Distinguishing trans women in men who have sex with men populations and their health access in East Africa: A Tanzanian study

Kashiha, John; Ross, Michael W.; Rider, Nic

doi:10.4102/phcfm.v14i1.3428

Cited by 2 publications

(3 citation statements)

References 14 publications

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“…In seven of the included studies, participants indicated that financial constraints deterred them from accessing desired services, such as PrEP and GAC [ 27 , 35 , 38 , 44 , 46 , 47 , 50 ]. The inability to afford medications, treatment, medical bills, and transportation to and from healthcare facilities limited participants’ access to care [ 27 ].…”

Section: Resultsmentioning

confidence: 99%

“…The inability to afford medications, treatment, medical bills, and transportation to and from healthcare facilities limited participants’ access to care [ 27 ]. Two studies highlighted how the lack of insurance coverage for various healthcare services, including GAC, prevented service access [ 38 , 47 ]. One study reported that the most common reason individuals chose not to take PrEP was a lack of medical insurance coverage [ 38 ].…”

Section: Resultsmentioning

confidence: 99%

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Healthcare access and barriers to utilization among transgender and gender diverse people in Africa: a systematic review

Jessani,

Berry-Moreau,

Parmar

et al. 2024

BMC Global Public Health

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Background Transgender and gender diverse (TGD) people face significant challenges in accessing timely, culturally competent, and adequate healthcare due to structural and systemic barriers, yet there is a lack of research exploring the access and utilization of healthcare services within African TGD communities. To address this gap, this systematic review explored: (1) barriers to accessing healthcare services and gender-affirming hormone therapy (GAHT) faced by TGD people, (2) demographic and societal factors correlated with the utilization of healthcare services and GAHT, (3) common healthcare and support services utilized by TGD people, and (4) patterns of accessing healthcare services and GAHT within TGD communities. Methods A systematic literature search was conducted in PubMed, Embase, and Scopus in September 2023. Eligible studies included peer-reviewed original research, reports, and summaries published in the English language assessing health service accessibility and utilization of TGD people in Africa between January 2016 and December 2023. Results From 2072 potentially relevant articles, 159 were assessed for eligibility following duplicate removal, and 49 were included for analysis. Forty-five articles addressed barriers to accessing healthcare services and GAHT, seven focused on demographic and societal factors correlated with the utilization of healthcare services and GAHT, 16 covered common healthcare and support services utilized by TGD people, and seven examined patterns of accessing healthcare services and GAHT. Findings suggested a limited availability of health services, inadequate knowledge of TGD healthcare needs among healthcare providers, a lack of recognition of TGD people in healthcare settings, healthcare-related stigma, and financial constraints within African TGD communities. An absence of studies conducted in Northern and Central Africa was identified. Conclusions TGD people in Africa encounter significant barriers when seeking healthcare services, leading to disparity in the utilization of healthcare and resulting in a disproportionate burden of health risks. The implications of these barriers highlight the urgent need for more high-quality evidence to promote health equity for African TGD people. Trial registration PROSPERO CRD42024532405.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Healthcare access and barriers to utilization among transgender and gender diverse people in Africa: a systematic review

Jessani,

Berry-Moreau,

Parmar

et al. 2024

BMC Global Public Health

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show abstract

“…There are limited data in Kenya and sub-Saharan Africa on processes of gender development and gender-related sense of self, gender perception, gender expression, gender presentation, and gender identity and labels; such assessment would inform gender-affirming interventions [ 41 ]. Among 300 MSM participants in a Tanzanian study, 17% identified as “transsexual or transgender”, and among those, 70% identified themselves as a “woman” [ 42 ]. This study further identified that time spent “living as a woman” was variable among participants identifying as transsexual or transgender, and authors acknowledged that varying concepts of the transfeminine identity may have led to misclassification.…”

Section: Discussionmentioning

confidence: 99%

Transgender women in Kenya experience greater stigma, depressive symptoms, alcohol and drug use and risky sexual practices than cis-gendered men who have sex with men

et al. 2023

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Background Worldwide, sexual and gender minority individuals have disproportionate burden of HIV. There are limited quantitative data from sub-Saharan Africa on the intersection of risks experienced by transgender women (TGW) in comparison to cis-men who have sex with men (MSM). This analysis addresses this gap by comparing reported stigma, psychosocial measures of health, and sexual risk practices between TGW and cis-MSM in Kenya. Methods We analyzed data from the baseline visit of an ongoing prospective cohort study taking place in three diverse metropolitan areas. Eligible participants were HIV-negative, assigned male at birth, ages 18–29 years, and reported anal intercourse in the past 3 months with a man or TGW. Data collected by audio computer assisted self-interview included sociodemographic measures, and sexual practices occurring in the past 3 months. Multivariable regressions assessed differences between TGW and cis-MSM in selected sexual practices, depressive symptoms, alcohol and drug use, and stigma. Results From September, 2019, through May, 2021, 838 participants were enrolled: 108 (12.9%) TGW and 730 (87.1%) cis-MSM. Adjusting for sociodemographic variables, TGW were more likely than cis-MSM to report: receptive anal intercourse (RAI; adjusted prevalence ratio [aPR] = 1.59, 95% CI: 1.32 – 1.92), engaging in group sex (aPR = 1.15, 95% CI: 1.04 – 1.27), 4 or more male sex partners (aPR = 3.31, 95% CI: 2.52 – 4.35), and 3 or more paying male sex partners (aPR = 1.58, 95% CI: 1.04 – 2.39). TGW were also more likely to report moderate to severe depressive symptoms (aPR = 1.42, 95% CI: 1.01 – 1.55), and had similar alcohol and drug abuse scores as cis-MSM. In sensitivity analysis, similar to TGW, male-identifying individuals taking feminizing gender affirming therapy had an increased likelihood of reporting RAI and group sex, and greater numbers of male sex partners and paying male sex partners relative to cis-MSM. Conclusions Across three metropolitan areas in Kenya, TGW were more likely to report depressive symptoms and increased sexual risk taking. We identified a need for research that better characterizes the range of gender identities. Our analysis affirms the need for programmatic gender-affirming interventions specific to transgender populations in Kenya and elsewhere in Africa.

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Distinguishing trans women in men who have sex with men populations and their health access in East Africa: A Tanzanian study

Cited by 2 publications

References 14 publications

Healthcare access and barriers to utilization among transgender and gender diverse people in Africa: a systematic review

Healthcare access and barriers to utilization among transgender and gender diverse people in Africa: a systematic review

Transgender women in Kenya experience greater stigma, depressive symptoms, alcohol and drug use and risky sexual practices than cis-gendered men who have sex with men

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