HIV Diagnosis, Linkage to Care, and Retention among Men Who Have Sex with Men and Transgender Women in Guatemala City

Abstract

Men who have sex with men (MSM) and transgender women are disproportionately affected by HIV in Guatemala, yet little is known about their experiences with diagnosis, linkage to care, and retention. We conducted qualitative interviews with 26 MSM and transgender women living with HIV in Guatemala City. HIV diagnosis experiences changed over time with increasing asymptomatic testing at non-governmental organizations. Fear of the physical and social impacts of HIV delayed testing, acceptance of diagnosis, and linkage to HIV care. These fears were driven by layered stigma and discrimination due to non-normative gender expressions and/or sexual orientation. Retention-specific determinants included HIV clinic dynamics and limited employment opportunities. There is an urgent need to improve support systems for early testing and linkage to care and to expand employment opportunities. Stigma and discrimination must be addressed at the family, clinic and contextual levels to reduce fear of diagnosis and improve access to care.

Estigma e resistência entre travestis e mulheres transexuais em Salvador, Bahia, Brasil

“…As trajetórias de muitas delas são marcadas por violações aos direitos humanos, com histórias de encarceramento policial por conta da identidade de gênero 18,19 , criminalização 20 e violência 21 . Nos serviços de saúde, muitas também enfrentam discriminação e possuem pouco acesso 21,22,23,24 . Além disso, enfrentam a ausência de acesso ao uso adequado de hormônios 13,20 e de procedimentos cirúrgicos para modificação corporal 25 .…”

HIV understanding, experiences and perceptions of HIV-positive men who have sex with men in Amazonian Peru: A qualitative study.

“…Most patients felt ashamed of their disease and feared the social and physical consequences. This led to delayed HIV testing and dissuaded participants from accessing care, closely corresponding to findings in Lima and Guatemala (28), (39). Addressing treatment adherence-related misinformation and providing access to social support in a culturally sensitive manner has been found to improve adherence by Simoni et al (54).…”

“…A worldwide search identified 16 relevant qualitative papers in HIV-positive men who have sex with men in regard to barriers to care; the majority undertaken in Africa and Asia. Stigma relating to HIV status and sexuality was a recurring theme as a barrier to disease control (34)(35)(36)(37)(38)(39). Two studies in China identified barriers to care in men who have sex with men as negative coping and mental health, misconceptions of ART benefits, non-disclosure of HIV status and lack of trust in the health services (34), (35).…”

“…Facilitators included social support, reduced HIV-related stigma and specialised services (34), (35). Public education and other measures to reduce stigma were widely recommended to improve healthcare access and adherence to care (34)(35)(36)(37)(38)(39).…”

HIV understanding, experiences and perceptions of HIV-positive men who have sex with men in Amazonian Peru: A qualitative study.

“…A worldwide search identified 16 relevant qualitative papers in HIV-positive MSM in regard to barriers to care; the majority undertaken in Africa and Asia. Stigma relating to HIV status and sexuality was a recurring theme as a barrier to disease control (34)(35)(36)(37)(38)(39). Two studies in China identified barriers to care in MSM as negative coping and mental health, misconceptions of ART benefits, non-disclosure of HIV status and lack of trust in the health services (34), (35).…”