Background The vulnerability of lesbian, bisexual, transgender and intersex (LBTI) women to HIV infection is a complicated public health issue that remains poorly documented. The Zimbabwe National AIDS Strategic Plan 2011–2015 does not acknowledge LBTI women as a vulnerable population for HIV infection. This study sought to explore sexual experiences and HIV risk behaviour among LBTI women and to determine challenges and experiences of accessing HIV services.
Methods Three focus group discussions were conducted with LBTI women aged 18 years and above, n = 29. Purposive sampling was used to recruit study participants through announcements at relevant meetings and safe spaces in Bulawayo. Focus group discussions were digitally recorded and transcribed verbatim. Using ATLAS. ti software, a set of a priori concept-driven codes were applied to the transcripts. The analysis concentrated on HIV risk perception, sexual behaviour and access to health services, experiences of violence, stigma and discrimination.
Results Participant`s perception of HIV risk was very low despite their engagement in sexual activities that involve sharing of body fluids. Narratives revealed that the majority of LBTI women never practised safe-sex, lacked awareness of the existence of LBTI specific protective measures against HIV and rarely sought HIV counselling and testing services. LBTI women reported experiencing a repertoire of social exclusion and violence in their lives including forced sexual experiences. Barriers to HIV care and support, included HIV-related stigma, hetero-normative assumptions in HIV and STI related health services and unprofessional, discriminatory and incompetent treatment by health professionals.
Conclusions HIV risk among LBTI women is elevated by lack of access to HIV prevention services and barriers to HIV care and support. This study highlights a trajectory of structural exclusion of LBTI women which accentuates their vulnerability to HIV infection. HIV/AIDS policy in Zimbabwe should address HIV prevention, care and support for LBTI women.