MGHD 2022

Introduction Men who have sex with men (MSM) and transgender women (TGW) around the globe and in Rwanda are at higher risk than the general population of being subject to sexual health disparities, as well as disparities pertaining to the affordability and accessibility of sexual and reproductive health care services (UNAIDS, 2019). As a result of discrimination and marginalization, the vulnerability of socially disadvantaged groups such as MSM and TGW is reinforced; especially, as it relates to sexual and reproductive health (SRH) care. Accordingly, this study was conducted to explore the perspectives of MSM & TGW populations, highlight the barriers they experience accessing the SRH services and give rise to community-informed recommendations for improvements across the SRH care provision spectrum in Rwanda. Methods An exploratory sequential mixed-methods study was conducted. Four semi-structured focus group discussions (FGDs) were conducted with members of the MSM and TGW populations in Rwanda. Subsequently, a quantitative survey was administered to 134 members of the identified population to ascertain the magnitude of the barriers and assign weight to the recommendations that were highlighted in the FGDs. Results Four main themes emerged from the focus group discussions. The qualitative results highlighted the notable disparities experienced in SRH service/care in rural versus urban settings, the preference for/recommendation of specialized services for these populations and the enabling impact that NGOs like Hope and Care can have on the acquisition of equitable, accessible SRH care. Lastly, the focus groups highlighted that despite the harassment and stigma this community faces at the hands of healthcare providers and society in general, they are highly empowered in their own sexual and gender identities and serve as active agents in their own SHR care seeking. The quantitative portion of the study corroborated the results of the focus group discussions, confirming the challenges faced by these populations while accessing SRH care due to harassment by healthcare providers, societal stigma, fear of outing and disclosure of identity, violence, stockouts and lack of knowledge of healthcare providers regarding issues that affect their communities amongst many others. The recommendations put forth in the focus group discussions were quantified, each one producing statistical significance across the group; with very negligible significant differences noted between MSM and TGW and across age groups, indicating mutual agreement on their collective importance. Conclusion and Recommendations The MSM and TGW are self-empowered communities and are acutely aware of their SRH needs. Hence community recommendations must lead policy change with focused research to fill existing gaps. Specialized training for healthcare professionals with a holistic approach including mental health care, strengthening of existing NGOs through government support, provision of individual insurance, increasing outreach to rural communities, and sensitization of the society and local leaders emerged as key recommendations. We further suggest an integrated, gender- transformative approach by strengthening existing medical curricula, training, insurance schemes and delivery models.