Understanding the effect of gender-based violence on uptake and utilisation of HIV prevention, treatment and care services among transgender women: Evidence from the Greater Kampala Metropolitan Area, Uganda
Authors: Naume Muyanga , Isunju John Bosco , Ssekamatte Tonny , Nalugya Aisha , Oputan Patience , Kiguli Juliet , Kibira Simon Peter S. , Wafula Solomon Tsebeni , Ssekamatte David , Mugambe Richard K. , Wanyenze Rhoda K. , Orza Luisa 
Published: April 2022

Abstract
BackgroundTransgender women (also known as transwomen) are disproportionately affected by all forms of gender-based violence (GBV). A high prevalence of physical, sexual and emotional violence not only predisposes transwomen to HIV infection but also limits uptake of HIV prevention, care and treatment services. Despite the high prevalence of HIV and GBV among the transwomen, there is limited evidence of how GBV affects uptake of HIV prevention, care and treatment services. This qualitative study therefore explored how GBV affects uptake of HIV prevention, treatment and care services among transgender women in the Greater Kampala Metropolitan Area (GKMA), Uganda. Methods This qualitative study was conducted among transgender women in the Greater Kampala Metropolitan Area. A total of 20 in-depth interviews, 6 focus group discussions and 10 key informant interviews were conducted to explore how GBV affects uptake of HIV prevention, treatment and care services among transgender women. Data were analyzed using a thematic content analysis framework. Data were transcribed verbatim, and NVivo version 12 was used for coding.ResultsAt individual level, emotional violence suffered by the transwomen led to fear of disclosing their HIV status and other health conditions to intimate partners and healthcare providers respectively; inability to negotiate condom use; and non-adherence to antiretroviral therapy (ART). Sexual violence compromised the ability of the transwomen to negotiate condom use with their intimate partners, clients and employers. Physical and emotional violence at community level led to fear among the transwomen to travel to healthcare facilities. Emotional violence suffered by the transwomen in healthcare settings led to limited use of pre-exposure prophylaxis and HIV testing services, denial of healthcare services and delays in receiving appropriate care. The fear of emotional violence also made it difficult for the transwomen to approach healthcare providers for services. Fear of physical violence such as being beaten while in healthcare settings made the transwomen shun healthcare facilities.Conclusion The effects of GBV on uptake of HIV prevention, care and treatment services were felt at the individual, community and healthcare settings. Across all levels, physical, emotional and sexual violence suffered by the transwomen led to the shunning of healthcare facilities, denial of healthcare services, delays in receiving appropriate care, and low use of post-exposure prophylaxis and HIV testing services. There is a need to develop and implement strategies/ interventions targeting a reduction in GBV, given its effects on the transmission of HIV. Interventions should include strategies to sensitize communities at accepting transgender women. Healthcare providers should create an environment at the healthcare facilities where transgender women can approach any healthcare provider of their choice so as to increase the uptake of HIV prevention, treatment and care services among transgender women.