Barriers to HIV testing among transgender women and men who have sex with men in sub-Saharan Africa

Abstract

Background: Accessing HIV testing services is a challenge for transgender women and men who have sex with men (MSM) in sub-Saharan Africa. Only a little about this issue has been understood and discussed. No systematic review exists that discusses barriers to HIV testing among transgender women and MSM on the regional level. Methods: We systematically searched databases namely MEDLINE, CINAHL, and Google Scholar to identify qualitative studies that reported decision-making and/or experiences with HIV testing uptake among transgender women or MSM and that were conducted in sub-Saharan Africa between January 2005 and March 2020. Two independent authors performed the selection, extraction, and thematic analysis of data. Results: Twelve out of 794 studies were found eligible and included for synthesis. The synthesis led to the development of a framework illustrating multi-level, inter-related barriers to HIV testing. Couple-based HIV testing policies, criminalizing same-sex behaviors, and (health) governance being influenced by traditional religious (Islamic or Christianity) belief systems were the barriers at the regional level. Discriminatory practices in the communities and health institutions were the community-specific barriers. Interpersonal barriers included interactions with healthcare providers leading to forced disclosure and/or discrimination, and individual level barriers included fears and depressive thoughts, and poor healthcare access. Conclusions: We identified policies and practices at the regional and country levels that hindered HIV testing practices among transgender women and MSM, which should be reconsidered while providing HIV prevention services to people of gender-minority backgrounds. We also think that countries from the global west do have a responsibility to question the sovereignty of some African countries for their inability to provide optimal health care to gender minority populations. Key messages: