Barriers and Facilitators of the Uptake of Human Immunodeficiency Virus (HIV) Services Among Transgender Women: A Mixed-Methods Study in Delhi, India.

BACKGROUND

Transgender women face higher human immunodeficiency virus (HIV) risk due to stigma, social marginalization, and high-risk behavior.

AIM: This study aimed to explore the barriers and facilitators to HIV service uptake among transgender women to improve healthcare access.

METHODOLOGY: A mixed-methods study was conducted among transgender women in Delhi, India. Data were collected from March to August 2023, using both quantitative and qualitative approaches. The quantitative study involved 170 participants from targeted intervention (TI) sites, focusing on sociodemographic characteristics, health profiles, and service utilization. The qualitative part included four focus group discussions (FGDs) and five in-depth interviews (IDIs) with transgender women, community leaders of the transgender community, and healthcare providers (medical officer, laboratory technician, and counsellor). Data analysis included statistical measures for quantitative data and thematic analysis for qualitative data to identify factors affecting service utilization. Ethical approval was obtained.

RESULTS

Among 170 transgender women, 48.2% were aged 20-30 years, and 43.5% lived within the transgender community. Nearly one-fifth (19.4%) reported a chronic health condition, while 26.5% had visited a health facility in the previous 30 days. HIV testing uptake was high, with 98.2% reporting periodic testing at TI sites and 12.5% testing HIV positive. Qualitative findings revealed multiple barriers to HIV service utilization, including internalized stigma, fear of disclosure, discriminatory experiences in healthcare settings, housing and financial insecurity, difficulties in condom negotiation, and limited transgender-sensitive services. Peer support, non-governmental organization (NGO) linkage, and transgender-inclusive TI services facilitated access.

CONCLUSION

Stigma, discrimination, and lack of a transgender-sensitive health system significantly hinder HIV prevention and antiretroviral therapy (ART) access for transgender individuals. Fear of disclosure, healthcare system deficiencies, and financial instability further complicate access. The study highlights the need for stigma reduction, trans-friendly healthcare, and economic empowerment to improve HIV-related services in this marginalized community.