Bothma Rutendo, Pettifor Audrey, Maphosa Innocent, Ndlovu Philisiwe, Imrie John, Poteat Tonia
Wits RHI, University of the Witwatersrand, Johannesburg, South Africa.
Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
J Int AIDS Soc. 2025 Jul;28 Suppl 3(Suppl 3):e26503. doi: 10.1002/jia2.26503.
The World Health Organization promotes a transgender-differentiated service delivery (TG-DSD) model to overcome barriers to HIV service engagement among transgender people (TGP). For TGP, an essential element of DSD includes gender-affirming care which is non-stigmatising, free from discrimination and celebrates their gender identity. The Jabula Uzibone Study, launched in November 2023, assesses the cost and effectiveness of TG-DSD on HIV outcomes. In this paper, we describe the baseline characteristics of TGP in our study and explore whether there are differences in healthcare experiences among those seeking care at TG-DSD clinics versus standard service delivery (SSD) clinics at baseline.
This observational, mixed-method, prospective implementation study compares models of care at four TG-DSD and four SSD facilities using standardised observation checklists, in-depth and key informant interviews. For this paper, we asked participants about healthcare experiences and experiences of stigma through a structured, interviewer-administered quantitative survey. We assessed the sections of the quantitative survey which ask about self-reported experiences of stigma.
The study enrolled 422 TGP with HIV (217 TG-DSD and 205 SSD) and 248 TGP without HIV (128 TG-DSD and 120 SSD); 15% (102/670) gender non-conforming, 15% (91/670) TG men and 70% (477/670) TG women. Participants' median age was 29 years, interquartile range: 24-35 years. SSD participants at baseline were 46% more likely to experience stigma compared to their TG-DSD counterparts (aOR = 1.46, 95% CI: 1.06, 2.01). SSD participants were more likely to encounter a healthcare provider who is unwilling to provide care for them (aOR = 1.55, 95% CI: 1.09, 2.21) and to report that healthcare workers are unable to provide the same quality care to TGP as they do other people (aOR = 1.46, 95% CI: 1.00, 1.91) compared to their TG-DSD counterparts.
TGP from TG-DSD facilities were less likely to report experiences of facility-based enacted stigma at baseline, compared to the TGP from SSD facilities. Our study highlights the importance of provider training in tailored transgender healthcare to provide gender-affirming healthcare services. Results from the Jabula Uzibone study will provide further evidence of the effectiveness of TG-DSD models in sub-Saharan Africa, and the role of stigma and discrimination in HIV outcomes among TGP.
世界卫生组织推行一种针对跨性别者的差异化服务提供（TG-DSD）模式，以克服跨性别者（TGP）在参与艾滋病病毒服务方面的障碍。对于跨性别者而言，差异化服务提供的一个关键要素包括性别肯定性护理，这种护理不存在污名化、没有歧视，且认可他们的性别认同。2023年11月启动的贾布拉·乌齐博内研究评估了TG-DSD对艾滋病病毒相关结果的成本和效果。在本文中，我们描述了研究中跨性别者的基线特征，并探讨在基线时，在TG-DSD诊所寻求护理的人与在标准服务提供（SSD）诊所寻求护理的人在医疗保健经历方面是否存在差异。
这项观察性、混合方法、前瞻性实施研究使用标准化观察清单、深入访谈和关键信息人访谈，比较了四个TG-DSD设施和四个SSD设施的护理模式。在本文中，我们通过结构化的、由访谈员进行的定量调查，询问参与者的医疗保健经历和污名化经历。我们评估了定量调查中询问自我报告的污名化经历的部分。
该研究招募了422名感染艾滋病病毒的跨性别者（217名在TG-DSD组，205名在SSD组）和248名未感染艾滋病病毒的跨性别者（128名在TG-DSD组，120名在SSD组）；15%（102/670）为性别不一致者，15%（91/670）为跨性别男性，70%（477/670）为跨性别女性。参与者的年龄中位数为29岁，四分位间距：24 - 35岁。与TG-DSD组的参与者相比，基线时SSD组的参与者经历污名化的可能性高46%（调整后的比值比 = 1.46，95%置信区间：1.06，2.01）。与TG-DSD组的参与者相比，SSD组的参与者更有可能遇到不愿意为他们提供护理的医疗服务提供者（调整后的比值比 = 1.55，95%置信区间：1.09，2.21），并且更有可能报告医护人员无法为跨性别者提供与为其他人相同质量的护理（调整后的比值比 = 1.46，95%置信区间：1.00，1.91）。
与来自SSD设施的跨性别者相比，来自TG-DSD设施的跨性别者在基线时报告基于设施的实际污名化经历的可能性较小。我们的研究强调了针对跨性别者的定制化医疗保健进行提供者培训以提供性别肯定性医疗服务的重要性。贾布拉·乌齐博内研究的结果将为TG-DSD模式在撒哈拉以南非洲的有效性以及污名化和歧视在跨性别者艾滋病病毒相关结果中的作用提供进一步证据。
