Abstract
Achieving the UNAIDS 90-90-90 targets hinges on identifying and engaging individuals with HIV in care, requiring 90% of those infected to be diagnosed, initiated on ART, and achieving viral suppression. Despite this imperative, HIV testing services as well as research in Ghana often overlook the unique experiences of transgender women in urban slums, impacting their engagement with care. Using the gender affirmative model lens, this study reports the HIV testing experiences of trans women in Ghanaian slums, highlighting how the healthcare environment, counseling, and healthcare provider attitudes shape these experiences. The study used a qualitative descriptive interview design with 20 trans women aged 18 to 31 from urban slums in Greater Accra Metropolitan Area, Ghana. Participants were recruited through purposive and snowball sampling. Data were collected via face-to-face interviews, transcribed, and analyzed using NVivo, with results presented in categories and subcategories. Two main categories emerged from our data analysis: 1) Positive Experiences with HIV Testing, and 2) Negative Experiences with HIV Testing. Positive experiences with HIV testing among trans women in Ghanaian slums included a welcoming environment at healthcare facilities, supportive counseling, and relatability with HIV-positive nurses. Negative experiences were characterized by fear and anxiety during testing, often intensified by healthcare worker attitudes, including unwelcoming behaviors and judgmental body language, especially in facilities that are not key population friendly. These categories provided a framework for understanding the varied experiences of trans women in Ghanaian slums regarding HIV testing. The study highlights the urgent need for Ghanaian slum healthcare facilities to address discrimination against trans women by creating inclusive, supportive environments. It stresses the importance of using a gender-affirmative approach to improve HIV testing and health outcomes for trans women. Policymakers and healthcare providers must focus on training, inclusive care, and cultural competence to reduce health disparities for this population.