"It's Not Easy for a Transgender Woman Here in Nigeria": A Qualitative Study to Inform HIV Prevention Intervention Development

Purpose: Transgender women have some of the highest rates of HIV globally. Sub-Saharan Africa is one of the more impacted regions, reflecting a higher underlying prevalence of HIV as well as greater social marginalization and criminalization of transgender women. While very little research has been conducted among transgender women in Nigeria, their risk for HIV infection is estimated to be much greater than the general population. In this study, we sought to determine both interest and adaptability of LifeSkills, an evidence-based intervention created by and for young transgender women in the United States, to reduce HIV-related risk among transgender women in Nigeria.Methods: Two focus groups were conducted in Ibadan, Nigeria, and data were analyzed using a content analysis approach.Results: A total of 15 transgender women participated in two focus groups with a mean age of 24.6 (standard deviation = 6.4). Echoing studies of transgender women globally, participants reported that the basic human need for kinship, acceptance, and support are undermined by harassment and violence. In addition to the personal and social harm of these experiences, they promote sexual risk, as described by focus group participants, by limiting options for basic HIV-related education, social support, access to preventive care, housing, and employment, all of which are a core focus of the LifeSkills curriculum. Interest in an empowerment approach focused on safety, support, and HIV prevention skill building, delivered in a group-based format was appealing to participants.Conclusion: The LifeSkills intervention elicited interest and may be adaptable to the needs of transgender women in Nigeria.