{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T03:20:40Z","timestamp":1787714440229,"version":"build-2784847793"},"reference-count":41,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01MH130277"],"award-info":[{"award-number":["R01MH130277"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The World Health Organization promotes a transgender\u2010differentiated service delivery (TG\u2010DSD) model to overcome barriers to HIV service engagement among transgender people (TGP). For TGP, an essential element of DSD includes gender\u2010affirming care which is non\u2010stigmatising, free from discrimination and celebrates their gender identity. The <jats:italic>Jabula Uzibone<\/jats:italic> Study, launched in November 2023, assesses the cost and effectiveness of TG\u2010DSD on HIV outcomes. In this paper, we describe the baseline characteristics of TGP in our study and explore whether there are differences in healthcare experiences among those seeking care at TG\u2010DSD clinics versus standard service delivery (SSD) clinics at baseline.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This observational, mixed\u2010method, prospective implementation study compares models of care at four TG\u2010DSD and four SSD facilities using standardised observation checklists, in\u2010depth and key informant interviews. For this paper, we asked participants about healthcare experiences and experiences of stigma through a structured, interviewer\u2010administered quantitative survey. We assessed the sections of the quantitative survey which ask about self\u2010reported experiences of stigma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study enrolled 422 TGP with HIV (217 TG\u2010DSD and 205 SSD) and 248 TGP without HIV (128 TG\u2010DSD and 120 SSD); 15% (102\/670) gender non\u2010conforming, 15% (91\/670) TG men and 70% (477\/670) TG women. Participants\u2019 median age was 29 years, interquartile range: 24\u221235 years. SSD participants at baseline were 46% more likely to experience stigma compared to their TG\u2010DSD counterparts (aOR = 1.46, 95% CI: 1.06, 2.01). SSD participants were more likely to encounter a healthcare provider who is unwilling to provide care for them (aOR = 1.55, 95% CI: 1.09, 2.21) and to report that healthcare workers are unable to provide the same quality care to TGP as they do other people (aOR = 1.46, 95% CI: 1.00, 1.91) compared to their TG\u2010DSD counterparts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>TGP from TG\u2010DSD facilities were less likely to report experiences of facility\u2010based enacted stigma at baseline, compared to the TGP from SSD facilities. Our study highlights the importance of provider training in tailored transgender healthcare to provide gender\u2010affirming healthcare services. Results from the <jats:italic>Jabula Uzibone<\/jats:italic> study will provide further evidence of the effectiveness of TG\u2010DSD models in sub\u2010Saharan Africa, and the role of stigma and discrimination in HIV outcomes among TGP.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26503","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T10:30:04Z","timestamp":1751884204000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Exploring healthcare experiences of transgender people in the Jabula Uzibone study, South Africa: a longitudinal implementation science study"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2967-4562","authenticated-orcid":false,"given":"Rutendo","family":"Bothma","sequence":"first","affiliation":[{"name":"Wits RHI University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3387-0817","authenticated-orcid":false,"given":"Audrey","family":"Pettifor","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Gillings School of Public Health University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Innocent","family":"Maphosa","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics Department of Global Health Faculty of Medicine and Health Sciences Stellenbosch University  Stellenbosch South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philisiwe","family":"Ndlovu","sequence":"additional","affiliation":[{"name":"Wits RHI University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Imrie","sequence":"additional","affiliation":[{"name":"Wits RHI University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6541-3787","authenticated-orcid":false,"given":"Tonia","family":"Poteat","sequence":"additional","affiliation":[{"name":"Division of Healthcare in Adult Populations Duke University School of Nursing  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00684-X"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s44263-024-00073-2"},{"key":"e_1_2_12_4_1","unstructured":"M\u00fcllerADK.The Southern and East African Collective on Health (SEARCH). 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