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

Abstract

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.

Keywords: HIV & AIDS; MENTAL HEALTH; Sexual and Gender Minorities; Sexually Transmitted Disease; Transgender Persons.

Figure 1

Flow diagram of record selection.

Figure 2

Network visualisation of stigmatised attributes. This illustrates the relationships between stigmas and the frequency in which their intersections are studied. The nodes in this figure represent stigmatised attributes and the size of each node represents the number of articles in the scoping review that focus on the stigmatised attribute. The width of the links represents the number of articles that analyze the intersection between the two stigmatised attributes.