Naidoo Dhee, Cloete Allanise, Skinner Donald, Savva Helen, Daniels Danielle, Kose Zamakayise, Ramatshekgisa Malebo Gratitude
Anthropology, Archaeology, and Development Studies, Faculty of Humanities, University of Pretoria, Pretoria, South Africa.
The Durban LGBTI Community and Health Centre, Durban, KwaZulu-Natal, South Africa.
Int J Transgend Health. 2024 Feb 5;26(3):709-724. doi: 10.1080/26895269.2024.2307348. eCollection 2025.
Epidemiological data show that transgender women are disproportionately affected by Human Immunodeficiency Virus (HIV). Data in South Africa on the HIV vulnerabilities of transgender women are sparse. This paper qualitatively explores the structural, personal, and economic factors that contribute to making South African transgender women vulnerable to HIV and other sexually transmitted infections (STIs).
We conducted a rapid qualitative assessment in the Cape Town, Johannesburg, and Buffalo City metropolitan municipalities to frame the HIV risk vulnerabilities of transgender women. Purposive sampling was used to recruit study participants. We conducted 25 key informant interviews, five focus group discussions, and 26 in-depth interviews with transgender women. Atlas.ti.8 was used to facilitate qualitative data analysis.
These data illustrate a pervasive theme of social rejection, discrimination, and everyday victimization among transgender women. The ubiquitous presence of stigma and rejection leads to internalized stigmatization, which affects the social and mental well-being of transgender women, who often turn to alcohol and illicit drug use to alleviate negative emotions. We found that transgender women may engage in high-risk sexual activities like sex work where they can express and affirm their gender identity. In this context, transgender women engaging in high-risk sexual activities found it challenging to access pre-exposure prophylaxis (PrEP). Stigma also leads to reluctance to use public healthcare services. Despite experiencing stigma and discrimination, qualitative data highlights the resilience of transgender women in the study.
Qualitative data demonstrate that HIV risk for transgender women is complex. Multi-level community-led interventions grounded in empowerment are also required to address interpersonal, biological, structural, and community risk. Successful interventions should address stigma and draw upon the resilience of transgender women. Peer-driven interventions may motivate personal responsibility to use high-impact HIV prevention and treatment services.
流行病学数据显示，跨性别女性受人类免疫缺陷病毒（HIV）影响的比例过高。南非关于跨性别女性HIV易感性的数据匮乏。本文定性探讨了导致南非跨性别女性易感染HIV和其他性传播感染（STIs）的结构、个人和经济因素。
我们在开普敦、约翰内斯堡和布法罗市都会区进行了快速定性评估，以界定跨性别女性的HIV风险易感性。采用目的抽样法招募研究参与者。我们进行了25次关键信息人访谈、5次焦点小组讨论以及26次对跨性别女性的深入访谈。使用Atlas.ti.8软件辅助定性数据分析。
这些数据表明，社会排斥、歧视和日常受害是跨性别女性中普遍存在的主题。无处不在的污名和排斥导致内化污名化，这影响了跨性别女性的社会和心理健康，她们常常借助酒精和非法药物使用来缓解负面情绪。我们发现，跨性别女性可能会从事性工作等高风险性行为，在这种行为中她们能够表达并确认自己的性别身份。在这种情况下，从事高风险性行为的跨性别女性发现获取暴露前预防（PrEP）具有挑战性。污名还导致她们不愿使用公共医疗服务。尽管经历了污名和歧视，但定性数据凸显了研究中跨性别女性的复原力。
定性数据表明，跨性别女性的HIV风险很复杂。还需要以赋权为基础的多层次社区主导干预措施，以应对人际、生物、结构和社区风险。成功的干预措施应解决污名问题，并利用跨性别女性的复原力。同伴驱动的干预措施可能会激发个人使用高效HIV预防和治疗服务的责任感。
