The influence of intersectional stigma on mental health, uptake and retention in antiretroviral treatment (ART) programmes for gender and sexuality diverse young people in Zimbabwe.

Provision of and access to HIV prevention, treatment and care among young gender and sexuality diverse people living with HIV in Zimbabwe occurs in a context characterised by stigma and discrimination based on HIV status and gender identity or sexual orientation. Little is known about the experiences and impact of intersecting stigma on adherence to anti-retroviral treatment (ART) among members of this group. To fill this gap, we conducted a concurrent mixed methods study to collect data through self-administered questionnaires and in-depth interviews among young men who have sex with men and transgender women. More than one-third of the participants scored above 10 on the CESD-10, with 5% in the highest band (>20), indicating the potential for a significant mental health burden. Experiences of intersectional stigma were common, impacting participants' mental health. Experiences and anxieties regarding the potential for stigma and discrimination contributed to threats to ART adherence and influenced commitment to staying on treatment. However, despite the many potential risks to adherence, participants utilised various means to remain adherent. Programmes to alleviate intersectional stigma among young gender and sexuality diverse people should seek to strengthen existing intrapersonal and interpersonal resources and enhance mental health.