Criminalization, Stigma, and Barriers to Justice: A Mixed-Methods Implementation Study of Rights-Based HIV Responses for Rural LGBTQ Population in Yakurr.

LGBTQ populations in rural Cross River State, Nigeria face intersecting barriers to HIV prevention, gender-based violence (GBV) response, and access to justice, driven by criminalization, stigma, and limited availability of inclusive services. This study evaluated a community-led, multi-level intervention implemented in Yakurr Local Government Area, in Cross River State, Nigeria. A convergent mixed-methods implementation study was conducted between August 2023 and December 2024 among LGBTQ individuals in selected rural communities (Ugep, Mkpani, Ekori, and Idomi). A total of 457 LGBTQ participants were engaged in community dialogues, from which a purposively selected subset of 221 individuals receiving antiretroviral therapy (ART) participated in in-depth interviews. The intervention comprised peer-led advocacy, community dialogues, GBV response services, safety and security training, and healthcare worker engagement, implemented using Human Rights-Based Approach (HRBA). Quantitative data were analyzed using descriptive and pre-post comparisons, while qualitative data were analyzed thematically. Findings were triangulated to assess effectiveness and implementation processes. At baseline, 72.4% of participants reported fear of arrest, and 68.9% reported prior exposure to GBV. Following the intervention, knowledge of HIV prevention increased from 54.2% to 81.7%, awareness of legal rights from 35.6% to 73.4%, and awareness of GBV response pathways from 41.3% to 78.9%. A total of 144 GBV survivors accessed integrated support services in addition, 178 individuals initiated ART, and 215 accessed viral load testing and counseling. Participants reported increased utilization of community-based GBV reporting mechanisms and improved linkage to LGBTQ-friendly healthcare services. Community-led, rights-based and multi-level interventions were associated with substantial improvements in knowledge, service uptake, and access to justice among LGBTQ populations in criminalized and resource-limited settings. Integrating peer-led systems with community mobilization and institutional engagement provides a scalable model for strengthening HIV and GBV responses in similar contexts.

HIV prevention, Gender-Based Violence

1. Adebajo, S., Eluwa, G., Njab, J., et al. (2018). Evaluating the effectiveness of HIV prevention interventions among men who have sex with men in Nigeria. AIDS Care, 30(S3), 1–8. https://doi.org/10.1080/09540121.2018.1492691 [Google Scholar] [Crossref]

2. Atkinson, R., & Flint, J. (2001). Accessing hidden and hard-to-reach populations: Snowball research strategies. Social Research Update, 33, 1–4. [Google Scholar] [Crossref]

3. Bandura, A. (2004). Health promotion by social cognitive means. Health Education & Behavior, 31(2), 143–164. https://doi.org/10.1177/1090198104263660 [Google Scholar] [Crossref]

4. Baral, S., Beyrer, C., Muessig, K., Poteat, T., Wirtz, A., Decker, M., Sherman, S., & Kerrigan, D. (2013). Burden of HIV among female sex workers in low-income and middle-income countries: A systematic review and meta-analysis. The Lancet Infectious Diseases, 12(7), 538–549. https://doi.org/10.1016/S1473-3099(12)70066-X [Google Scholar] [Crossref]

5. Beyrer, C., Baral, S. D., Collins, C., et al. (2016). The global response to HIV in men who have sex with men. The Lancet, 388(10040), 198–206. https://doi.org/10.1016/S0140-6736(16)30781-4 [Google Scholar] [Crossref]

6. Beyrer, C., Sullivan, P., Sanchez, J., et al. (2012). The increase in global HIV epidemics in MSM. The Lancet, 380(9839), 367–377. https://doi.org/10.1016/S0140-6736(12)60821-6 [Google Scholar] [Crossref]

7. Campbell, C., & Cornish, F. (2010). Towards a “fourth generation” of approaches to HIV/AIDS management: Creating contexts for effective community mobilisation. AIDS Care, 22(S2), 1569–1579. https://doi.org/10.1080/09540121.2010.525812 [Google Scholar] [Crossref]

8. Creswell, J. W., & Plano Clark, V. L. (2018). Designing and conducting mixed methods research (3rd ed.). SAGE Publications. [Google Scholar] [Crossref]

9. Damschroder, L. J., Aron, D. C., Keith, R. E., et al. (2009). Fostering implementation of health services research findings into practice: A consolidated framework. Implementation Science, 4, 50. https://doi.org/10.1186/1748-5908-4-50 [Google Scholar] [Crossref]

10. Decker, M. R., Crago, A. L., Chu, S. K. H., et al. (2015). Human rights violations against sex workers: Burden and effect on HIV. The Lancet, 385(9963), 186–199. https://doi.org/10.1016/S0140-6736(14)60800-X [Google Scholar] [Crossref]

11. Earnshaw, V. A., & Chaudoir, S. R. (2009). From conceptualizing to measuring HIV stigma: A review of HIV stigma mechanism measures. AIDS and Behavior, 13(6), 1160–1177. https://doi.org/10.1007/s10461-009-9593-3 [Google Scholar] [Crossref]

12. Farmer, P. (2004). An anthropology of structural violence. Current Anthropology, 45(3), 305–325. https://doi.org/10.1086/382250 [Google Scholar] [Crossref]

13. Fay, H., Baral, S. D., Trapence, G., et al. (2011). Stigma, health care access, and HIV knowledge among men who have sex with men in Malawi. Journal of the International AIDS Society, 14, 12. https://doi.org/10.1186/1758-2652-14-12 [Google Scholar] [Crossref]

14. Federal Ministry of Health Nigeria. (2021). National HIV/AIDS strategic framework. Abuja: Federal Ministry of Health. [Google Scholar] [Crossref]

15. Govindasamy, D., Meghij, J., Negussi, E. K., et al. (2014). Interventions to improve linkage to HIV care. Journal of the International AIDS Society, 17, 19032. https://doi.org/10.7448/IAS.17.1.19032 [Google Scholar] [Crossref]

16. Gruskin, S., Mills, E. J., & Tarantola, D. (2007). History, principles, and practice of health and human rights. The Lancet, 370(9585), 449–455. https://doi.org/10.1016/S0140-6736(07)61200-8 [Google Scholar] [Crossref]

17. Hladik, W., Barker, J., Ssenkusu, J. M., et al. (2017). HIV infection among MSM in sub-Saharan Africa. AIDS, 31(S3), S233–S240. https://doi.org/10.1097/QAD.0000000000001511 [Google Scholar] [Crossref]

18. Human Rights Watch. (2016). “Tell me where I can be safe”: The impact of Nigeria’s Same Sex Marriage (Prohibition) Act. https://www.hrw.org/report/2016/10/20/tell-me-where-i-can-be-safe/impact-nigerias-same-sex-marriage-prohibition-act [Google Scholar] [Crossref]

19. Kawachi, I., & Berkman, L. F. (2001). Social ties and mental health. Journal of Urban Health, 78(3), 458–467. https://doi.org/10.1093/jurban/78.3.458 [Google Scholar] [Crossref]

20. Kerrigan, D., Kennedy, C. E., Morgan-Thomas, R., et al. (2015). A community empowerment approach to HIV prevention. The Lancet, 385(9964), 172–185. https://doi.org/10.1016/S0140-6736(14)60955-9 [Google Scholar] [Crossref]

21. Logie, C. H., Lacombe-Duncan, A., Wang, Y., et al. (2018). Pathways from HIV-related stigma to health outcomes. AIDS Patient Care and STDs, 32(5), 193–205. https://doi.org/10.1089/apc.2017.0313 [Google Scholar] [Crossref]

22. Logie, C. H., Wang, Y., Lacombe-Duncan, A., et al. (2019). HIV-related stigma, racial discrimination, and mental health. Social Science & Medicine, 231, 1–9. https://doi.org/10.1016/j.socscimed.2019.04.025 [Google Scholar] [Crossref]

23. Logie, C. H., Marcus, N., Wang, Y., et al. (2020). A structural equation model of HIV-related stigma. BMC Public Health, 20, 1–10. https://doi.org/10.1186/s12889-020-08673-5 [Google Scholar] [Crossref]

24. Lyons, C. E., Schwartz, S. R., Murray, S. M., et al. (2017). The role of stigma in HIV risk among MSM in sub-Saharan Africa. AIDS and Behavior, 21(8), 2254–2263. https://doi.org/10.1007/s10461-017-1763-2 [Google Scholar] [Crossref]

25. Medley, A., Kennedy, C., O’Reilly, K., & Sweat, M. (2009). Effectiveness of peer education interventions. AIDS Education and Prevention, 21(3), 181–206. https://doi.org/10.1521/aeap.2009.21.3.181 [Google Scholar] [Crossref]

26. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674 [Google Scholar] [Crossref]

27. Nyblade, L., Stockton, M. A., Giger, K., et al. (2019). Stigma in health facilities. BMC Medicine, 17, 31. https://doi.org/10.1186/s12916-019-1271-3 [Google Scholar] [Crossref]

28. Oldenburg, C. E., Perez-Brumer, A. G., & Reisner, S. L. (2018). Poverty and HIV risk. Current Opinion in HIV and AIDS, 13(2), 161–165. https://doi.org/10.1097/COH.0000000000000434 [Google Scholar] [Crossref]

29. Poteat, T., Malik, M., Beyrer, C., & Baral, S. (2017). Epidemiology of HIV among transgender populations. Journal of the International AIDS Society, 20(Suppl 3), 21658. https://doi.org/10.7448/IAS.20.4.21658 [Google Scholar] [Crossref]

30. Poteat, T., Scheim, A., Xavier, J., et al. (2016). Global epidemiology of HIV among transgender people. Journal of Acquired Immune Deficiency Syndromes, 72(Suppl 3), S210–S219. https://doi.org/10.1097/QAI.0000000000001087 [Google Scholar] [Crossref]

31. Putnam, R. D. (2000). Bowling alone: The collapse and revival of American community. Simon & Schuster. [Google Scholar] [Crossref]

32. Schwartz, S., Nowak, R. G., Orazulike, I., et al. (2015). The immediate effect of the Same-Sex Marriage Prohibition Act. AIDS and Behavior, 19(12), 2237–2245. https://doi.org/10.1007/s10461-015-1008-4 [Google Scholar] [Crossref]

33. Stahlman, S., Sanchez, T. H., Sullivan, P. S., et al. (2016). The prevalence of HIV among MSM in sub-Saharan Africa. AIDS and Behavior, 20(Suppl 3), 1–12. https://doi.org/10.1007/s10461-016-1394-1 [Google Scholar] [Crossref]

34. Turan, B., Budhwani, H., Fazeli, P. L., et al. (2017). How does stigma affect people living with HIV? AIDS and Behavior, 21(1), 283–291. https://doi.org/10.1007/s10461-016-1451-5 [Google Scholar] [Crossref]

35. UNAIDS. (2020). Global AIDS update 2020. Geneva: Joint United Nations Programme on HIV/AIDS. [Google Scholar] [Crossref]

36. UNAIDS. (2023). Global AIDS update 2023: The path that ends AIDS. Geneva: Joint United Nations Programme on HIV/AIDS. [Google Scholar] [Crossref]

37. Wallerstein, N. (2006). What is the evidence on effectiveness of empowerment? Health Evidence Network Report. WHO. [Google Scholar] [Crossref]

38. Wirtz, A. L., Pretorius, C., Beyrer, C., et al. (2015). Epidemic impacts of stigma among MSM. AIDS, 29(S3), S243–S251. https://doi.org/10.1097/QAD.0000000000000657 [Google Scholar] [Crossref]

• Tribal Child Nutrition and Health in District of Sundargarh: A Public Health Review of ICDS Intervention
• Knowledge, Attitudes and Practices Towards Prostate Cancer Screening Amongst Men Aged 40-60 Years in The Buea Health District: A Cross-Sectional Study
• Compliance with JCI Protocols: A Focus on Employee Safety
• Influence and Involvement of Teachers in Menstrual Hygiene Management of Female Secondary School Students in Kogi State, Nigeria
• A Critical Evaluation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in Bihar