FRAD0401 | BARRIERS TO HIV SERVICE ACCESS AMONG MARGINALIZED WOMEN AND SEXUAL MINORITIES IN LAGOS AND OGUN STATES: A MIXED-METHOD STUDY

Awawu Adegbite | The Rainbow Alive Hub Initiative (TRAHI), Ikeja, Nigeria

Key populations (KPs) in Southwest Nigeria including Lesbian-Bisexual-Queer women, trans-women, female sex workers (FSWs), women living with HIV, and women who inject drugs face entrenched discrimination within public health systems, particularly during HIV testing, counseling, and treatment. In Lagos and Ogun States, KPs are being misgendered, denied care, or verbally abused by healthcare workers. ART is often unaffordable, with out-of-pocket costs exceeding monthly minimum wage. Many facilities also lack privacy and safe complaint channels, deterring sustained care. These systemic and interpersonal barriers continue to undermine Nigeria’s progress toward equitable HIV service delivery. Community-led organizations designed and implemented this study, supported by the Gender Equality Fund, in response to persistent HIV service barriers. A mixed-methods approach was used across Lagos and Ogun States, combining a desk review, online questionnaires, eight FGDs, ten KIIs, and five IDIs. A total of 267 participants aged 18–49 were purposively sampled: 20 trans-women, 65 lesbian women, 18 bisexual women, 13 queer women, 13 women who inject drugs, 40 women living with HIV, and 98 FSWs. Qualitative data were analyzed using SPSS, qualitative data were thematically analyzed. Triangulation was employed for comprehensive insights into systemic barriers and intervention outcomes. Stigma and provider bias remain entrenched. 49.5% of participants reported judgmental treatment; 41.2% were misgendered; 36.8% had been denied care. Qualitative narratives highlighted verbal abuse and hostile environments. 54% said ART costs exceeded their monthly income. 46.7% cited lack of privacy during consultations. A striking 71.4% reported no access to safe, anonymous mechanisms for lodging complaints about mistreatment. Among those who experienced mistreatment, 63.9% reported disengaging from care due to accumulated fear and distrust. These findings confirm that structural stigma, not just individual bias, drives health disparities. The evidence calls for mandatory, community-informed training for frontline providers, emphasizing respectful engagement with LBQ and trans clients. Advocacy is needed to expand ART subsidies and integrate privacy safeguards into service points. A community-monitored complaint system should be piloted with facility buy-in. Lastly, government HIV programs must adopt inclusive service protocols and disaggregate uptake data by sexual orientation and gender identity to improve accountability and impact.