A qualitative description of HIV testing and healthcare experiences among trans women in Ghanaian urban slums BSGH-011

Abstract

Background Achieving the UNAIDS 90–90–90 targets hinges on identifying and engaging individuals with HIV in care, requiring 90% of those infected to be diagnosed, initiated on ART, and achieving viral suppression. Despite this imperative, HIV testing services as well as research in Ghana often overlook the unique experiences of transgender women in urban slums, impacting their engagement with care. Using the gender affirmative model lens, this study reports the HIV testing experiences of trans women in Ghanaian slums, highlighting how the healthcare environment, counseling, and healthcare provider attitudes shape these experiences. Methods A qualitative descriptive interview design was employed, involving 20 trans women aged 18 to 31 years living in urban slums in the Greater Accra Metropolitan Area of Ghana. Participants were recruited using purposive and snowball sampling techniques. Data were collected through face-to-face interviews, transcribed verbatim, and analyzed using NVivo. Results were presented in categories and subcategories. Results Two main categories emerged from our data analysis: 1) Positive Experiences with HIV Testing, and 2) Negative Experiences with HIV Testing. Positive experiences with HIV testing among trans women in Ghanaian slums included a welcoming environment at healthcare facilities, supportive counseling, and relatability with HIV-positive nurses. Negative experiences were characterized by fear and anxiety during testing, often intensified by healthcare worker attitudes, including unwelcoming behaviors and judgmental body language, especially in facilities that are not key population friendly. These categories provided a framework for understanding the varied experiences of trans women in Ghanaian slums regarding HIV testing. Conclusion The study emphasizes the urgent need for healthcare facilities in Ghanaian slums to address discriminatory practices and attitudes towards trans women, fostering a welcoming and affirming environment. Adopting a multifaceted approach integrating the gender-affirmative model's principles is crucial to enhancing HIV testing experiences and achieving improved health outcomes for trans women. Policymakers and healthcare providers must prioritize comprehensive training, inclusive healthcare environments, and culturally competent care to mitigate health disparities among this population.