Barriers to Healthcare among Gender and Sexual Minorities in Bangladesh: A Community-based Mixed Methods Study
1
ZE Project, Dhaka, Bangladesh
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Gender and sexual minorities in Bangladesh have long been underrepresented in health research due to prevailing social norms and silence around non-heteronormative identities, leaving critical gaps in evidence, policy, and practice(1).
METHODS:
We conducted a mixed methods study among 132 participants, including self-identified men who have sex with men (MSM; n = 56), women who have sex with women (WSW; n = 46), and transgender people (n = 30), recruited through community organizations and trusted digital networks. An online survey assessed engagement with and experiences of health-service use. Subsequently, a random 10% subsample from each group (MSM n = 6, WSW n = 5, transgender n = 3) participated in in depth interviews (IDIs). Quantitative data were summarized descriptively. Qualitative data were analysed thematically using the Minority Stress Model(2).
RESULTS:
Uptake of preventive sexual health-services was low across all groups and lowest among WSW. Overall HIV screening was 28% (MSM 38%, transgender 33%, WSW 13%). Screening for other-STIs was 23% (MSM 30%, transgender 27%, WSW 11%), and HPV-related prevention (screening or vaccination) was 14% (MSM 9%, transgender 15%, WSW 18%). Healthcare related discrimination was pervasive, with 62% (n = 82) reporting verbal abuse or service refusal, and 40% (n = 53) reporting delayed care due to fear of mistreatment. IDIs revealed three dominant themes. Anticipated stigma led participants to delay or avoid healthcare due to fear of moral judgement, breaches of confidentiality, or denial of services. Enacted discrimination was evidenced by direct experiences of harassment and service refusal, reinforcing medical mistrust. Internalized exclusion manifested as participants’ self-perception of being undeserving of respectful care, often compounded by providers’ lack of knowledge of minority health-needs.
CONCLUSIONS:
Structural stigma drives exclusion from sexual and reproductive health-services among gender and sexual minorities in Bangladesh(3), underscoring the need for inclusive, equity-driven health system reforms.
Gender and sexual minorities in Bangladesh have long been underrepresented in health research due to prevailing social norms and silence around non-heteronormative identities, leaving critical gaps in evidence, policy, and practice(1).
METHODS:
We conducted a mixed methods study among 132 participants, including self-identified men who have sex with men (MSM; n = 56), women who have sex with women (WSW; n = 46), and transgender people (n = 30), recruited through community organizations and trusted digital networks. An online survey assessed engagement with and experiences of health-service use. Subsequently, a random 10% subsample from each group (MSM n = 6, WSW n = 5, transgender n = 3) participated in in depth interviews (IDIs). Quantitative data were summarized descriptively. Qualitative data were analysed thematically using the Minority Stress Model(2).
RESULTS:
Uptake of preventive sexual health-services was low across all groups and lowest among WSW. Overall HIV screening was 28% (MSM 38%, transgender 33%, WSW 13%). Screening for other-STIs was 23% (MSM 30%, transgender 27%, WSW 11%), and HPV-related prevention (screening or vaccination) was 14% (MSM 9%, transgender 15%, WSW 18%). Healthcare related discrimination was pervasive, with 62% (n = 82) reporting verbal abuse or service refusal, and 40% (n = 53) reporting delayed care due to fear of mistreatment. IDIs revealed three dominant themes. Anticipated stigma led participants to delay or avoid healthcare due to fear of moral judgement, breaches of confidentiality, or denial of services. Enacted discrimination was evidenced by direct experiences of harassment and service refusal, reinforcing medical mistrust. Internalized exclusion manifested as participants’ self-perception of being undeserving of respectful care, often compounded by providers’ lack of knowledge of minority health-needs.
CONCLUSIONS:
Structural stigma drives exclusion from sexual and reproductive health-services among gender and sexual minorities in Bangladesh(3), underscoring the need for inclusive, equity-driven health system reforms.
| eISSN: | 2654-1459 |
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