Scoping review of HIV-related intersectional stigma among sexual and gender minorities in sub-Saharan Africa

D Dada, GR Abu-Ba'are, DA Turner, IW Mashoud… - BMJ open, 2024 - bmjopen.bmj.com
D Dada, GR Abu-Ba'are, DA Turner, IW Mashoud, F Owusu-Dampare, A Apreku, Z Ni
BMJ open, 2024bmjopen.bmj.com
Objectives Sexual and gender minority (SGM) populations in sub-Saharan Africa (SSA) are
disproportionately impacted by HIV and often face multiple HIV-related stigmas. Addressing
these stigmas could reduce SGM HIV vulnerability but little is known about how the stigmas
operate and intersect. Intersectional stigma offers a lens for understanding the experiences
of stigmatised populations and refers to the synergistic negative health effects of various
systems of oppression on individuals with multiple stigmatised identities, behaviours or …
Objectives
Sexual and gender minority (SGM) populations in sub-Saharan Africa (SSA) are disproportionately impacted by HIV and often face multiple HIV-related stigmas. Addressing these stigmas could reduce SGM HIV vulnerability but little is known about how the stigmas operate and intersect. Intersectional stigma offers a lens for understanding the experiences of stigmatised populations and refers to the synergistic negative health effects of various systems of oppression on individuals with multiple stigmatised identities, behaviours or conditions. This review aims to (1) assess how often and in what ways an intersectional lens is applied in HIV-related stigma research on SGM populations in SSA and (2) understand how intersectional stigma impacts HIV risk in these populations.
Design
Scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews.
Data sources
Public health and regional databases were searched in 2020 and 2022.
Eligibility criteria
Articles in French and English on HIV-related stigma and HIV outcomes among men who have sex with men, women who have sex with women and/or transgender individuals in SSA.
Data extraction and synthesis
Articles were screened and extracted twice and categorised by use of an intersectional approach. Study designs and stigma types were described quantitatively and findings on intersectional stigma were thematically analysed.
Results
Of 173 articles on HIV-related stigma among SGM in SSA included in this review, 21 articles (12%) applied an intersectional lens. The most common intersectional stigmas investigated were HIV and same-sex attraction/behaviour stigma and HIV, same-sex attraction/behaviour and gender non-conformity stigma. Intersectional stigma drivers, facilitators and manifestations were identified across individual, interpersonal, institutional and societal socioecological levels. Intersectional stigma impacts HIV vulnerability by reducing HIV prevention and treatment service uptake, worsening mental health and increasing exposure to HIV risk factors.
Conclusion
Intersectional approaches are gaining traction in stigma research among SGM in SSA. Future research should prioritise quantitative and mixed methods investigations, diverse populations and intervention evaluation.
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