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      Healthcare worker training to improve quality of care for sexual and gender minority people in sub‐Saharan Africa: learning from efforts in Uganda

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          Abstract

          Introduction

          Training in care for sexual and gender minority (SGM) populations is critical for ending the HIV epidemic. SGM people, particularly men who have sex with men (MSM) and transgender women, experience disproportionate HIV infection across the globe. The objective of this commentary was to synthesize facilitators of and barriers to SGM health training efforts for healthcare workers in Uganda, in order to help inform potential priorities, strategies and next steps to advance culturally responsive HIV‐related care for SGM communities across Uganda and sub‐Saharan Africa.

          Discussion

          SGM health training often includes education on: foundational concepts and language; stigma, discrimination and SGM health disparities; understanding and addressing implicit bias; sensitive and effective communication and building SGM‐inclusive and welcoming healthcare environments. Clinicians’ education includes sexual and gender histories, sex‐positive HIV counselling, sexually transmitted infections, HIV pre‐exposure prophylaxis and gender‐affirming hormone therapy. SGM communities in sub‐Saharan Africa have often experienced discrimination, persecution, incarceration and physical violence, and they encounter unique barriers to engagement in sexual health services and HIV prevention and treatment. SGM health training efforts in Uganda reveal challenges to and opportunities for advancing equity for SGM communities in sexual health and HIV medical care across the region. In Uganda, SGM community advocacy, as well as policies and programmes of the Ministry of Health and US President’s Emergency Plan for AIDS Relief, have increased readiness and need for scaling up training and skills‐sharing in SGM‐focused HIV and sexual healthcare, including Ugandan‐led and international initiatives.

          Conclusions

          Numerous challenges exist to widespread culturally responsive HIV and sexual healthcare for SGM communities in sub‐Saharan Africa. Lessons learned from healthcare worker training efforts in Uganda may inform future replication, adaptation and dissemination initiatives to meet the needs of more SGM communities in the region. Evaluation of SGM health training programmes to determine the impact on HIV virological suppression and sexual health outcomes will be critical for identifying best practices and strategies that may support advancing HIV epidemic control for SGM communities in Uganda and across sub‐Saharan Africa.

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          Most cited references34

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          Worldwide burden of HIV in transgender women: a systematic review and meta-analysis

          The Lancet Infectious Diseases, 13(3), 214-222
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            Stigma and Minority Stress as Social Determinants of Health Among Lesbian, Gay, Bisexual, and Transgender Youth: Research Evidence and Clinical Implications.

            In this article, we review theory and evidence on stigma and minority stress as social/structural determinants of health among lesbian, gay, bisexual, and transgender (LGBT) youth. We discuss different forms of stigma at individual (eg, identity concealment), interpersonal (eg, victimization), and structural (eg, laws and social norms) levels, as well as the mechanisms linking stigma to adverse health outcomes among LGBT youth. Finally, we discuss clinical (eg, cognitive behavioral therapy) and public health (eg, antibullying policies) interventions that effectively target stigma-inducing mechanisms to improve the health of LGBT youth.
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              HIV prevalence and behavioral and psychosocial factors among transgender women and cisgender men who have sex with men in 8 African countries: A cross-sectional analysis.

              Sub-Saharan Africa bears more than two-thirds of the worldwide burden of HIV; however, data among transgender women from the region are sparse. Transgender women across the world face significant vulnerability to HIV. This analysis aimed to assess HIV prevalence as well as psychosocial and behavioral drivers of HIV infection among transgender women compared with cisgender (non-transgender) men who have sex with men (cis-MSM) in 8 sub-Saharan African countries.
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                Author and article information

                Contributors
                akeuroghlian@partners.org
                amujugira@idi.co.ug
                kmayer@fenwayhealth.org
                Journal
                J Int AIDS Soc
                J Int AIDS Soc
                10.1002/(ISSN)1758-2652
                JIA2
                Journal of the International AIDS Society
                John Wiley and Sons Inc. (Hoboken )
                1758-2652
                30 June 2021
                July 2021
                : 24
                : Suppl 3 , Key Populations: the Future of the African HIV/AIDS Pandemic? Guest Editors: David Barr, Geoff P Garnett, Kenneth H Mayer, Michelle Morrison ( doiID: 10.1002/jia2.v24.s3 )
                : e25728
                Affiliations
                [ 1 ] The Fenway Institute Fenway Health Boston MA USA
                [ 2 ] Department of Psychiatry Massachusetts General Hospital and Harvard Medical School Boston MA USA
                [ 3 ] Infectious Diseases Institute Makerere University Kampala Uganda
                [ 4 ] Department of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
                [ 5 ] Department of Global Health and Population Harvard T.C. Chan School of Public Health Boston MA USA
                Author notes
                [*] [* ] Corresponding author: Alex S Keuroghlian, The Fenway Institute, 126 Brookline Avenue, 3 rd Floor Boston, Massachusetts, 02215, USA. Tel: +(617) 927‐6204. ( akeuroghlian@ 123456partners.org )

                Author information
                https://orcid.org/0000-0002-6624-8354
                https://orcid.org/0000-0001-7460-733X
                Article
                JIA225728
                10.1002/jia2.25728
                8242968
                34189872
                a98c545d-ffa6-49b6-a897-50292fa51aa5
                © 2021 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 April 2021
                : 30 October 2020
                : 20 April 2021
                Page count
                Figures: 0, Tables: 0, Pages: 5, Words: 12861
                Funding
                Funded by: Center for AIDS Research, Harvard University , open-funder-registry 10.13039/100007301;
                Award ID: P30AI060354
                Funded by: National Institute of Mental Health , open-funder-registry 10.13039/100000025;
                Award ID: R34 MH121084
                Funded by: Health Resources and Services Administration , open-funder-registry 10.13039/100000102;
                Award ID: U30CS22742
                Categories
                Commentary
                Supplement: Commentary
                Custom metadata
                2.0
                July 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.2 mode:remove_FC converted:30.06.2021

                Infectious disease & Microbiology
                sexual and gender minorities,hiv,education,training,sub‐saharan africa,uganda,pepfar

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