Listening to the voices of Guatemalan community leaders: a participatory approach to identifying priorities to curtail HIV within transgender communities

Transgender (trans) communities in Guatemala are severely and disproportionately affected by the human immunodeficiency virus (HIV), with overall HIV prevention and care services severely limited. Our binational community-based participatory research partnership sought to identify priorities for advancing HIV health equity and curtailing the epidemic within Guatemalan transgender communities. In June 2024, we held five stratified, in-person Spanish-language listening sessions in Guatemala City with community leaders (N = 18) representing grassroots trans advocacy groups, frontline mental health providers, and community-based and lesbian, gay, bisexual, transgender, and queer+ (LGBTQ+) organizations. Constant comparison was used to analyze listening session data. Nine macrolevel themes were identified including the context in which Guatemalan trans communities live-a context characterized by profound stigmatization and discrimination, the pathologization of sexual and gender minorities, and violence. Twenty-four actionable community priorities were also identified, including improving HIV surveillance, addressing social and structural stigma and discrimination, ensuring comprehensive provider training, conducting community-centered research, enhancing mental health services, and addressing upstream social determinants of health (e.g. economic opportunities). While further research is needed, our findings offer insights into the experiences of Guatemalan trans communities, highlight community priorities for advancing health equity and curtailing the HIV epidemic, and provide a roadmap for culturally responsive interventions and policy development.