“You are not a man”: a multi-method study of trans stigma and risk of HIV and sexually transmitted infections among trans men in Uganda

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dc.contributor.authorMujugira, Andrew
dc.contributor.authorKasiita, Vicent
dc.contributor.authorBagaya, Monica
dc.contributor.authorNakyanzi, Agnes
dc.contributor.authorBambia, Felix
dc.contributor.authorNampewo, Oliva
dc.contributor.authorKamusiime, Brenda
dc.contributor.authorMugisha, Jackson
dc.contributor.authorNalumansi, Alisaati
dc.contributor.authorTwesigye, Collin C.
dc.contributor.authorMuwonge, Timothy R.
dc.contributor.authorBaeten, Jared M.
dc.contributor.authorWyatt, Monique A.
dc.contributor.authorTsai, Alexander C.
dc.contributor.authorWare, Norma C.
dc.contributor.authorHaberer, Jessica E.
dc.date.accessioned2023-02-07T18:12:41Z
dc.date.available2023-02-07T18:12:41Z
dc.date.issued2021
dc.description.abstractTransgender (trans) men in sub-Saharan Africa are a hidden and vulnerable population who may engage in sex work due to socio-economic exclusion and lack of alternative employment opportunities. Little is known about HIV and sexually transmitted infection (STI) risk among trans men in this setting. We conducted a multi-method study to characterize HIV/STI risk among trans men in Uganda. Methods: Between January and October 2020, we enrolled 50 trans men into a cross-sectional study through snowball sampling. Data were collected on socio-demographic characteristics, sexual practices and depression. We conducted 20 qualitative interviews to explore: (1) descriptions of sexual practices that could increase HIV/STI exposure; (2) experiences of accessing public healthcare facilities; (3) perceptions of HIV or STI testing; (4) HIV and STI service delivery; and (5) drug and alcohol use. We used an inductive content analytic approach centring on descriptive category development to analyse the data. Results: The median age was 25 years (interquartile range 23–28). The prevalence of HIV, syphilis and hepatitis B was 4%, 6% and 8%, respectively. We observed multiple levels of intersecting individual, interpersonal and structural stigmas. (1) Trans men reported transphobic rape motivated by interpersonal stigma that was psychologically traumatizing to the survivor. The resultant stigma and shame hindered healthcare access. (2) Structural stigma and economic vulnerability led to sex work, which increased the risk of HIV and other STIs. Sex work stigma further compounded vulnerability. (3) Individualized stigma led to fear of disclosure of gender identity and HIV status. Concealment was used as a form of stigma management. (4) Multiple levels of stigma hampered access to healthcare services. Preference for trans-friendly care was motivated by stigma avoidance in public facilities. Overall, the lived experiences of trans men highlight the intertwined relationship between stigma and sexual health. Conclusions: In this sample from Uganda, trans men experienced stigma at multiple levels, highlighting the need for gendersensitive healthcare delivery. Stigma reduction interventions, including provider training, non-discrimination policies, support groups and stigma counselling, could strengthen uptake and utilization of prevention services by this marginalized population.en_US
dc.identifier.citationMujugira, A., Kasiita, V., Bagaya, M., Nakyanzi, A., Bambia, F., Nampewo, O., ... & Haberer, J. E. (2021). “You are not a man”: a multi‐method study of trans stigma and risk of HIV and sexually transmitted infections among trans men in Uganda. Journal of the International AIDS Society, 24(12), e25860. https://doi.org/10.1002/jia2.25860en_US
dc.identifier.urihttps://doi.org/10.1002/jia2.25860
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/7627
dc.language.isoenen_US
dc.publisherJournal of the International AIDS Societyen_US
dc.subjectTrans menen_US
dc.subjectHIVen_US
dc.subjectSTIen_US
dc.subjectStigmaen_US
dc.title“You are not a man”: a multi-method study of trans stigma and risk of HIV and sexually transmitted infections among trans men in Ugandaen_US
dc.typeArticleen_US
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