Tinzweiwo Research 2024
Title: Challenges Faced by Young Gay and Transgender People Living with HIV Aged 15-24: A Qualitative Study
Abstract
This study explores the lived experiences of 10 young gay and transgender individuals aged 15-24 who are living with HIV. It identifies and delves into the challenges they face related to the disclosure of their HIV status, access to sexual and reproductive health and rights (SRHR) information, sexual abuse, and mental health. The findings point to significant barriers in disclosing HIV status to sexual partners, family members, and peers due to fears of stigma and discrimination. Furthermore, the study uncovers alarming rates of sexual abuse, particularly within close family circles, and a lack of access to vital SRHR information. Additionally, the study reveals troubling patterns of transactional sex as a survival strategy. Mental health concerns, including mild depression, were also evident among the participants. These findings highlight the urgent need for targeted interventions and support systems for this marginalized group, aiming to address the unique challenges they face.
Introduction
The Tinzweiwo Research was initiated by the Action for Youth Foundation Trust to investigate the lived experiences of young gay and transgender individuals living with HIV, aged 15-24. This age group, often at the intersection of multiple vulnerabilities, faces particular challenges that can exacerbate their HIV status and overall wellbeing. This study aimed to provide an in-depth understanding of these challenges, particularly around HIV status disclosure, sexual abuse, access to SRHR information, and mental health. The exploration was crucial in identifying the gaps in healthcare, social support, and legal protections that young gay and transgender individuals encounter.
Research Objectives
The primary objective of this study was to explore the specific challenges young gay and transgender individuals living with HIV face. More specifically, the research sought to:
Understand the barriers to disclosing HIV status.
Explore the level of access to SRHR information and services.
Assess the prevalence of sexual abuse and its impact.
Examine the mental health status of participants.
Understand the role of transactional sex in their lives and relationships.
Methods
A qualitative research approach was chosen for this study to capture the lived experiences and personal narratives of participants. Data were collected through in-depth, semi-structured interviews with 10 young individuals who identified as gay or transgender and were living with HIV. Participants were recruited through snowball sampling, ensuring that the study included individuals with diverse experiences and backgrounds. All interviews were conducted in a private, safe, and confidential environment to facilitate open and honest discussions. The interviews focused on the participants’ experiences with HIV disclosure, sexual abuse, mental health, access to SRHR, and relationships.
Data Analysis
The interviews were transcribed verbatim and analyzed using thematic analysis. This method enabled the researchers to identify recurring themes and patterns in the data, highlighting the key challenges faced by the participants. The findings were coded and categorized, and the analysis was conducted in an iterative process to refine the themes and ensure that the research questions were thoroughly addressed.
Findings
Non-disclosure of HIV Status
A significant barrier to the health and well-being of young gay and transgender individuals was the non-disclosure of their HIV status. Eight out of 10 participants reported that they did not disclose their HIV status to sexual partners due to fears of stigma and discrimination. These fears were not limited to peers but extended to family members and close friends. This non-disclosure created a sense of isolation and posed serious risks to their sexual health and the health of their partners.
HIV Transmission Routes
Among the participants, 5/10 acquired HIV at birth, while 5/10 contracted the virus through sexual encounters at a young age. Of those who acquired HIV through sexual transmission, 2/10 attributed their status to a lack of access to SRHR information, while 3/10 cited a fear of seeking out healthcare services as the primary reason for their exposure to HIV.
Disclosure to Family Members
When it came to disclosing their HIV status to family members, 3 out of 5 transgender participants chose not to disclose, citing fear of rejection and violence. For the 5 gay participants, 4 reported never disclosing their sexual orientation to any family members, with one participant who did disclose being subsequently expelled from their home.
Sexual Abuse
Sexual abuse emerged as a prevalent and deeply distressing theme. Seven out of 10 participants experienced sexual abuse by close relatives, while 3/10 were abused by domestic workers or house staff. Alarmingly, all incidents of abuse went unreported, highlighting a critical gap in the availability of safe reporting mechanisms and a deeply ingrained culture of silence around these issues.
Mental Health
Mental health concerns were another significant challenge. Three participants showed signs of mild depression, with feelings of hopelessness and a lack of social support. These individuals struggled to access mental health services, as these were often either unavailable or not tailored to their specific needs. Seven participants did not report mental health issues, but this may also reflect a lack of awareness or resources to seek help.
Relationship Status and Transactional Sex
Transactional sex was reported by 6 out of 10 participants as a regular practice, with some engaging in sex in exchange for money, shelter, or food at least twice a month. This form of survival sex can further complicate their HIV status, increase their vulnerability to violence, and increase the risk of mental health problems.
Discussion
The findings from this study paint a sobering picture of the challenges faced by young gay and transgender individuals living with HIV. The stigma associated with both HIV and non-heteronormative sexualities significantly impacts their ability to seek healthcare, disclose their HIV status, and access supportive resources. The high prevalence of sexual abuse, often within families, coupled with the lack of accessible mental health care, further exacerbates the vulnerability of these individuals. The engagement in transactional sex is indicative of the limited options available for survival and highlights the intersectionality of economic hardship, lack of support, and health risks.
Conclusion
This study underscores the urgent need for targeted interventions that can address the unique challenges faced by young gay and transgender individuals living with HIV. The experiences of these young people reveal the intersection of social, health, and economic factors that demand a comprehensive approach to HIV care, mental health, and sexual and reproductive health services. In particular, there is a need to create more inclusive healthcare systems, raise awareness about SRHR, and provide mental health support tailored to the needs of this vulnerable population.
Recommendations
Tailored Health Services
Healthcare providers should develop and implement services that are sensitive to the needs of young gay and transgender individuals living with HIV. This includes confidential HIV counseling and testing services, as well as accessible treatment options.
Education on SRHR
Educational programs should be designed to provide accurate and comprehensive SRHR information to young people, with a focus on sexual health, HIV prevention, and healthy relationships. These programs should be inclusive of sexual minorities and address stigma and discrimination.
Mental Health Support
Mental health services must be made accessible to young gay and transgender individuals, providing counseling and therapy that acknowledges the specific challenges faced by this group. Mental health professionals should be trained in LGBTQ+ issues to better support their clients.
Legal Protections
Policymakers should enact laws that protect the rights and dignity of young gay and transgender individuals, including protections from discrimination, violence, and exploitation.
Further Research
Additional research is needed to further explore the experiences of young gay and transgender people living with HIV, especially in low- and middle-income countries. Further studies should focus on identifying effective interventions and support systems that can help this population thrive.
References
Journal of Adolescent Health. (2018). HIV and transgender youth: A review of the literature.
AIDS and Behavior. (2017). HIV and mental health among gay and transgender individuals: A systematic review.
International AIDS Society. (2020). HIV and Mental Health.
The Global Fund. (2020). HIV and Sexual and Reproductive Health and Rights.
Centers for Disease Control and Prevention. (2020). HIV and Transgender People.
List of Researchers
Wilfred Chiunda, Marvin F. Musekiwa, Petra Dope, Lisa T. Katuruza, Bridget Kapuyanyika, and Zvikomborero M. Chakaza