A qualitative study of the ecology of stigma experiences - An application of the ecological model to stigma experiences of trans-women from Ghana. BSGH019.

Trans-women in Ghana experience stigma from institutions, social groups, and individuals. Yet, studies are needed to provide a comprehensive understanding of the nature of stigma experienced by trans-women, especially in Ghana and West Africa. This study employs an ecological model to qualitatively explore the ecology of stigma experiences of trans-women living in urban slums in Accra, Ghana (N = 20). Findings revealed stigma across various ecological levels. At the public policy level, the LGBTQ+ bill emerged as a key driver of stigma. Various subcategories related to this bill included: (a) Restricted freedoms of expression and isolation from harm, (b) LGBTQ+ bill potential for facilitating violence, and (c) fear of arrest and jail time. At the institutional level, trans-women encountered stigma in three areas. The first was in the healthcare sector involving rude gestures and behaviors. The second was from law enforcement officers and included (a) harassing attitudes from law officers, and (b) extortion. Community-level stigma encompassed: (a) insults, name-calling, (b) possible harm from gender expression, and (c) fear of attacks. At the interpersonal level, Trans-women experienced: (a) invasion of privacy, (b) leaving home due to safety, (c) threat of bodily harm, and (d) rejection. At the individual/self-stigma level, trans-women experienced (a) self-doubt and internal struggles, and (b) sense of regret and guilt. Findings highlight the unique experiences and pervasive and multi-layered stigma faced by trans-women across different levels of society. Addressing stigma experiences requires a multi-tiered approach that tackles issues from public policy to individual self-acceptance.