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Background : Transgender women who have sex with men (TWSM) carry a disproportionately high HIV burden. Compared to general population prevalence of 0.4% in Vietnam, existing studies suggest transgender women HIV prevalence is 18%. In Kenya, prevalence data are lacking for transgender women in Kenya, but all indications are the is higher than among the general population.
Despite an urgent need for sexual health services (SHS), few studies have examined how stigma and discrimination impact access to SHS among TWSM in Vietnam and Kenya. Action for Access! is a community-lead participatory action research study that explores the relationships between social-structural factors and access to SHS among TWSM in Vietnam and Kenya.
Methods : Qualitative individual in-depth interviews were conducted between September 2017 and October 2018. Twenty-three Interviews (Table 1.) were recorded, transcribed and (Vietnamese and Swahili interviews) translated into English. The research team developed a coding lexicon and coded interviews after reaching 80% inter-rater reliability. For this study, stigma and discrimination (S&D)-, mental health- and resiliency-coded
quotes were used to analyze patterns of association among them. Additionally, resiliency-coded quotes were used to explore how TWSM take care of themselves under oppressive environments.
Results : All TWSM reported pervasive experiences of transgender-S&D (Table 2.). Narratives reveal that this highly stigmatizing environments, coupled with discrimination by providers, contributes to an internalized fear of being “mistreated or shamed” resulting in hesitancy to seek SHS. For example, TWSM described how S&D on the part of health providers often resulted in abandoning accessing SHSs in favor of, for example: 1) self-care based on internet information or advice from friends or pharmacists, 2) waiting until there is a crisis to seek professional care, or 3) suffering indignities from the health care systems because “it is all that is available”. The principal respite noted was accessing SHS from community-led organizations. Resiliency findings also suggest that TWSM find relief through creating community with each other, providing support and sharing of resources to support each other.
Tables with illustrative quotes for each domain by country will be presented.
Conclusions : Stigma and discrimination, particularly by providers, significantly impaired TWSM’s access to SHS that are critical for addressing HIV health disparities in Vietnam and Kenya. Strengthening community-led SHS, training providers on appropriate care of transgender patients, and developing comprehensive and safe SHS, are key for improving the health and well being of TWSM in Kenya and Vietnam.