The scoping review identified a limited number of studies that evaluated the effectiveness of transgender stigma reduction interventions in sub-Saharan Africa. The studies that were analyzed employed different methodological approaches and evaluated the interventions qualitatively. The interventions targeted stigma at different levels including structural, interpersonal, and participatory theatre interventions. The study recommended that future interventions should be multi-level, incorporating strategies that address other forms of stigma, and should be accompanied by rigorous implementation science to ensure ongoing learning and adaptation. The study also noted three gaps in the literature, including the lack of intervention targeting transgender people, the need for greater details about interventions for potential replication, and the absence of assessments of implementation outcomes. The review concludes with a recommendation for primary research and interventions targeting transgender populations in Africa, and for the reporting of details about interventions’ core components and descriptions. The authors also acknowledge their funding sources, the organizations that provided technical assistance and their roles in the study, and declare no conflicts of interest.
Understanding Transgender Stigma Reduction Interventions in Sub-Saharan Africa
The transgender or trans population is a highly marginalized social group globally, often experiencing discrimination and ill-treatment. The term “transgender” refers to individuals whose gender identity is incongruent with societal gender norms or the sex category assigned to them at birth. This mistreatment and discrimination are referred to as transphobia, which describes an irrational fear and hatred of transgender individuals.
Transgender stigma can take different forms, including enacted, felt, perceived, or anticipated stigma, and internalized or self-stigma. Stigma is complex, with challenges around measurement of its level, severity, and frequency. Transgender stigma influences numerous health outcomes and works through multi-faceted risk factors. Healthcare-related stigma can negatively affect health outcomes, including depression, anxiety, substance abuse, HIV, and condomless sex among transgender people.
Trans women, in particular, face systemic oppression or state-sanctioned stigma codified in laws or rooted in societal norms, in addition to interpersonal and individual forms of stigma. Stigma in low-resource settings poses a greater obstacle to accessing services than in other contexts. The socioecological framework has been used to explain how stigma operates at multiple levels to impact health.
The gender minority stress theory suggests that stressors related to stigma attached to one’s incongruous gender identity/expression adversely affect health and account for health differences between transgender and cisgender individuals. Gender insensitivity, displays of discomfort, denied services, suboptimal or forced care, and verbal abuse are at the core of transgender individuals’ views on healthcare challenges.
The scoping review investigates the implementation and effectiveness of transgender stigma reduction interventions in sub-Saharan Africa. The review aimed to identify studies that evaluated interventions aimed at reducing transgender stigma, regardless of study design or outcome measures. The review included 13 studies conducted across six countries, with most studies being non-randomized before-and-after intervention studies. The interventions focused on increasing knowledge, attitudes, and practices towards transgender individuals among healthcare providers and the general public. The review found that stigma reduction interventions can have a positive effect on healthcare providers’ knowledge, attitudes, and practices towards transgender individuals. The review also revealed the need for more research on transgender stigma reduction interventions in sub-Saharan Africa.
Addressing Transgender Stigma in Africa: Challenges and Opportunities
Transgender populations in Africa face significant challenges due to the criminalization of LGBT communities in most African countries. Stigma and discrimination are widespread, and accessing healthcare services can be challenging due to hostility from healthcare providers. Transgender women report various forms of stigma, including beatings, abuse, and discrimination in the workplace or from family members. Healthcare-related stigma is a significant barrier to accessing services, with nearly half of MSM and transgender women experiencing at least one healthcare-related stigma experience. Internalized stigma is also prevalent, hindering access to HIV/STI prevention and care services.
Stigma reduction interventions have been developed to improve coping at the individual level, reduce interpersonal stigma, and change the norms, policies, and systems that propagate stigma at the structural level. However, data on health-related stigma and discrimination are often lacking, limiting intervention and program development.
The scoping review aimed to assess the extent of literature on the implementation and effectiveness of transgender stigma reduction interventions in sub-Saharan Africa. The review identified 13 studies conducted across six countries, with most studies being non-randomized before-and-after intervention studies. The interventions focused on increasing knowledge, attitudes, and practices towards transgender individuals among healthcare providers and the general public.
Despite the limited evidence base, the review found that stigma reduction interventions can have a positive effect on healthcare providers’ knowledge, attitudes, and practices towards transgender individuals. However, more research is needed on transgender stigma reduction interventions in sub-Saharan Africa.
The criminalization of LGBT communities in most African countries exacerbates the challenges faced by transgender populations. Stigma and discrimination remain widespread, with healthcare-related stigma hindering access to services. Stigma reduction interventions have the potential to improve healthcare providers’ attitudes and practices towards transgender individuals. However, more research is needed to determine the most effective interventions in sub-Saharan Africa.
Mapping Existing Evidence: Transgender Stigma Reduction Interventions in Sub-Saharan Africa
A scoping review methodology was selected to map existing evidence, identify gaps, and determine the main sources and types of evidence available regarding transgender stigma reduction interventions in sub-Saharan Africa. The review sought to provide synthesized evidence that policymakers and programs in similar settings could use to design evidence-based stigma reduction interventions to improve healthcare access for transgender individuals and other sexual and gender minority populations.
The review was guided by the JBI methodology for scoping reviews and the framework initially described by Arksey and O’Malley and modified by Levac et al. The research question guiding the review was “What is the implementation and effectiveness of transgender stigma reduction interventions in sub-Saharan Africa?” The review sought to identify the target population for transgender stigma reduction interventions, the type of interventions being implemented, the outcomes of interventions aimed at reducing transgender stigma, and the effectiveness of stigma reduction interventions.
The search strategy aimed to locate both published and unpublished studies, and a medical librarian was consulted to provide advice on the search strategy. An initial limited search of MEDLINE was undertaken to identify relevant articles, and the text words contained in the titles and abstracts of these articles and the index terms used to describe them were used to develop a full search strategy. The search strategy was applied to different databases using the Peer Review of Electronic Search Strategies guidelines, and search terms and free-text words were combined using Boolean operators “AND” and “OR”. The search strategy was adjusted to cater to differences in functionality of other databases.
The review included 13 studies conducted across six countries, with most studies being non-randomized before-and-after intervention studies. The interventions focused on increasing knowledge, attitudes, and practices towards transgender individuals among healthcare providers and the general public. The review found that stigma reduction interventions can have a positive effect on healthcare providers’ knowledge, attitudes, and practices towards transgender individuals. However, more research is needed on transgender stigma reduction interventions in sub-Saharan Africa.
In conclusion, this scoping review provides important insights into the implementation and effectiveness of transgender stigma reduction interventions in sub-Saharan Africa. The review highlights the need for evidence-based interventions to improve healthcare access for transgender individuals and other sexual and gender minority populations, and more research is needed in this area.
A comprehensive literature search was conducted to identify eligible studies for this scoping review. The search was performed on several electronic databases, including MEDLINE, Cochrane Library, EBSCOhost, CINAHL, Embase, Web of Science, clinicaltrials.gov, and the International Clinical Trials Registry Platform. Grey literature was sourced from Mednar, conference proceedings, white papers, and theses. Hand searching was conducted on relevant journals and reference lists of relevant articles. There were no language restrictions, and any article published from database inception to the index search date was screened. The search was re-run in May 2022.
Two reviewers independently screened the titles and abstracts of all retrieved records from the search output based on pre-determined inclusion/exclusion criteria. Articles meeting the inclusion criteria were further subjected to a full-text assessment for eligibility. Any disagreement between the reviewers was resolved through consensus.
To define the inclusion criteria, the PCC (Population, Concept, and Contexts) framework proposed by Peters et al. was applied. Populations eligible for this scoping review included all individuals involved in providing or receiving transgender healthcare, including transmen, transwomen, gender-diverse persons, gender non-conforming persons, staff at community-based organizations, staff at drop-in centers, health workers, peer educators, peer counselors, and partners of transgender people, among others. The concepts related to the stigma reduction intervention were assessed following the template for intervention description and replication (TIDier) guidelines, including the type of intervention, mode of delivery, setting, implementers, timing or duration or dose, materials or information given to participants, procedures, activities and/or processes of the intervention, tailoring of the intervention, modifications during the study, if intervention fidelity or adherence were assessed, and how the intervention outcomes were determined. Eligible studies were limited to those conducted in Africa.
This scoping review aims to identify and map the available evidence on the implementation and effectiveness of transgender stigma reduction interventions in sub-Saharan Africa. The review will provide synthesized evidence that can be used by health policymakers and programs in similar settings to design evidence-based stigma reduction interventions that can improve healthcare access for transgender people and other sexual and gender minority populations. By comprehensively searching and screening studies using the PCC framework and TIDier guidelines, this scoping review will provide valuable insights and help identify gaps in the literature on the topic.
Scoping Review: Implementation and Effectiveness of Transgender Stigma Reduction Interventions in sub-Saharan Africa
Introduction
A scoping review was conducted to map the existing evidence and identify gaps, main sources and types of evidence available regarding the implementation and effectiveness of transgender stigma reduction interventions in sub-Saharan Africa. The study was guided by the JBI methodology for scoping reviews and a PCC (Population, Concept, and Contexts) framework to define inclusion criteria.
Methodology
Study Selection
The review included studies that reported stigma reduction among transgender persons, reported stigma reduction interventions, reported quantifiable outcomes of stigma reduction interventions, and were conducted in Africa. The review considered both experimental and quasi-experimental study designs, analytical observational studies, and descriptive observational study designs. Qualitative studies, systematic reviews, and text/opinion papers were also considered.
Charting the Evidence
Following the search, identified citations were collated, uploaded into EndNote, and duplicates were removed. For each eligible study, data was independently abstracted and recorded using a data abstraction tool containing study and intervention characteristics.
Results
The search strategy located published and unpublished studies on electronic databases including MEDLINE (via PubMed), Cochrane Library, CINAHL, and Embase, among others. Additional literature was sourced from the internet, related journals, and reference lists of relevant articles. Grey literature was sourced from Mednar, conference proceedings, white papers, and theses.
Study Details
Eligible populations included all categories of individuals involved in providing or receiving transgender healthcare. The concepts related to the stigma reduction intervention were assessed following the TIDier guidelines. Studies needed to present disaggregated data on the trans-sub-sample to be included.
Abstraction Tool
The abstraction tool included five domains: study details, design and methods, type of stigma targeted, intervention and outcomes, and key findings. The full text of selected citations was assessed in detail against the inclusion criteria by two independent reviewers.
Conclusion
This scoping review provides synthesized evidence that policymakers and programs in similar settings may use to design evidence-based stigma reduction interventions to improve healthcare access for transgender people and other sexual and gender minority populations.
Study Objective
The scoping review aims to map the existing evidence on transgender stigma reduction interventions in sub-Saharan Africa, and identify gaps and the main sources and types of evidence available. The study seeks to determine the population that is targeted for transgender stigma reduction interventions, the type of interventions implemented to reduce transgender stigma, the outcomes of the interventions aimed at reducing transgender stigma, and the effectiveness of stigma reduction interventions in reducing or alleviating transgender stigma.
Design and Methods
The study design may include quantitative, qualitative, or mixed methods such as randomised controlled trials, pragmatic trials, non-randomised controlled trials, and observational studies, with or without controls, and hybrid trials. The study population includes the community, transgender persons, providers, and/or policy-makers. The study may or may not state the hypothesis and may or may not be guided by a conceptual model or theory. The measures used to collect data should be validated, and the sample size and characteristics, as well as the follow-up period, must be reported.
Type of Stigma
The level of stigma targeted may be individual, interpersonal, and/or structural, while the type of stigma targeted may be enacted, internalised, and/or anticipated. The measurement used to assess stigma and stigma reduction should also be reported.
Interventions and Outcomes
The study should report the official name of the intervention, the rationale, theory, or goal of the intervention, the mode of delivery, location/setting of intervention, implementers of intervention, timing or duration or dose, materials or information given to participants, procedures, activities, and/or processes of the intervention including enabling and supporting activities, tailoring of the intervention vs homegrown, modifications during the study, and whether intervention fidelity or adherence were assessed. The level of stigma reduction intervention may be individual, interpersonal, and/or structural. The study should report the implementation outcomes such as acceptability, adoption, appropriateness, feasibility, fidelity, cost, penetration, and/or sustainability, as well as the effectiveness and outcomes related to stigma or transgender health.
Key Findings
The study should report conclusions and recommendations based on the findings of the review.
Synthesizing and Reporting the Evidence
The reporting of the findings of this review follows the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. The data abstraction tool used for study and intervention characteristics should be complete, and the accuracy of the analysis should be verified. Any disagreements between reviewers during the selection process should be resolved through discussion, or with an additional reviewer as needed. The accuracy and fidelity of the data should be checked by two other review team members, and the findings confirmed by an independent medical librarian who re-ran the search strategy on the different databases.
Scoping Review of Stigma Reduction among Transgender Persons in Africa
Data Extraction and Analysis
Data were extracted by independent reviewers using a data extraction tool that captured specific details about participants, concept, context, study methods, and key findings relevant to the review question/s. For qualitative studies, data were summarized narratively, while quantitative evidence was aggregated and summarized using appropriate statistics and methods. A narrative synthesis of key results was conducted for each stigma reduction intervention and outcome.
Consultation with Stakeholders
Key stakeholders from transgender-led community-based organizations, health care workers at trans-friendly health facilities, policymakers, psychologists, and experts in HIV programming were engaged to obtain relevant grey literature and provide support with the identification of critical concepts and contextual interpretation of the review findings. Stakeholders will receive a copy of the review findings to assess whether critical concepts have been captured and interpreted correctly in the context of transgender stigma.
Results
A total of 4 studies out of 877 screened met all the inclusion criteria and implemented a range of stigma reduction interventions. Several studies were excluded from the review because while they conducted stigma reduction interventions among key populations, they did not disaggregate the data for transgender people.
Characteristics of Included Studies
The included studies in this scoping review were carried out in Africa and employed a range of quantitative and qualitative study designs. The studies targeted various populations involved in providing or receiving transgender healthcare, including transmen, transwomen, gender-diverse persons, gender non-conforming persons, staff at community-based organizations, staff at drop-in centres, health workers, peer educators, peer counsellors, and partners of transgender people, among others. The studies reported on the type, mode, and location of interventions, the implementers of interventions, timing, duration, or dose, materials or information given to participants, procedures, activities and/or processes of the intervention including enabling and supporting activities, tailoring of intervention, modifications during the study, and fidelity or adherence to the intervention. Key findings related to implementation outcomes, acceptability, adoption, appropriateness, feasibility, fidelity, cost, penetration, and/or sustainability, as well as effectiveness and outcomes related to stigma or transgender health, were also reported.
The included studies in this scoping review were published between 2019 and 2022 and had a total sample size of 2526 participants. All the studies were conducted in Sub-Saharan African countries, except for one that also included two Caribbean countries. Only one study used a conceptual framework – Community-based research (CBR). The study types varied and included one qualitative, one pre-and post-test intervention cross-sectional survey, and one qualitatively driven triangulated longitudinal mixed-methods design. The study participants included community stakeholders, clinical and non-clinical staff, and organizations for advocacy of LGBTQI and other key stakeholders. Only one study used a globally validated tool to measure health worker stigma and discrimination. One study explicitly mentioned transgender people among the study participants, while another involved SGM peer educators. However, another study did not report demographic information about study participants for their security, and thus, the involvement of transgender people is unclear. Table 2 summarizes the characteristics of the included studies.
The study by Logie et al. aimed to assess the potential of participatory theatre as a mechanism to change stigmatizing attitudes towards LGBT people in Swaziland and Lesotho. Nyblade et al. aimed to evaluate the impact of a “total facility” stigma-reduction intervention on the drivers and manifestations of stigma and discrimination among health facility staff in Ghana. Miller et al. documented the intended and unintended outcomes of an advocacy initiative designed to contribute to dismantling structural barriers to HIV care for gay and bisexual men and transgender women in select countries in Africa. Keuroghlian et al. aimed to improve the capacity of providers to deliver gender-affirming HIV prevention and care to transgender women in Uganda.
The studies had various sample sizes, ranging from 106 to 2308 participants. The validated stigma measures used in the studies varied, with only one study utilizing a globally validated tool measuring health worker stigma and discrimination. The study populations included community stakeholders, nursing students, nurses, educators, community leaders, police, and other community members, clinical and non-clinical staff, lead collaborating partners, medical community, government officials, media, LGBTQI organizations, LGBTQI constituents, and other civil society organizations.
Synthesizing Facilitators and Barriers to SGM Health Training Efforts in Uganda
This scoping review aimed to identify facilitators and barriers to sexual and gender minority (SGM) health training efforts for healthcare workers in Uganda. The goal was to provide information on priorities, strategies, and next steps to advance culturally responsive HIV-related care for SGM communities in Uganda.
Geographical Location of Included Studies
The studies included in this review were conducted in Swaziland (Eswatini) and Lesotho, Uganda, Ghana, and Burundi, Cameroon, Côte d’Ivoire, and Zimbabwe.
Intervention Level Descriptive Characteristics
The interventions implemented in the studies included in this review were:
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Participatory Theatre Intervention (PTI) in Lesotho and Eswatini (Swaziland): This intervention targeted interpersonal stigma and involved two components. Community animators from theatre groups enacted skits and invited intervention participants to portray positive and supportive solutions.
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“Total Facility” Intervention in Ghana: This two-day participatory stigma-reduction training targeted interpersonal stigma among clinical and non-clinical staff. Staff and clients were trained as stigma-reduction facilitators.
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MARPI Model Training in Uganda: Conducted by SGM peer educators for research staff for a clinical trial, about inclusive service delivery.
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Advocacy and Other Community Tactics (ACT) Intervention: This intervention targeted structural stigma in five African countries and self-stigma in Ghana, through partnerships with stakeholders for advocacy.
Key Findings and Recommendations
The PTI intervention resulted in a change in attitudes or perspective through self-reflection and learning, while also highlighting ambivalence in changing attitudes or perspectives. The “Total Facility” intervention increased staff and client awareness of stigma and resulted in increased support for SGM health. The MARPI Model Training improved research staff’s understanding of SGM health issues and service delivery. Finally, the ACT intervention emphasized the importance of community-led and partnership-based approaches to reduce SGM stigma.
Recommendations include expanding interventions to targeted groups, integrating interventions into existing community events, and focusing interventions on rural communities.
Mechanisms for Addressing Stigma in HIV-related Care for SGM Communities
To effectively address HIV-related care for SGM (sexual and gender minorities) communities, there is a need for a comprehensive approach that includes policy- and community-level changes. Three studies that focused on stigma reduction interventions in Ghana, Uganda, and several African countries provide valuable insights into the mechanisms for addressing stigma.
Ghana “Total Facility” Intervention
The intervention was a two-day participatory stigma-reduction training for all staff levels in health facilities, with delivery by staff and clients who were trained as stigma-reduction facilitators. The training included 14 core activities and was focused on observed and perceived interpersonal stigma. Fear of acquiring HIV while providing care for clients living with HIV, and associated stigmatizing avoidance behaviors, improved significantly in the intervention facilities. However, there were no significant differences in stigmatizing attitudes between the intervention and control facilities.
ACT: Advocacy and Other Community Tactics
The intervention was designed to target structural stigma in five African countries and self-stigma in Ghana. The intervention involved awareness building, community mobilization, documentation, policy analysis and engagement, self-stigma reduction, and sensitization. The intervention led to increased commitments to equality in access to HIV care, improvements in access to HIV care, enhanced advocacy capacity, and formal policy changes. Combining structural interventions with activities to address self-stigma and self-care can be beneficial.
MARPI: (Most At Risk Populations Initiative) Training Model
The training model focused on providing cultural responsiveness training to HIV and sexual healthcare staff and involving SGM peer educators in the training process. The training aimed to equip healthcare staff with knowledge, skills, and empathy needed to serve SGM people, increase understanding of the relationship between societal stigma and health disparities, cultivate staff’s insight into their personal level of comfort and confidence serving SGM people, and foster vigilance to keep personal attitudes towards SGM people separate from professional behavior.
Next Steps
To foster lasting attitudinal changes, mechanisms should be considered to address policy- and community-level changes in stigma. Social-ecological approaches can be employed to help identify barriers and facilitators to attitudinal change. Healthcare facilities should rigorously implement stigma-reduction interventions to ensure ongoing learning and adaptation to maximize effectiveness and long-term impact.
In sub-Saharan Africa, mitigating transgender stigma is essential to improve HIV-related care for sexual and gender minority (SGM) communities. The studies conducted in different African countries provide insights into effective interventions to address stigma and improve HIV-related care for SGM people.
Key intervention approaches
The studies revealed that participatory theatre intervention, total facility intervention, MARPI training model, and advocacy and other community tactics multi-country intervention were effective in mitigating transgender stigma. These interventions targeted different levels of stigma and utilized diverse strategies.
Facilitators and barriers
The studies identified different facilitators and barriers to implementing these interventions. The barriers included stigma, discrimination, and socio-cultural norms that hinder access to health care services by SGM people. However, partnerships with local SGM communities, cultural responsiveness, and involving SGM peer educators were found to be significant facilitators to delivering interventions.
Implementation and effectiveness outcomes and findings
The participatory theatre intervention and total facility intervention were found to be effective in reducing stigma and improving attitudes towards SGM people. The MARPI-led intervention was reported to create a welcoming and inclusive environment for SGM communities. Meanwhile, the advocacy and other community tactics multi-country intervention had significant outcomes related to equality in access to HIV care and enhancement in advocacy capacity. Combining interventions targeting stigma at different levels, including self-stigma, was also recommended.
Key recommendations
To deliver effective interventions, the studies suggest establishing partnerships with local SGM communities and expanding interventions to targeted groups and rural communities. Online live trainings, technical assistance programs, and no-cost web-based educational resources may facilitate the scale-up of tailored HIV and sexual healthcare for SGM communities in rural areas. Utilizing implementation science approaches was recommended to improve intervention effectiveness and sustainability.
Discussion
Mapping the evidence on evidence-based interventions for transgender stigma mitigation in sub-Saharan Africa is critical to inform the development of implementation strategies that target different levels of stigma. Applying key concepts and terminology for sensitive and effective communication, promoting warmth and sincerity in service delivery, raising awareness of verbal and nonverbal communication, and prioritizing flexibility, choice, and autonomy in care were found to be significant in effective intervention delivery.
This scoping review analyzed the literature on transgender stigma reduction interventions in sub-Saharan Africa and found that only three out of 23 eligible articles explicitly mentioned transgender populations. Moreover, none of the included studies targeted stigma among transgender people. The interventions identified at various socio-ecological levels to address individual stigma and interpersonal and structural stigma were evaluated qualitatively, and while some studies incorporated conceptual frameworks, none assessed implementation outcomes. The lack of attention given to transgender populations in stigma reduction interventions highlights the need for further research in the design or adaptation of evidence-based interventions.
One key gap in the literature identified by this review was the lack of sufficient details necessary for the replication and adoption of interventions in other contexts, with only one study providing such details. The studies recognized the limitation of the short evaluation time frame, which did not allow for the assessment of longer-term intervention effects, raising concerns about sustainability. Despite the absence of data on transgender populations, the review identified the need for implementation science research to guide the design and adaptation of evidence-based interventions.
The review highlights the need for interventions that are sustainable and can deliver intended benefits over an extended period after external support is terminated. This emphasizes the importance of considering implementation outcomes, including acceptability, feasibility, adoption, appropriateness, cost, fidelity, penetration, or sustainability, in the assessment of interventions. The limited available data suggests that research efforts need to prioritize transgender stigma reduction interventions in sub-Saharan Africa, incorporating approaches that address policy and community-level changes in stigma, apply key concepts and terminology for sensitive and effective communication, promote warmth and sincerity in service delivery, raise awareness of verbal and nonverbal communication, and prioritize flexibility, choice, and autonomy in care.
Mitigating Transgender Stigma in Sub-Saharan Africa: A Scoping Review
This scoping review aimed to assess the implementation and effectiveness of transgender stigma reduction interventions in sub-Saharan Africa (SSA) and identify gaps in the literature.
Interventions Targeting Transgender Stigma
Three studies were identified as eligible for data extraction, and none of them targeted stigma among transgender people. However, the interventions in these studies targeted stigma at different levels, including structural and interpersonal stigma. The studies recommended targeting a range of actors and socio-ecological levels for mitigation interventions among transgender people. Future stigma reduction interventions in SSA may consider multi-level strategies to address the problem.
Recommendations for Mitigating Transgender Stigma
The main recommendations from the studies include designing interventions that are coupled with activities to address other forms of stigma and to ensure ongoing learning and adaptation to maximize effectiveness and long-term impact. Expanding interventions to targeted groups such as LGBT for interventions among other stakeholders, integrating interventions into existing community events, and consideration of mechanisms to address policy- and community-level changes in stigma to foster lasting attitudinal changes were also recommended.
Strengths and Limitations
The study utilized a systematic approach to the literature search, employing the PCC framework. However, there is a possibility that some articles may have been missed. The scoping review revealed the paucity of literature on the implementation and effectiveness of transgender stigma reduction interventions in sub-Saharan Africa.
Conclusions
The limited evidence of interventions delivered to mitigate stigma at interpersonal and structural levels in SSA highlighted the need for primary research and interventions targeting transgender populations in Africa. Future anti-transgender stigma research should report details about the core components and descriptions of the interventions. Furthermore, the use of validated measures of stigma and evaluation of interventions for implementation outcomes are recommended.
Funding
No information was provided about funding sources for this study.
Funding and Author Contributions
This study was supported by the HIV, Infectious Diseases and Global Health Implementation Research Institute (HIGH IRI) of Washington University in St. Louis, along with training grants from the Fogarty International Center and the National Institute of Mental Health of the National Institutes of Health. The authors declare that the funders had no role in the study design, data collection, and analysis, decision to publish, or preparation of the manuscript. All authors contributed to the study design, data analysis, and manuscript preparation. The authors also declare no conflicts of interest.
Author Contributions
The authors of this study made significant contributions to the conceptualization, protocol development, data collection and analysis, manuscript preparation, and critical insights. All authors have read and approved the final version of the manuscript.
Acknowledgements
The authors would like to acknowledge the African Center for Health Equity Research and Innovation (ACHERI) for their support with the literature search and review of full-text articles.
Contact Information
Patience A. Muwanguzi, from the College of Health Sciences at Makerere University, is the corresponding author of this study. For any inquiries, please contact her at pamuwanguzi@gmail.com or call +256392178085.
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