Overlooked Aspects of Sexual and Reproductive Health and Rights (SRHR) of Gender and Sexually Diverse People in Dhaka, Bangladesh

Objectives This article highlights neglected areas of sexual and reproductive health and rights (SRHR) among gender and sexually diverse people (GSDP) in Dhaka (the capital), Bangladesh.Methods We pioneered an SRHR surveillance system, applying mixed-methods approaches, for 670 men who have sex with men (MSM), 552 male sex workers (MSW), and 610 hijra (local transgender subculture). Participants were recruited through time-location sampling. In-depth interviews were conducted with 10 MSM, 12 MSW, and 10 hijra, which were thematically analyzed as per the minority stress model. Alongside descriptive statistics for prevalence estimates, multivariate logistic regression identified associations between proximal and distal stressors with sexual health, mental health, and service uptake outcomes.Results Findings demonstrated that marginality of GSDP evoked diverse manifestations of minority stress. Specifically, 12% of MSM, 44.9% of MSW, and 56.1% of hijra self-reported depressive symptoms, with similar statistics for anxiety and stress. Qualitative findings attributed this to hopelessness and disappointment, rooted in loneliness and bullying. Findings revealed that 50.4% of MSM, 67.4% of MSW, and 68.2% of hijra experienced sexual health concerns. Qualitative evidence highlighted insecurity toward genital size, and performance anxiety. Findings depicted an SRHR service vacuum, where very few participants utilized face-to-face or digital services. Service providers in NGO-based interventions and public/private healthcare were not adequately capacitated on unmet SRHR needs, especially of marginalized populations. Multivariate models identified bidirectional links between mental health and sexual health concerns across all groups, whereas service uptake linked to mental health concerns only amongst MSM.Conclusion Findings revealed that SRHR concerns such as mental health, sexual health concerns, and healthcare access barriers beyond HIV and sexually transmitted infections (STIs) are critically overlooked. Rather than solely addressing condom promotion, it is crucial to introduce holistic healthcare with adequately trained and sensitized providers, especially in the mainstream health care settings.