Intersectional Stigma and HIV Services Use Among Men Who Have Sex With Men And Transgender Women Living With HIV In Kigali, Rwanda: A Qualitative Study.

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.