Stigma, sexual health, and human rights among women who have sex with women in Lesotho

Abstract

In recent years, gender and sexual minorities have become increasingly visible across sub-Saharan Africa, marking both the progression and violation of their human rights. Using data from a study with sexual minorities in Lesotho, this analysis leveraged the social ecological model to examine relationships between stigma, human rights, and sexual health among women who have sex with women in Lesotho. A community-based participatory approach was used for the mixed-method, cross-sectional study. A total of 250 women who have sex with women completed a structured questionnaire, of which 21 participated in a total of three focus group discussions. Stigma was common within and outside the health sector. Stigma and human rights abuses were associated with increased risk for HIV and STIs. Interventions to address stigma at the structural, community, and interpersonal levels are essential to ensuring sexual health and rights for women who have sex with women in Lesotho.

Considerations for the design of Human Immunodeficiency Virus (HIV) prevention programs for lesbian and bisexual women

“…Recently, the link between human rights violations and HIV vulnerability was confirmed in a sample of LB women in Africa 6 . One relevant issue that maximizes the risk of HIV in LB women is the figures of sexual harassments reported by them.…”

“…Few studies conducted in the population have revealed that LB women feel that health workers do not meet their needs; prefer to hide their sexual orientation in health services out of fear or services are often denied 6,16,39 . This situation may delay the detection of possible irregularities and treatment on time for this population.…”

“…One relevant issue that maximizes the risk of HIV in LB women is the figures of sexual harassments reported by them. Studies have reported figures from 8% to 30% of sexual abuses related to sexual orientation in countries like the United States, Africa and Colombia 6,26,41 . Therefore, in order to safeguard the human rights of LGBT people, as it was established by the United Nations Human Rights Commission 42 , states have the legal obligation to plan and develop actions to mitigate this situation and protect them from sexual violence and discrimination.…”

“…Although nearly seven thousand cases of HIV positive lesbian and bisexual women (LB) are estimated in the United States 3 , the global numbers remain invisible in global reports, even when HIV transmission between them has been scientifically proven 4,5 . This is a great weakness in the characterization of the epidemic among this group, particularly in places with a high burden of HIV cases, such as Africa, where it has been demonstrated that women from sexual minorities face particular social and structural susceptibilities related to sexual stigma and violence, which significantly exposes them to HIV 6 . Despite the fact that some women voluntarily report their sexual orientation when the HIV diagnosis occurs, many others prefer to remain silent while this unknown figure keeps quietly increasing.…”

Lesbian, Gay, and Bisexual human rights as a global health issue

“…Poteat et al, study of women who have sex with women (WSW); in Lesotho reports, 22.5% of women were afraid to seek health care due to discrimination, with 23% of women reporting health care services did not meet their needs. Disclosure of their sexual orientation to health care workers was also associated with being 8.5 times more likely to lose employment.…”