They’ll think you’re infected’: perceived barriers and facilitators of HIV/STI awareness and testing among young Rohingya refugee women in Bangladesh
Outcomes: Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Social norms—particularly those linking HIV/STI testing to immorality, reinforcing male gatekeeping, and embedding stigma through religious and community surveillance—are central barriers to care. These norms operate across levels, shaping knowledge, restricting mobility, and discouraging service use. However, norms are also malleable: trusted female health workers, peer networks, and faith-aligned messaging can shift perceptions and create culturally acceptable pathways to testing and care.
Objectives This study aimed to explore the socio-cultural and structural barriers and facilitators influencing HIV/STI awareness and testing among young Rohingya refugee women (aged 15–24) in Cox’s Bazar, Bangladesh, incorporating perspectives from women, men, community leaders, and healthcare providers.
Methods The study used a qualitative cross-sectional design with purposive and snowball sampling. Data were collected through 40 in-depth interviews and five focus group discussions across four stakeholder groups. A phenomenological approach guided analysis, using a socio-ecological framework to examine individual, community, and structural influences, with thematic analysis applied to identify key patterns.
Results Findings revealed severe knowledge gaps and widespread misconceptions about HIV/STIs, alongside high levels of stigma and fatalistic beliefs that discouraged testing. Social norms—such as associating testing with promiscuity, enforcing male permission for healthcare access, and religious framing of testing as sinful—limited women’s autonomy and suppressed demand for services. Structural barriers, including restrictions on HIV testing within camps, lack of youth- and male-friendly services, and poor health system navigation, further reduced access. At the same time, facilitators included female-led home-based education, peer testimonials, supportive messaging from some religious leaders, and youth-friendly or community-based approaches that increased awareness and acceptability of testing.
Conclusions HIV/STI awareness and testing among young Rohingya women are shaped by intersecting social norms, gender dynamics, and structural constraints. Addressing these challenges requires multi-level, culturally tailored strategies that engage community and religious leaders, expand female-led and peer-based outreach, and integrate confidential, youth-friendly services. Leveraging norm change—rather than only information provision—is critical to improving equitable access and health outcomes in humanitarian settings.
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