV risk among LBQT women, limit access to HIV prevention and present barriers to HIV care and support. This study's conceptualization of a trajectory of marginalization enriches the discussion of structural factors implicated in the wellbeing of LBQT women and highlights the necessity of addressing LBQT women's needs in HIV prevention, care and research. Interventions that address intersecting forms of marginalization (e.g. sexual stigma, transphobia, HIV-related stigma) in community and social norms, HIV programming and research are required to promote health equity among LBQT women.
艾滋病毒感染者中的女同性恋、双性恋、酷儿和跨性别者（LBQT）被描述为隐形和研究不足的群体。然而，暴力和歧视的社会和结构性背景加剧了 LBQT 女性感染艾滋病毒的风险。本研究的目的是探讨加拿大多伦多 HIV 阳性 LBQT 女性在日常生活中面临的挑战和获得艾滋病毒服务的经历。
我们使用社区为基础的定性方法，以交叉理论框架为指导。我们进行了两次焦点小组讨论；一次焦点小组讨论是与 HIV 阳性女同性恋、双性恋和酷儿女性（n=7）进行的，另一次是与 HIV 阳性跨性别女性（n=16）进行的。参与者是通过目的性抽样招募的。焦点小组的讨论内容被数字化记录并逐字转录。使用主题分析对数据进行分析，以增强对影响 HIV 阳性 LBQT 女性福祉的因素的理解。
参与者的叙述揭示了一条边缘化的轨迹。社会排斥和暴力等结构性因素增加了感染艾滋病毒的风险；艾滋病毒预防信息不足进一步加剧了这种风险。参与者描述了获得艾滋病毒护理和支持的多种障碍，包括普遍存在的艾滋病毒相关耻辱感、艾滋病毒阳性女性服务中的异性恋规范假设以及卫生专业人员的歧视性和不称职的治疗。艾滋病毒研究中 LBQT 女性代表性不足进一步导致边缘化和排斥。参与者表示愿意参与将转化为行动的艾滋病毒研究。
结构性因素增加了 LBQT 女性感染艾滋病毒的风险，限制了艾滋病毒预防措施的获取，并对艾滋病毒护理和支持造成障碍。本研究对边缘化轨迹的概念化丰富了对影响 LBQT 女性福祉的结构性因素的讨论，并强调了在艾滋病毒预防、护理和研究中解决 LBQT 女性需求的必要性。需要采取干预措施，解决社区和社会规范、艾滋病毒规划和研究中交叉形式的边缘化（如性耻辱感、跨性别恐惧症、艾滋病毒相关耻辱感），以促进 LBQT 女性的健康公平。
