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

Abstract

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.