Provider discrimination and structural barriers to sexual and reproductive health services among LGBTQI + youth across 14 countries in Eastern Europe and Central Asia: A cross-national survey
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background LGBTQI+ youth in Eastern Europe and Central Asia (EECA) face intersecting barriers to sexual and reproductive health and rights (SRHR), yet multi-country evidence on their patterning and predictors is scarce. We examine SRHR barriers, provider discrimination, and their structural predictors across 14 EECA countries. Methods We analysed a cross-sectional online survey of 1,023 LGBTQI+ youth aged 18–28 recruited via non-probability snowball sampling in 14 EECA countries (June–December 2024). Three primary outcomes — provider discrimination, service refusal, and past-year STI testing — were modelled with modified Poisson and logistic regression with country fixed effects. Adjusted prevalence ratios (aPRs) are the primary effect measure. Estimates are not nationally representative. Findings Overall, 49.0% reported provider discrimination and 16.4% service refusal because of their LGBTQI+ identity; among 428 giving a definitive response, 68.7% found gender-affirming care “not easy.” After adjustment, transgender men (aPR 2.05, 95% CI 1.67–2.51) and transgender women (1.79, 1.43–2.23) faced more discrimination than cisgender men, with service-refusal aPRs of 3.94 (2.47–6.29) and 3.30 (2.02–5.37). STI testing was lower with rural residence (0.61, 0.43–0.85), higher with income (1.16 per step, 1.10–1.21), and lower among cisgender women, transgender women, and non-binary respondents. Interpretation: Discrimination concentrated among transgender people after adjustment for country, income, and location, consistent with a health-workforce accountability failure, whereas preventive-service use reflected structural barriers and a gender-targeting effect — mechanisms requiring differentiated responses. A 50-percentage-point gap between PrEP awareness (57.6%) and use (7.2%) signals limited HIV prevention reach among cisgender women and non-binary respondents.
Source: SSM - Health Systems
Author: Uluk Batyr
Language: English
Subfield: Social Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $1,490
OpenAlex ID: W7225253054