Across the southern African region, individuals from key populations, particularly young men who have sex with men (MSM) and young transgender women, have become priorities for HIV programming, including those already living with HIV.  The efforts to reach these groups take place in a context where the risks of stigma, discrimination and violence remain acute, based on sexual orientation, gender identity and health status, and where little is know about the influence of these factors on uptake and retention on anti-retroviral treatment (ART) and other health outcomes.

This mixed-methods research project explored the influence of stigma on uptake and retention on ART for young (18-24 years) HIV-positive MSM and transgender women in three settings, Malawi, Zambia and Zimbabwe.  It drew on the emerging concepts in stigma research of intersectionality and intersectional stigma, among others.

The results show that intersectional stigma remains a potent influence in the lives of these young people as they seek to live out their diverse identities and to also embrace themselves as people living with HIV in harsh and marginalising socio-political contexts. The risks to ART adherence remain high for many as the burden of intersectional stigma excerpts a strongly negative influence on their mental, spiritual and emotional health.  There is an absence of robust programming in the region to address this burden, although many young participants had managed to build up their own coping and resilience strategies to protect themselves and to sustain their commitment to ART.

The findings from the research will be used to develop and pilot interventions to strengthen and sustain these coping and resilience mechanisms.  The project is a partnership between researchers at HEARD, the Kamuzu University of Health Sciences (Malawi), University of Zambia, and the University of Zimbabwe.  It is supported through a grant from the HIV/AIDS Special Fund Round III managed by the Southern African Development Community.


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