Socioeconomic inequality, health inequity and well-being of transgender people during the COVID-19 pandemic in Nigeria.

BACKGROUND: We aimed to explore socioeconomic inequality, health inequity, and the well-being of transgender people during the COVID-19 crisis in Nigeria. METHODS: Between June and December 2021, a cross-sectional survey was conducted collaboratively with community-based organisations in Nigeria. Participants living with or at risk of HIV were recruited voluntarily, online and face-to-face, using a combination of venue-based and snowball sampling. We assessed the association between gender identity (transgender and vulnerable cisgender women), and (i) socioeconomic inequality measured with socioeconomic status, social status, economic vulnerability, macrosocial vulnerability; (ii) health inequity measured with self-assessment of health, recency of HIV test, access to HIV and sexual and reproductive health services, gender-affirming care, financial and non-financial barriers to accessing health services; and (iii) well-being, measured with gender-based violence, mental health, psychoeconomic preferences. We used multivariable logistic regressions and controlled for interactions and confounders. RESULTS: There were 4072 participants; 62% were under 30, and 47% reported living with HIV. One in ten (11.9%; n = 485) was transgender, and 56.5% reported living with HIV. Compared to vulnerable cisgender women, the results showed significantly higher odds (aOR:3.80) of disruption in accessing HIV services in transgender participants; gender-based violence (aOR:2.63); severe (aOR:2.28) symptoms of anxiety and depression. Among the barriers to accessing health and HIV services, transgender had three-time higher odds of reporting additional non-official fees compared to vulnerable cisgender women. The disclosure of their gender identity or sexual orientation was the most important non-financial barrier to accessing health services (aOR:3.16). Transgender participants faced higher housing insecurity (aOR: 1.35) and lower odds of using drugs (aOR:0.48). Importantly, they are more likely to have performed a recent HIV test and less likely to not know their HIV status (aOR:0.38) compared to vulnerable cisgender women. CONCLUSIONS: Socioeconomic inequality, health and well-being inequity in transgender people appear to be exacerbated by the COVID-19 pandemic in Nigeria. Interventions are necessary to mitigate socioeconomic challenges, address structural inequality, and ensure equitable access to health services to meet the Sustainable Development Goals for transgender people.

Associations between COVID-19 vaccine hesitancy and the experience of violence among women and girls living with and at risk of HIV in Nigeria.

Aim: Women and girls living with and at high risk of HIV (WGL&RHIV) had an increased risk for gender-based violence (GBV) during COVID-19. The study aimed to assess the associations between vaccine hesitancy and GBV, HIV status and psychological distress among these vulnerable women and girls in Nigeria.Methods: This cross-sectional study collected data from WGL&RHIV in 10 states in Nigeria between June and October 2021. The dependent variable was vaccine hesitancy. The independent variables were the experience of physical, sexual, economic and emotional GBV, HIV status and psychological distress during the COVID-19 pandemic. We conducted a multivariable logistics regression analysis to test the associations between vaccine hesitancy and the independent variables and covariates.Results: Among the 3 431 participants, 1 015 (22.8%) were not willing to be vaccinated against COVID-19. Not knowing or willing to disclose HIV status (aOR 1.40) and having mild (aOR 1.36) and moderate (aOR 1.38) symptoms of anxiety and depression were significantly associated with higher odds of vaccine hesitancy. Being a survivor of intimate partner physical violence (aOR 5.76), non-intimate partner sexual violence (aOR 3.41), as well as emotional abuse (aOR 1.55) were significantly associated with respectively more than five, three and one and half times higher odds of vaccine hesitancy. One positive outcome is that HIV-positive women and girls appeared to be more likely to get the COVID-19 vaccine when available.Conclusions: Sexual and gender-based violence, low socio-economic status, psychological distress and an unknown HIV status are essential determinants of COVID-19 vaccine hesitancy among vulnerable women and girls in Nigeria. National authorities and civil society organisations need to better integrate COVID-19 mitigation activities with HIV and gender-based violence interventions through a more feminist approach that promotes gender equality and the empowerment of women and girls in all their diversity for better access to health services.

The effects of COVID-19 on food insecurity, financial vulnerability and housing insecurity among women and girls living with or at risk of HIV in Nigeria.

Aim: Women and girls living with or at high risk of acquiring HIV (WGL&RHIV) in Africa are economically vulnerable. This study aims to advance understanding of the economic impact of COVID-19 on WGL&RHIV and to identify the factors associated with this insecurity.Methods: Data were collected from a cross-sectional survey conducted among a convenience sample of WGL&RHIV in Nigeria between May and September 2021. Logistic regressions enabled the study of the role of HIV status, mental health and macrosocial characteristics (people with disability, transgender women, sex workers, persons engaged in transactional sex, substance users, and people on the move) on economic vulnerability, measured by food, financial and housing insecurity, since the COVID-19 pandemic began. The model accounted for the possible interactions between the macrosocial characteristics and controlled for confounders.Results: There were 3 313 (76.1%) of 4 355 respondents facing food insecurity, 3 664 (83.6%) of 4 385 with financial vulnerability and 1 282 (36.2%) of 3 544 with housing insecurity. Being a member of the key and vulnerable groups was strongly associated with food insecurity, financial vulnerability and housing insecurity, regardless of HIV serostatus. For example, WGL&RHIV engaging in transactional sex were more than four times more likely (aOR 4.42; 95% CI 2.57-7.59) to face housing insecurity and more than twice more likely to face food insecurity (aOR 2.47, 95% CI 1.35-4.52) and financial vulnerability (aOR 2.87, 95% CI 1.39-5.93). This economic vulnerability may reduce their negotiating power for safer sex or the use of HIV prevention methods, exposing them to increased risks of HIV infection. Poor mental health was also associated with the three forms of economic vulnerability.Conclusions: As the long-term impact of the COVID-19 crisis on African economies unfolds, HIV programmes at the country level must include economic vulnerability and mental unwellness mitigation activities for WGL&RHIV.

Factors associated with poor access to HIV and sexual and reproductive health services in Nigeria for women and girls living with HIV during the COVID-19 pandemic.

Aim: To determine the proportion of women and girls living with HIV (WGLHIV) who had poor access to HIV, tuberculosis and sexual and reproductive health (SRH) services in Nigeria during the COVID-19 pandemic and associated factors.Methods: This was a cross-sectional study that recruited WGLHIV with six categories of vulnerability (sex work, transactional sex, injecting or using illegal drugs, people on the move, transgender women and people with a disability) through an online survey conducted in ten Nigerian states between june and October 2021. The associations between the limited access to HIV, tuberculosis and SRH services due to COVID-19, the categories of vulnerability and the financial and non-financial barriers to these services were determined using multivariable logistics regression analysis.Results: Over 6 in 10, almost 2 in 10, and almost 4 in 10 WGLHIV had limited access to HIV, tuberculosis and SRH services respectively during the COVID-19 pandemic. Transgender women had 3.59 (95% CI 2.19-5.91) higher odds, women who engaged in sex work had 4.51 (95% CI 2.28-8.42) higher odds, and women who inject or use illegal drugs had 2.39 (95% CI 1.47-32.90) higher odds of facing limited access to sexual and reproductive health services when it was needed. In addition, the direct consequences of the COVID-19 crisis, such as the closure of HIV services and SRH service points, exacerbated pre-existing barriers significantly. Having no money, having to pay additional unofficial fees and the lack of security on the road to the health facility were the barriers with the greatest impact on access to health services.Conclusions: The COVID-19 pandemic had a negative impact on the access of WGLHIV to essential health services. This impact was disproportionately higher for marginalised groups. WGLHIV need non-discriminatory and affordable access to essential health services during the pandemic.

The health inequity and socioeconomic inequality faced by adolescent girls and women on the move living with or at high risk of HIV infection, during the COVID-19 pandemic in Nigeria.

BACKGROUND: We assessed if women and girls on the move living with or at high risk of HIV faced increased health inequity and socioeconomic inequalities during the COVID-19 pandemic compared with other vulnerable women and girls. METHODS: We used data collected through a survey conducted in Nigeria between June and October 2021. Women and girls living with or at risk of HIV were recruited voluntarily, using a combination of venue-based and snowball sampling. We performed multivariable logistic regression models per mobility and HIV status to determine associations between health inequity, socioeconomic inequalities and macrosocial characteristics. FINDINGS: There were 3442 participants, of which 700 were on the move. We found no statistical difference between HIV-negative women and girls on the move and those not on the move. On the opposite, we found substantial differences in health inequity and socioeconomic inequalities between women and girls on the move living with HIV and those not on the move living with HIV. There are very strong associations between being a woman or girl on the move living with HIV and facing economic precarity (aOR 6.08, 95% CI 1.94 to 19.03), food insecurity (aOR 5.96, 95% CI 2.16 to 16.50) and experiencing more gender-based violence since COVID-19 started (aOR 5.61, 95% CI 3.01 to 10.47). INTERPRETATION: Being a woman or girl on the move and living with HIV compound increased health and socioeconomic vulnerabilities. The COVID-19 crisis seems to have exacerbated inequalities and gender-based violence. These findings call for more feminist interventions to protect women on the move living with HIV during health crises.