Barriers and facilitators to HIV testing among transgender people in Georgia: Qualitative study results using the COM-B Framework

TL;DR

This study explores why transgender people in Georgia get or avoid HIV testing, finding that stigma, lack of knowledge, and community support are key factors.

Contribution

The study applies the COM-B framework to identify specific barriers and facilitators to HIV testing among transgender individuals in Georgia.

Findings

Barriers include stigma, low HIV knowledge, and confidentiality fears.

Facilitators include community outreach, self-testing, and peer support.

Structural and sociocultural factors significantly influence testing behaviors.

Abstract

Transgender (TG) people face a disproportionately high burden of HIV globally due to stigma, discrimination, criminalization, and limited access to trans-specific healthcare. In Georgia, HIV prevalence among TG individuals is 24.1%, compared with 0.3% in the general adult population. While predictors of HIV testing have been documented, the factors influencing testing behaviors remain insufficiently understood. This study explored barriers and facilitators to HIV testing among TG in Georgia using the Capability, Opportunity, Motivation–Behavior (COM-B) model. We conducted 15 in-depth interviews (IDIs) with TG and non-binary individuals aged 18–45 years in Tbilisi between February–April 2025. Eligible participants were HIV-negative, not enrolled in pre-exposure prophylaxis (PrEP), and recruited with support from community-based organizations. Data were transcribed, coded, and thematically analyzed, with findings mapped to the COM-B framework. Participants (8 TG women, 5 non-binary, 2 TG men; median age 23) identified multiple barriers to HIV testing: limited HIV-related knowledge, low perceived risk and limited interest in testing, confidentiality fears, stigma and discrimination in healthcare settings, geographical barriers, and the influence of substance use and mental health challenges. Facilitators included awareness of free, anonymous, and confidential services; access to outreach-based and self-testing options through community organizations; HIV risk perception; community encouragement and support; social media and dating apps; recognition of testing as self-care and moral responsibility; and financial or non-financial incentives. This study demonstrates that HIV testing behaviors among TG individuals in Georgia are shaped by intersecting individual, structural, and sociocultural factors. While community-based organizations, peer support, and self-testing reduce barriers and enhance engagement, persistent challenges like stigma, low HIV literacy, geographic inequities, and substance use continue to limit uptake. Expanding decentralized, community-driven, and confidential testing services, coupled with targeted education, peer-led interventions, and integration of stigma and discrimination reduction strategies, is essential to improving HIV testing coverage among TGs in Georgia.

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