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

Background:
Accessing HIV testing services is a challenge for transgender
women and men who have sex with men (MSM) in subSaharan 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 genderminority 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:
Policies/practices that hinder access to HIV testing for
transgender women and MSM in African countries should
be discussed on the regional and global levels.
Countries from the global west do have a responsibility to
enforce African countries to provide optimal health care to
gender minority populations.