Sexual and Gender Minorities Inclusion and Uptake of Sexual and Reproductive Health Services: A Scoping Review of Literature

Abstract

Despite the efforts to ensure that sexual and reproductive health services are integrated into global, regional, and national initiatives, a significant number of countries are overwhelmed by frames of exclusion and violations of fundamental human rights, particularly for sexual and gender minority groups such as lesbians, gays, bisexuals, and transgender people. This study sought to review the literature on access and barriers faced by sexual and gender minorities. A scoping literature review was conducted on literature that focused on sexual and gender minorities and sexual and reproductive health services and published in the English language. Studies were independently screened and coded, categorizing themes such as policies, uptake of services, barriers to sexual and reproductive health access, and strategies to aid the uptake of services. The search yielded 1,148 literature sources, of which 39 met the inclusion criteria and were reviewed. The average sexual and reproductive health service uptake was generally low overall and was influenced by factors such as clinical settings, punitive laws, and availability of services specific to sexual and gender minorities. Noted strategies to aid sexual and reproductive health uptake include education, friendly health care facilities, availability of specific services, and legislative reform. The sexual and reproductive health program is an important component of short-term and long-term sexual and reproductive health needs. Health intervention initiatives targeted at improving or increasing sexual and reproductive health uptake must be supported by suitable legal and regulatory framework contexts and based on context-specific evidence.

Oral Pre-Exposure Prophylaxis Accessibility, Knowledge, Barriers, and Facilitators Among Men Who Have Sex With Men in Bulawayo, Zimbabwe

“…Significant progress has been made in preventing new HIV infections, although HIV transmission among MSM remains challenging (UNAIDS, 2016a(UNAIDS, , 2016b. Many countries have laws prohibiting same-sex sexual relations, and Pérez-Jiménez et al (2009) noted that most interventions for people living with HIV have focused largely on heterosexuals in Latin America and Sub-Saharan Africa (Khozah & Nunu, 2023). There is a significant lack of programmatic intervention research to address self-management among this population.…”

Exploring Barriers and Facilitators That Influence Uptake of Oral Pre-Exposure Prophylaxis Among Men Who Have Sex With Men in Bulawayo, Zimbabwe: Key Stakeholder’s Perspectives

“…Many studies reported MSM preferring to access their PrEP from MSM-friendly facilities due to barriers they face in non-MSM facilities, such as negative attitudes from health care workers ( Adeagbo et al, 2021 ; Graham et al, 2022 ; Holloway et al, 2017 ; Patrick et al, 2019 ), lack of confidentiality by health care providers ( Graham et al, 2022 ), and PrEP being unaffordable ( Dean et al, 2023 ; Graham et al, 2022 ; Kota et al, 2021 ; Voglino et al, 2021 ). In Sub-Saharan African countries where same-sex sexual interaction is criminalized, health service providers also exhibit negative attitudes toward MSM, thus reducing their ability to access services they need, such as accessing PrEP ( Khozah & Nunu, 2023 ; Munyimani & Nunu, 2022 ). Despite Zimbabwe criminalizing same-sex sexual interaction, health care providers must be educated and trained to render good quality services to MSM without any form of discrimination because transmission of HIV and AIDS remains unacceptably high among this population.…”

“…Several factors hamper PrEP uptake for HIV prevention in African nations. Different authors have alluded to this low uptake of PrEP among MSMs in different country contexts in Sub-Saharan Africa to be a lack of awareness and knowledge ( Matacotta et al, 2020 ), stigma and discrimination ( Isano et al, 2020 ; Keuroghlian et al, 2021 ), legal and policy barriers ( Embleton et al, 2023 ; Mbilizi Chimwaza et al, 2022 ), limited access to health care ( Mgodi et al, 2023 ; Muraguri et al, 2012 ), cost and affordability of health services ( Mgodi et al, 2023 ), health care provider bias and inadequate training ( Keuroghlian et al, 2021 ), and lack of tailored health services and privacy and confidentiality concerns ( Khozah & Nunu, 2023 ; Munyimani & Nunu, 2022 ).…”

“…African countries such as Zambia, Malawi, Algeria, and Zimbabwe prohibit same-sex sexual relations, which negatively affects the uptake of sexual and reproductive health services ( Khozah & Nunu, 2023 ). Some of the notable barriers to PrEP uptake include lack of knowledge about PrEP, ongoing stigma and discrimination surrounding HIV, challenges in obtaining and affording PrEP medications and services, flaws in the health care system, and cultural and gender norms that restrict access ( Adeagbo et al, 2021 ; Galea et al, 2011 ; Graham et al, 2022 ).…”