Homeless HIV-Seropositive Queer People’s Experiences at Healthcare Facilities in Sub-Saharan Africa

  1. Senzelokuhle.M. Nkabini

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Abstract

Background: The ratio of homeless HIV-seropositive queer people has escalated drastically in the 21st century, within the 49 countries located in the sub-Saharan African region. Homeless people in the African continent amount to 38.7%, and the reasons regarding the cause of homelessness range from poverty, climate change, political wars and inhumane governmental legislations (1,2). However, the quantity is proportionately higher for homeless HIV-seropositive queer people compared to their heterosexual counterparts, because of the numerous anti-queer legislations that are adopted by governments that lead countries located in sub-Saharan Africa (3). Numerous homeless HIV-seropositive queer people have been forced into destitution, due to family rejection because of their queer identity, communal bullying, harassment & discrimination (4). This is regardless of evidence which states that tolerance for queer individuals in this region has increased (25%), because younger members of these sub-Saharan African urban communities are more open to learning about queer identities unlike the older ultra-religious members of society (5). Even though there is marginal progress regarding the patience, leniency and open-mindedness afforded to queer individuals by sub-Saharan Africa’s future leaders, the region still remains as the most hostile territory for any individual that does not align with heteronormative ideals. Regionally, miniscule improvements have been implemented regarding equality, inclusion, access and the protection of queer individuals within all facets of society (social, political, economic etc.) (6). The discrimination is even more merciless when queer people are both homeless and HIV-seropositive at the same time. Objective: To systematically map and synthesise the scientific evidence regarding Homeless HIV-seropositive Queer People’s Experiences at Healthcare Facilities in Sub-Saharan Africa. Methods: The primary aim of this systematic review is to map out and synthesise evidence of homeless HIV-seropositive queer people’s experiences at healthcare facilities in sub-Saharan Africa from existing literature. All forms of studies, grey literature and peer-reviewed journal articles focusing on homelessness, and HIV-seropositive queer people’s experiences at healthcare facilities in sub-Saharan Africa will be sourced. The primary research question that will guide this review is: What are the experiences of homeless HIV-seropositive queer people at healthcare facilities in sub-Saharan Africa? The secondary research questions are: What is known about the factors (service delivery, support, and policies) that contribute to homeless HIV-seropositive queer people’s experiences at health care facilities in sub-Saharan Africa? What is known about the consequences of homeless HIV-seropositive queer people’s experiences at health care facilities in sub-Saharan Africa? The eligibility of the research question was adequately addressed by the PCC (population, context, concept) framework. All searches will be conducted by SMN (author), LN and FZ (database search and records screening assistants) for studies and study designs published in peer-reviewed journals, grey literature, published and unpublished dissertations, case studies, reviews, essays, theses and symposium abstracts. The following databases will be utilized to search for studies: PubMed, PsycINFO, ProQuest, ERIC (Education Resources Information Center), Cochrane Reviews, UNAIDS, UNESCO (United Nations Educational, Scientific and Cultural Organization), ACHPR, UN-Habitat, Sociology Database and Scopus. The Preferred Reporting Items for Systematic and Meta Analyses (PRISMA) ScR flow chart/diagram presented in figure 1 will be utilized to summarize the study selection process (24,25). Results: The present protocol is registered on the PROSPERO platform. The results of this study will be disseminated through publication in peer-reviewed scientific journals. The data will also be made available to humanitarian organisations such as WHO, UNESCO, UNAIDS, ACHPR, UN-Habitat and ILGA. The findings from this study will inform the future research projects that these organisations embark on. Conclusion: The proposed review will generate findings that identify and describe the experiences of homeless HIV-seropositive queer people while accessing, or when they attempt to access services at health care facilities in sub-Saharan Africa. The systematic review will also identify knowledge gaps that can assist humanitarian organisations such as WHO, UNAIDS, UNESCO, PEPFAR, ACHPR, ILGA and UN-Habitat. The results of this study will be disseminated through publication in peer-reviewed scientific journals, and also be made available to the humanitarian organisations. Moreover, the findings from this study will inform the future research projects that these organisations embark on which includes homelessness, HIV/STIs, gender and sexual diversity, health and education.

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  1. PREreview

    This Zenodo record is a permanently preserved version of a PREreview. You can view the complete PREreview at https://prereview.org/reviews/18642812.

    Write a short summary of the research's main findings and how this work has moved the field forward.

    Major issues

    1. The topic needs to be remodified to "The experiences of homeless HIV seropositive queer people at health facilities in Sub-Saharan Africa"

    2. The abstract is too long and contains unnecessary information and also the authors added a citation which we believe it is not appropriate in the abstract section. The abstract can be best written by capturing the problem statement and the objectives in the introduction, stating the databases searched and repositories, inclusion and exclusion criteria, data screening and extraction process and how the results will be synthesized in the method section. Also the results and conclusion should capture the relevance of the paper

    3. The introduction section seems too long and we hope the authors could highlight the key concepts to avoid redundancy. We also suggest that the authors should consider removing the last paragraph which we believe it is unnecessary in the introduction section.

    4. The systematic process used in this studies seems not to be appropriate, why the authors utilized the systematic review, we believe using a scoping review will be appropriate as the authors aim to map out information on healthcare access among homeless HIV seropositive queer people in Sub-Saharan Africa, the possibility of limited studies on this concept could affect the use of systematic review.

    5. Also, the data search should be addressed as the authors used the wrong Boolean operator. It is advisable the authors contact experienced librarian or researcher in systematic literature review process. The inclusion criteria needs to be revised with so many unclear and unjustified reasons such as the studies from 2016 to 2025, the age 80+, using studies published in English language. Also, the structure of the method section is poorly arranged.

    6. We also suggest the authors to state their data screening process to ensure transparency. The author should clearly state if the title and Abstract and full-text screening were done manually or using a software or tool. The

    7. The inconsistency in the method section should be addressed under the "Discrepancies Between the Protocol and the Scoping Review" as it quite not clear what the authors are stating.

    8. We are suggesting the authors could use some frameworks in their data synthesis such as Intersectionality Theory, ‎Health Stigma and Discrimination (HSD) Framework and ‎Gender Affirmative Model. The frame work used for their thematic analysis should be influenced by the information extracted from their included studies.

    • Minor issues • List concerns that would improve the overall flow or clarity but are not critical to the understanding and conclusions of the research.

    1. Address some grammatical construction and typographical errors

    Competing interests

    The authors declare that they have no competing interests.

    Use of Artificial Intelligence (AI)

    The authors declare that they did not use generative AI to come up with new ideas for their review.

  2. Version published to 10.20944/preprints202508.1584.v1