Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.
Programs Department, Transgender Equality Uganda, Kampala, Uganda.
BMC Infect Dis. 2020 Dec 7;20(1):932. doi: 10.1186/s12879-020-05649-5.
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.
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.
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.
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.
跨性别女性性工作者是 HIV 和其他性传播感染（STI）的最大受害者。跨性别女性感染 HIV 的风险比一般人群高 49 倍。然而，她们的服务需求仍然得不到满足，并且仍然难以获得和利用 HIV/性传播感染预防服务。本研究探讨了跨性别女性性工作者获得和利用 HIV/性传播感染预防服务的障碍以及相关的应对机制。
本探索性定性研究在乌干达坎帕拉大都市区的跨性别女性性工作者中进行。共进行了 22 次深入访谈、6 次关键知情人访谈和 9 次焦点小组讨论，以获取有关跨性别女性性工作者获得和利用 HIV 和其他 STI 预防和护理服务的障碍以及应对策略的数据。使用混合归纳和演绎方法的主题分析对数据进行分析。
个人层面获得和利用 HIV/性传播感染预防和护理服务的障碍包括内在的耻辱感和较低的社会经济地位。医疗保健系统障碍包括社会排斥和其他关键人群群体的不认可；一些医疗保健提供者的污名化；一些医疗保健提供者违反保密规定；一些关键人群友好型医疗设施营业时间有限；异性恋患者和医疗保健提供者的歧视；性传播感染药物缺货；获得设备齐全的治疗中心的机会有限，以及药物费用高昂。在社区层面，跨性别恐惧症阻碍了跨性别女性性工作者获得和利用 HIV/性传播感染预防和护理服务。应对策略包括使用乳液、鳄梨或酸奶等替代品来应对润滑剂不足的问题。草药被用作性传播感染药物的替代品，而精神活性物质则被用于应对耻辱和歧视，以及改变着装规范以隐藏他们偏爱的性别认同。
个人、社区和医疗保健系统的障碍阻碍了跨性别女性性工作者获得和利用 HIV/性传播感染预防和护理服务。需要创造一个有利的环境，通过提高医疗保健提供者、其他关键人群群体和整个社区对跨性别身份的认识，来增强跨性别女性性工作者获得和利用 HIV/性传播感染预防和护理服务的机会。
