MGHD 2023

Background Men who have sex with men (MSM) and transgender women (TGW) are disproportionately affected by HIV worldwide and in Rwanda. Additionally, MSM and TGW living with HIV are subjected to intersecting stigmatization of their sexual orientation, gender identity, and HIV status. Interventions have been put in place to avail HIV services to everyone including these vulnerable populations in Rwanda. However, the stigma against people living with HIV, MSM, and TGW and their overlap impedes the efforts. Therefore, the purpose of this study was to explore the effect of intersectional stigma on the use of HIV services among MSM and TGW living with HIV in Kigali, Rwanda. Methods This is a qualitative phenomenological study. In-depth interviews were conducted with MSM and TGW living with HIV to explore their lived experiences of intersectional stigma and the use of HIV services. Results Seventeen in-depth interviews (nine MSM and eight TGW) were conducted in total. The findings yielded four themes that highlighted how intersectional stigma affects the use of HIV services among MSM and TGW living with HIV. Those themes are: 1. Internalized, anticipated, and experienced stigma negatively affects mental health and consequently the use of HIV services, 2. Social and employment discrimination exacerbate financial difficulties and negatively affect HIV services use, 3. Experienced stigma from healthcare providers contributes to mistrust and fear of disclosure leading to inadequate use of HIV services, 4. Resilience, social support, inclusive healthcare provision, and positive health outcomes have a positive effect on HIV services use. The results revealed the mechanisms through which the HIV services use are affected by multiple intersecting stigmas and therefore emphasize areas to address in HIV care engagement for MSM and TGW living with HIV. Conclusion The findings of this study highlight how intersectional stigma contributes to economic and mental health challenges among these populations which further exacerbates the barriers to accessing and utilizing HIV services effectively. Therefore, the findings recognize the unique experiences of these communities and emphasize the need for inclusive approaches to reduce stigma and its effect on health-seeking behaviors. By amplifying the voices of these communities, we contributed to the efforts toward achieving inclusive and equitable HIV services for all.