Unveiling the Lived Experiences of Sexual and Gender Diverse Individuals in Guyana: A Qualitative Investigation into Wellbeing

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In this qualitative study, we employed a theoretical framework integrating the Social Determinants of Health, Well-being Domains Theory, and Intersectional Minority Stress Theory to explore the positive and negative experiences of individuals from sexual and gender identity minority groups residing in Guyana. Methods Four focus groups were convened that included adult non-heterosexual men, women and transgender persons (Total N = 45). The focus groups prompted discussions about participants’ experiences in various life domains, including social, interpersonal, vocational, healthcare, housing, public spaces, socio-political contexts, significant life events, and personal successes. We used thematic analysis to identify recurring patterns and themes in the participants’ discussions, providing a structured framework for understanding and interpreting their experiences in the specified life domains. Results Major positive themes included non-governmental organization support, family acceptance and healthy habit adoption to cope with stress. Negative themes included transportation inaccessibility, job discrimination, and lack of governmental support. Conclusion The Guyanese sexual and gender identity minority community is resilient and productive, despite enduring centuries-old social norms in Guyana that ostracize them. They have developed community resilience through the support of NGOs and past government initiatives, yet there remains a significant need for further efforts to achieve social parity. Collaborative initiatives involving both governmental and civil society organizations can play a vital role in dismantling the barriers. sexual and gender identity minority Guyana LGBTQ+ wellbeing qualitative Introduction Globally, sexual and gender identity minority individuals are marginalized along multiple intersecting identities, making them vulnerable to extreme biopsychosocial stressors, including heterosexism, known to impact longevity, mental health, and physical health (1, 2). These disparities are likely heightened in Guyana, where cultural biases and laws continue to contribute to the marginalization of the sexual and gender identity minority community. Moreover, other disparities within Guyana’s larger society, including one of the world’s highest suicide rates, a high prevalence of inter-partner violence, and relatively high rates of mental health disorders (3, 4, 5, 6), underscore the importance of examining factors associated with the health and wellbeing of gender identity minority individuals in Guyana—the primary objective of this qualitative research. History of Sexual and Gender Identity Minority Exclusion in Guyana Intolerance of sexual and gender identity minorities in Guyana, and the Caribbean more generally, can be traced to European and British cultural norms that were enforced through colonialism (7). Guyana remains a largely religious society, with 64% of Guyanese reported to belong to a Christian denomination, 25% identifying as Hindu, and 7% identifying as Muslim (8). According to the Institute on Religion and Public Policy (IRPP), the British colonial establishment supported Anglicanism as the state religion, and after independence, the Anglican Church and the Catholic Church cooperated to maintain influence in the society (9). As a result of this colonial era religious influence, the cultural norms of British colonial rule remain largely intact, both in cultural biases and law. The Constitution of Guyana includes a clause that is a barrier to revising laws that were inherited from the British Empire, even when they undermine human rights. As a result, the so-called “buggery and gross indecency laws,” Criminal Law (Offences) Act 1893, Section 353 Buggery Under Section 353, “anyone who commits ‘buggery’ is liable to life imprisonment,” continues to empower acts of discrimination (10). Recent Findings on Sexual and Gender Identity Minority Life in Guyana Despite significantly improved social circumstances for sexual and gender identity minority Guyanese (11), recent studies on the state of the Guyanese sexual and gender identity minority population have revealed a persistent lack of positive media and public messaging, as well as inertia in repealing colonial-era laws that enforce Old Testament (Levitical)-derived sexual behavior codes. A 2013 survey found that women and younger adults tend to be more tolerant of homosexuality, whereas the Evangelical Christian community and those with lower education levels are less tolerant (12). When examining the attitudes and knowledge of sexual and gender identity minority needs within the medical community, Rambarran and colleagues (13) found that medical personnel lacked community-centric knowledge and a significant reluctance to learn more about the unique needs of sexual and gender identity minorities. However, limited research has examined the experiences of sexual and gender identity minority individuals in Guyana, indicating a significant gap in our understanding of this community’s challenges and needs. One recent study by Guybow (14) found that a substantial portion of sexual and gender identity minority individuals, approximately 54%, reported struggling to meet their financial obligations. This highlights potential economic vulnerabilities within this group, suggesting that disparities may exist, which could negatively impact their overall well-being and quality of life. Additionally, the study revealed that very few individuals in this community had sought support from law enforcement (14). This reluctance to seek help implies a potential lack of trust in or fear of discrimination or mistreatment when dealing with authorities, with potential consequences for access to justice and protection from discrimination or violence for the gender and sexual identity minority community in Guyana. Moreover, research conducted by the Georgetown University Law Center Human Rights Institute (15) found that sexual and gender identity minority individuals in Guyana face verbal and physical threats when in public. These experiences indicate significant safety concerns within this community and suggest that individuals may be at risk of harassment and violence. In light of these findings, it is clear that there are pressing issues facing sexual and gender identity minority individuals in Guyana. The limited research, economic struggles, reluctance to seek help from law enforcement, and experiences of threats in public spaces underscore the need for further research, as well as the development of policies and support systems to address these challenges and promote the well-being and safety of the community. Conceptual Approach To gain a comprehensive understanding of the experiences among sexual and gender identity minorities in Guyana, we use a theoretical framework that integrates the Social Determinants of Health (SDH), Well-being Domains Theory (16), and Intersectional Minority Stress Theory (17). We use this integrated theoretical framework with the goal of providing a holistic understanding of the experiences and challenges faced by sexual and gender identity minorities in Guyana by examining the interplay of social determinants of health, well-being domains, and intersectional minority stress. We believe that this integrated framework offers a more comprehensive perspective on the factors influencing well-being and health, paving the way for targeted interventions and policy initiatives to address the unique needs and challenges of sexual and gender identity minorities in Guyana. The Social Determinants of Health The Social Determinants of Health (SDH) framework acknowledges that non-medical factors profoundly impact the physical and psychological health of individuals (18, 19). SDH operates through three key mechanisms: (1) the social context during an individual’s development, (2) social stratification in adulthood affecting exposure to stressors, and (3) the differential consequences affecting mental and physical health. The World Health Organization’s (WHO) commission on social determinants of health has identified two major categories of social determinants of health that affect health equity and well-being. Structural determinants of health such as public policy, cultural and socioeconomic factors, and intermediary factors such as living circumstances and biopsychosocial factors (19). These determinants encompass structural factors, including public policy, cultural and socioeconomic conditions, and intermediary factors such as living circumstances and biopsychosocial elements. Through the lens of human rights, recognizing SDH is a means to empower governments to address health disparities among social groups. The ultimate goal is to provide marginalized communities, including sexual and gender minority individuals, with the resources to control the factors influencing their health, contingent on fair resource allocation and informed communities. Understanding well-being is central to this process. Well-being Domains Theory At the individual level, SDH is better understood through objective well-being, linked to community factors that promote wellness. For sexual and gender identity minority communities facing ongoing social inequities across numerous life domains, this objective well-being perspective is essential. The Well-being Domains Theory focuses on identifying and understanding various domains or areas of life that contribute to an individual’s overall well-being and quality of life. This theory recognizes that a person’s well-being is influenced by a combination of factors and experiences in different aspects of their life (20, 21). By identifying the proximal factors affecting their well-being, we can better understand the contexts that shape their decisions and experiences. Well-being measures provide a balanced approach to identify common domains influencing quality of life for populations worldwide (22, 23, 24, 25). Some domains of wellbeing found in multiple measures include social connectedness, mental health, physical health, and productivity (20, 21). For the sexual and gender identity minority community in Guyana, we selected nine domains that we believe to be most appropriate: social, interpersonal, vocational, healthcare, housing, public spaces, socio-political, significant experiences, and successes. Stressors within each of these domains can collectively impact the wellness of individuals, depending on their intersections. Intersectional Minority Stress Theory Multiple socially and self-stigmatized minority identities result in cumulative psychological stress that impacts wellbeing through various means such as social alienation, discrimination and self-medication (26). The intersectional ecology model of marginalized minority stress is a crucial framework to comprehend the unique stressors faced by marginalized communities, such as sexual and gender minority Guyanese individuals (17). Sexual and gender minority Guyanese experiences are situated at the crossroads of multiple identities and communities within which they reside. Factors like gender expression, sexual behavior, socioeconomic status, race, region of residence, and religious beliefs intersect to create compounding stressors that result in a unique experience for these individuals. These stressors can significantly impact both physical and psychological health. The exclusion of sexual and gender minority individuals in Guyana is deeply rooted in history, further compounding the intersectional nature of the stressors they face. Methods Study Design We used a deductive approach to data gathering ( 27 ) based on the Well-being Domain Theory and informed by previous research on the Guyanese sexual and gender identity minority. This method enabled us to investigate various life domains through the lens of multiple subjective experiences. We conducted four focus groups between December 2023 and January 2024, following the guidelines set by Krueger and colleagues ( 28 ). Each focus group represented specific subsets of the sexual and gender identity minority community, including trans-identified individuals (trans), women who have sex with women (WSW), men who have sex with men with higher socio-economic status (MSM1), and men who have sex with men with lower socio-economic status (MSM2). Participants were recruited through local sexual and gender identity minority-focused non-governmental organizations (NGOs), targeting individuals open to participating in discussions about their experiences. Participants received GY $ 2000 (roughly $ 10 USD) for taking part in the study. The number of participants in each focus group ranged from 5 to 16, depending on the challenges posed by the COVID-19 pandemic in a society where transportation, inclement weather, and concerns about disclosing one’s identity are barriers to engagement. We provided participants with instructions that outlined the purpose of the focus groups, the well-being domains that would be discussed, and the expectation to share positive, neutral, or negative experiences in each life domain. They were also instructed to avoid using names and to speak from their own experiences. The facilitator guided the conversation, transitioning from one domain to another. Participants were assured that their voice recordings would be destroyed after transcription to maintain confidentiality. All recordings underwent a two-pass system involving auto-transcription software and correction by a single researcher. Recordings were deleted after the transcripts were corrected. This study was approved by the Guyana’s Ministry of Health Institutional Review Board. Data Analysis Strategy Data analysis consisted of using the 9 domains of well-being (social, interpersonal, vocational, healthcare, housing, public spaces, socio-political, significant experiences, and successes) to identify themes across life experiences. Two researchers collaborated on extracting codes from the transcripts and the lead researcher compiled a codebook of the major themes ( 29 , 30 ). Surface codes were then subject to another round of thematic analysis to detect themes that were not included in the domains of wellness areas. Results Demographics Forty-five participants over the age of 18 who identified as a sexual and/or gender minority person participated in this study. Of the 45 participants, only 40 completed the demographic questionnaire. Of these 40 respondents, 18 identified as men, 12 identified as women and 10 identified as gender non-conforming persons. Twenty-seven identified as Christian, 3 as Muslim, 2 as Hindu and 8 were non-religious. There were 6 Indo-Guyanese, 17 Afro-Guyanese, 17 Mixed-race persons, and 5 who declined to identify their race. Median income was GY $ 70, 000 - GY $ 100, 000/month (approximately $ 335- $ 479 USD/Month). The majority (48%) had completed high school, and 10% had not. See Table 1 for full demographic information. Table 1 Reported Demographics of Study Respondents. Demographic Category Total (N = 40)* N % Race/Ethnicity Indo-Guyanese 6 ( 15 ) Afro-Guyanese 17 (42.5) Mixed-Race 17 (42.5) No data* 5 (12.5) Sex Male 32 (80) Female 8 ( 20 ) Gender Man 18 (45) Woman 12 ( 30 ) Non-conforming 10 ( 25 ) Age Range 19–59 Median 28 Religion Christian 27 (67.5) Muslim 3 (7.5) Hindu 2 (0.5) Non-religious 8 ( 20 ) Monthly Income ($GY) $ 0- $ 70K 12 ( 30 ) $ 71K – 100K* 10 ( 25 ) $ 100K – 200K 16 (40) $ 200K – 400K 0 (0) $ 400K and above 1 (2.5) Undisclosed 1 (2.5) Education Completed < High School 4 ( 10 ) High School* 19 (47.5) Some College 3 (7.5) 2-yr College 4 ( 10 ) 4-yr College 7 (17.5) Master’s Degree 2 ( 5 ) Living Situation Parents 4 ( 10 ) Family 13 (32.5) Relatives 3 (7.5) Roommates 3 (7.5) Partner 4 ( 10 ) Alone 13 (32.5) Relocations (past 5 years) Barima-Waini (Region 1) 21 (52.5) Pomeroon-Supenaam Waini (Region 2) 5 (12.5) Essequibo Islands-West Demerara Waini (Region 3) 3 (7.5) Demerara-Mahaica Waini (Region 4) 3 (7.5) Mahaica-Berbice Waini (Region 5) 3 (7.5) Undisclosed 5 (12.5) *Note: 40 out of 45 focus group participants completed the demographic questionnaire. * = location of median. Themes and Sub-themes Extracted from Focus Groups See the Supplement for themes and example excerpts. Social Domain Positive Social Themes Social acceptance : Members of the sexual and gender identity minority community highlighted several positive aspects of their lives, demonstrating their strengths in coping with daily stressors. In the social domain, religion and social groups emerged as significant themes. Notably, non-Abrahamic religions were seen as less likely to discriminate and ostracize trans individuals. For example, the Hindu community was recognized as relatively accepting: “[sexual and gender minority] people or trans people, the Hindu community might be a little more accepting in some way or the other.” Community leadership : Becoming a community leader in the arts or local community activism was seen as a means of gaining local community acceptance. Participants expressed feeling comfortable in such leadership roles: “I have a comfort zone as a community leader in my community.” Sexual and gender minority-focused NGOs : Participants emphasized the importance of sexual and gender minority-focused non-governmental organizations (NGOs) in building social contacts, identity, and well-being. These organizations were described as places where individuals could gain self-confidence, connect with like-minded people, and learn that they were not alone. They also provided opportunities for skills development: “It gives me satisfaction knowing that I am facilitating it; it gives other people a sense of community; it’s a place of learning.: Inclusivity in non-sexual and gender minority social groups : Non-sexual and gender minority social groups were considered important for establishing a sense of connection to the larger society. One participant highlighted their involvement in a bingo community in their village, where they interacted with “straight” individuals and did not face discrimination within that setting: “I'm a part of the bingo community in the village where I come from. And it have a lot of straight people within that community, but I don't face any discrimination or anything within that setting.” Negative Social Themes Religious exclusion Despite the positive aspects, the religious community was identified as a major source of exclusion. Participants shared experiences of discrimination and rejection within religious contexts, which had a significant impact on their relationship with these institutions. Inter-sexual and gender minority group friction : Another major theme within the social domain was the presence of discrimination within sexual and gender minority communities. Participants acknowledged that discrimination among different subgroups within the sexual and gender minority community posed a significant barrier to cohesion and unity. Some individuals believed that certain subgroups received preferential treatment: “The challenges as I mentioned would be sometimes there’s a lot of in-house discrimination because you know, some of these groups would involve MSM, trans people and some of them think lesbians get an easy pass.” One other significant source was the differential experience of discrimination between gender non-conforming persons and cis-gender individuals. For instance, one participant revealed a life of relative isolation as a strategy for avoiding discrimination: “For me though. I've been living by myself since 17. Even though I live in this area, I don’t mix or meddle. Other persons can’t tell you if I'm there or where I'm living ... I don’t have any issues. In my area if a gay guy walks, he’s tormented.” This suggests that gender non-conforming individuals often face heightened discrimination compared to cis-gender members of the community. Additionally, friction within the sexual and gender identity minority community seemed to stem from issues related to gender-role normativity. Participants discussed in-house discrimination scenarios, such as becoming pregnant as a “stud” or engaging in various relationship dynamics that led to questions and judgment from others within the community. These examples highlight how gender roles and stereotypes within the community can contribute to tension and division among sexual and gender identity minority subgroups. Trauma from discrimination Past experiences of discrimination continued to shape participants’ perceptions of safety. Some expressed the need to protect themselves and others within the sexual and gender minority community when venturing into various public spaces, owing to concerns about potential discrimination and the realities of being gay. Interpersonal Domain Positive Interpersonal Themes Biological family acceptance The most crucial positive theme in the interpersonal domain was the impact of acceptance from biological family members on the mental health and resilience of sexual and gender identity minority individuals. Participants emphasized that coming out to supportive family members, like their mothers, was significant for their well-being. Some individuals shared that they cared most about what their immediate family members thought, while opinions of others were less important. Intimate partners as support systems Intimate partners were identified as essential sources of support for well-being and resilience, particularly when family support was absent. Living with a partner provided a sense of security and reduced the experience of discrimination. Diverse interpersonal supports Participants highlighted the importance of a variety of interpersonal supports in their lives. These included relationships with friends and colleagues at work. They considered these support systems crucial for balancing family issues and coping with stress in different areas of life. Negative Interpersonal Themes Early life exclusion and trauma : Early life exclusion was described as traumatic for trans individuals. Many felt that they had not experienced genuine love, particularly within family settings. The lack of acceptance from their biological families had a profound impact on their mental health and identity: “So when somebody come you know whether they are genuine love so many times we as LGBT and trans persons don't experience genuine love. Especially from family settings so.” Few intimate partners and unstable relationships Especially within the trans community, participants noted that having few intimate partners often led to unstable relationships. Some described a competition for partners, which strained relationships and prevented them from becoming healthy. In some cases, individuals resorted to sex work due to societal condemnation. Family threats and violence : Family-related threats and violence were described as traumatic experiences. Participants shared instances where family members threatened their lives or subjected them to violence. These traumatic encounters had a lasting impact on their relationships with their families and their overall well-being: “When my family get to know it was a [big event]. They wanted to poison me. They wanted to kill me. One big brother pulled me down the stairs at one time, but now it’s 50/50. We still don’t get along on a regular basis.” Vocational Domain Positive Vocational Themes Supportive teachers and school friends Positive themes in the vocational domain highlighted the significance of teachers and school friends in protecting the mental health of the sexual and gender identity minority community during their school years. Teachers were recognized as potential allies against discrimination and trauma, particularly for individuals from lower socio-economic backgrounds. Accepting workspaces for financial independence The importance of stable and accepting work environments for achieving financial independence was emphasized. Participants noted that workplaces with policies resembling those in the United States, which create safe work environments, contributed to their well-being. Having access to unisex washrooms for trans workers was seen as a positive development. Allies at work : Allies at the workplace were considered important for work stability and success. Participants spoke positively about their coworkers, many of whom were aware of their sexuality and treated them with respect and support: “at work?. Well, everybody treat me normal cause they Know I am gay, but they never disrespect me.” Negative Vocational Themes Bullying and teacher-induced traumas during school days : Negative themes included the traumatic experiences of bullying and traumas caused by teachers during school days. Participants shared instances where teachers themselves contributed to traumas, either through direct actions or insensitive comments. Some described the traumatic effects of corporal punishment and being outed by teachers, which resulted in family conflicts: “When I was small before my mother found out I was gay I used to get a lot of licks [beatings]. Licks and embarrassed in school. In front of the entire school as soon as she found out that I am gay.” School bullying and academic impact : Bullying was identified as a significant problem in the school setting, leading to academic difficulties and emotional distress. Participants noted how school bullying affected their academic performance and contributed to depression. The use of derogatory terms like “anti-man” was particularly harmful: “I didn’t participate in sports, but I think I was more subject to bullying from the boys. And so, and afterwards I got depressed but I used to manage, um, with work.” Discrimination in public service job settings Discrimination in public service job settings was a key negative theme, involving bullying from co-workers and punitive transfers. Discrimination, including professional discrimination, was seen as a barrier to career advancement. Some participants felt that their hard work did not lead to promotions, and others experienced difficult working conditions, such as extended 12-hour shifts, without the option to change their schedules. Healthcare Domain Positive Healthcare Themes Importance of sexual and gender identity minority-focused NGOs One positive theme in the healthcare domain highlighted the crucial role of sexual and gender identity minority-focused NGOs in facilitating access to safe healthcare. Participants noted that social workers from these organizations had established relationships with healthcare providers, making it easier for trans individuals to receive referrals and access care. Government-run sexually transmitted infection (STI) clinics : Government-run STI clinics were seen as a positive aspect of healthcare. Participants noted that these clinics provided accessible and less stressful testing experiences. They found the staff at these clinics to be friendly and the environments safe: “So I revealed my sexuality to the person during their assessment. I was comfortable with that and they, they, they had no judgment. She was that’s fine. That’s quite okay. So it was very positive. It was a positive experience at the South Road Clinic.” Negative Healthcare Themes Variability in medical staff professionalism The professionalism of medical staff could vary depending on the institution contacted. Some participants expressed concerns about the lack of trauma-informed training for medical and mental health staff. For example, biased mental health professionals were described as traumatizing, as they invalidated the experiences of trans individuals living with HIV and mental health conditions. Onerous procedures and document-focused workflow Participants noted that onerous procedures and document-focused workflows frustrated testing opportunities. The process for STI testing, in particular, was described as frustrating and complicated, which made it difficult for individuals to access testing services. Referral-related issues, such as the need for a stamp on referrals, added further complications to the testing process. Housing Domain Positive Housing Themes Feeling of safety and well-being Housing was associated with a sense of safety and well-being, particularly because it allowed individuals to have intimate relationships without fear of judgment or discrimination. Having accepting and private housing spaces was seen as crucial for developing intimate relationships. Participants expressed feeling comfortable and secure in their homes, where they could host friends and romantic partners, creating a safe and private space for themselves. Non-housing intimate spaces For those whose housing was not considered safe, participants identified alternative spaces for intimacy or relaxation away from judgment and harassment. These alternatives included using hotels or the homes of individuals who lived alone, though the latter was less common among people of their age. Negative Housing Themes Dependence on accepting family and adequate income : Access to stable housing was often dependent on having accepting family members and adequate income, which posed challenges for many individuals in the community. Family prejudice and rejection could result in homelessness and disrupt educational and career opportunities. Some participants described how they were put out of their homes due to family rejection, which affected their academic performance: “I was preparing to sit, CSEC [high school standardized exam], that is a time I become more flamboyant and I start to show it. So I got put out of my home, family rejection and so, I think. So I was staying between different, different homes and so forth, and I wasn’t getting any financial support.” Discrimination in government housing programs Government housing programs were identified as discriminatory against sexual and gender identity minority persons, particularly within the trans community. Some individuals reported facing discrimination when attempting to apply for house lots through government housing programs. Discrimination based on gender identity prevented access to housing support. Public Spaces Positive Changes in Public Spaces Increased visibility One positive change in public spaces was the increased visibility of the sexual and gender identity minority community. This increase in visibility was attributed to the ongoing efforts of non-governmental organizations (NGOs) and individuals coming out. Participants noted that the growing visibility of LGBTQ + individuals had led to a more comfortable and accepting atmosphere in public spaces. This positive change was seen as a result of more people openly identifying as LGBTQ+. Challenges in Public Spaces Transportation access barrier Despite the positive changes, transportation access remained a major barrier to travel, especially for the trans community. Minibuses were identified as a barrier to travel for trans individuals, with reports of conductors refusing to pick up transgender passengers. This discrimination in public transportation made travel difficult for some. Speedboat access was also identified as a barrier to free travel, particularly in the context of racial differences. Some individuals reported that the black community faced more challenges when using speedboats, while the Indian community did not encounter similar issues. This racial disparity in boat transportation was noted as a concern. Concerns about sexual assault : For women who have sex with women individuals, the threat of sexual assault remained a constant source of stress. Participants expressed concerns about the risk of sexual assault, especially during nighttime travel. This concern extended to both gender identity and being a woman, as participants feared being robbed or attacked due to their sexual and gender identities: “In the night I would travel with taxi. Not only for being gay but also a woman. Like you know, how men behave. You afraid to be robbed, or you frighten somebody hold you down. Not because of being gay, but also being a woman.” Socio-Political Domain Positive Sociopolitical Changes Government support One of the most positive themes identified was the major social change facilitated by the government between 2015 and 2020. Participants mentioned that there was a notable shift in government support during this period. This change allowed for significant progress, including the organization of the first Pride event. The government’s support was also extended to training sessions for nurses and police officers, contributing to a more inclusive society. NGOs’ role in sociopolitical change Participants highlighted the pivotal role of NGOs in driving social change in Guyana. Specifically, trans-led NGOs were credited with playing a significant role in advancing education and awareness within the community. The work of these NGOs made it easier to address challenges and promote acceptance. Challenges in Creating Sociopolitical Change Media’s influence : One significant challenge mentioned was the influence of broadcast media, particularly the choice of music and radio personality opinions. Music from other Caribbean territories, such as Jamaica, was seen as a source of hostility and contributed to negative attitudes. Participants expressed concerns about the impact of these musical messages on local culture: “I don’t think it’s because of religion. I think the influence of the music on slangs these things that come from other Caribbean territories, for instance from Jamaica and these kinds of stuff.” Government’s lack of active support A key challenge in creating social change was the absence of active support from the current government. Participants reported that government policies and current ministers were not inclusive of the sexual and gender minority community. While there was a symbolic act of raising the Pride flag at a United Nations event, the government did not take substantive steps to support the LGBTQ + community. Efforts by NGOs to engage with the Minister of Social Protection did not yield a positive response, reflecting a lack of government commitment to addressing the community’s needs. Significant Experiences Strengths and Resilience of the Community Expertise in lived experience : The sexual and gender minority community’s strength is evident in their ability to work through complex traumas by becoming experts in their own lived experiences. Sharing their experiences and educating others has been a means of self-acceptance. For example, teaching family members and friends about their experiences has led to increased openness, reduced discrimination, and greater acceptance within their own households. This approach has enabled individuals to come out and express their identities more freely, such as one participant’s experience of coming out as pansexual: “And I found out the more I teach, I taught them the more open they became and the more, you know, less, you know, discrimination and what on. And that’s when I came out as pansexual. I explained to her and she was like okay. I started bringing home one two girlfriends.” Healthy coping mechanisms Another reflection of the community’s strength is their practice of self-care and healthy coping habits. Engaging in these positive behaviors is an important skill in reducing stress. Participants mentioned various ways of practicing self-care, such as reading, watching movies, listening to music, singing, dancing, and even engaging in creative activities like art or music. Achieving personal milestones and professional growth also contribute to their sense of well-being. For example, overcoming suicidal tendencies, accepting themselves, and making positive changes in their lives, like quitting unhealthy habits, demonstrate their resilience. Challenges and Areas of Need Intersection of marginalized identities Despite the strengths of the community, they still face challenges related to the intersection of marginalized identities, particularly in a society that traditionally ostracizes vulnerable individuals. Disabilities, in particular, add to the sense of exclusion and create additional stress for some members of the community. Participants reported that society’s attitudes toward disabilities can be quite harsh, making it difficult for individuals who are already marginalized due to their sexual orientation or gender identity. Unrecognized traumatic experiences Traumatic experiences go unrecognized and unaddressed within the community. Many individuals have experienced traumas during their upbringing, but these experiences often remain unspoken and unprocessed. These traumas can lead to ongoing emotional distress, depression, and self-harming thoughts. The lack of awareness and resources to address these issues creates a significant need for support in dealing with past traumas and building resilience. Successes Improved mental health : One of the most significant achievements celebrated by the community is the improvement in mental health. For example, members of the women who have sex with women community consider the ability to maintain good mental health as a major accomplishment. Being able to overcome suicidal ideation and remain emotionally strong is a remarkable achievement, as it represents a substantial victory over past challenges: “For me. Um, my biggest or greatest achievement currently is being here today because a year I go from now, I would not have been here physically [suicidal ideation]. So that's one of my greatest achievement to keep staying strong and holding it up.” Educational advancements : Educational achievements are a significant focus for all sexual and gender identity minority groups. Many community members have worked diligently to pursue their educational goals. For instance, one participant mentioned working hard and successfully obtaining a job promotion. Continuously striving to move forward and reach educational objectives is a source of great pride: “Oh, achievement. Oh, um, work. I work very hard. So I basically got promotion, um, outside. I’m still studying. So every day being able to move forward for my goal as an achievement to me.” Self-acceptance : Self-acceptance is another major accomplishment for individuals across all sexual and gender identity minority groups. Many have experienced personal growth and transformation, shedding shyness, and embracing a more outspoken and self-assured identity. Participants expressed a sense of pride in their ongoing journey of self-acceptance, recognizing that everyone is a “work in progress” and acknowledging the limitless potential for greater achievements: “Um, I would say I’m proud over now knowing like a few years ago, I was very shy and not so outspoken, but after coming out that has changed a lot. So I know everybody’s a work in progress and the sky is the limit. So I’m looking forward to doing greater things, even so.” Discussion The goal of the project was to highlight points of strength and areas for improvement for the sexual and gender identity minority community in Guyana. The frameworks of Social Determinants of Health, Domains of Well-being and Multiple Minority Stress theories allowed superimposition of internationally defined areas of wellbeing for marginalized communities, while a qualitative approach provided a deep understanding of the everyday challenges that the sexual and gender identity minority community experiences. Sexual and gender identity minority-focused NGOs have played a vital role in various aspects of Guyanese society. Through civil society training, mutual aid projects, and research initiatives, these NGOs have created spaces for personal acceptance, identity development, and skill enhancement. The work carried out during the previous government administration (2015–2020) has also been instrumental in propelling social change. Additionally, the strong desire within the sexual and gender identity minority community to educate their support networks, pursue advanced education, and attain stable employment in the face of structural inequalities is noteworthy. These successes reflect remarkable resilience and resourcefulness of the sexual and gender identity minority community in Guyana. The qualitative findings reveal a complex landscape for sexual and gender identity minority individuals across various domains. In the social domain, they find strength in non-Abrahamic religious communities, particularly the Hindu community, which are seen as more accepting. Additionally, they gain acceptance by becoming leaders in local community activism and the arts, while sexual and gender minority-focused NGOs play a crucial role in building social networks and fostering self-confidence. However, religious exclusion remains a major source of discrimination and rejection, creating tension between religious institutions and these individuals. Discrimination within the sexual and gender identity minority community itself poses challenges, as unequal treatment and division sometimes arise from disparities in gender non-conformity and gender-role normativity. In the interpersonal domain, support from biological family members, particularly mothers, significantly impacts their mental health and resilience. Intimate partners also provide crucial support, reducing discrimination and creating a sense of security. Diverse interpersonal networks, including friends and colleagues, help individuals balance family issues and cope with life challenges. Nevertheless, early life exclusion and trauma, especially for trans individuals, have a profoundly negative impact, leading to a lack of genuine love and emotional distress. Intimate partner competition, unstable relationships, and family-related threats and violence further compound these negative experiences. In the vocational domain, supportive teachers and school friends protect the academic and emotional well-being of sexual and gender identity minority individuals. Accepting workplaces are crucial for financial independence, while allies at work foster respect and support. However, bullying and teacher-induced traumas during school days have a detrimental impact on academic performance and emotional well-being. Discrimination in public service job settings remains a significant barrier to career advancement. In the healthcare domain, support from sexual and gender identity minority-focused NGOs and government-run STI clinics facilitates accessible and less stressful healthcare experiences. Nevertheless, varying levels of professionalism among medical staff and onerous healthcare procedures present challenges in seeking healthcare services. Within the housing domain, feeling safe and secure in housing settings is essential for intimate relationships without fear of discrimination. Non-housing intimate spaces serve as alternatives for fostering intimacy. However, access to stable housing depends on accepting family members and adequate income, making many vulnerable to family prejudice and rejection. Discrimination within government housing programs further limits housing support for sexual and gender identity minority individuals. In public spaces, the increased visibility of sexual and gender identity minority individuals is a positive change, attributed to the efforts of NGOs and individuals coming out. Yet, transportation access remains a significant barrier, particularly for the trans community, due to discrimination in public transportation and boat transportation. Concerns about sexual assault in public spaces further compound the challenges faced by sexual and gender identity minority individuals. In the socio-political domain, positive changes include government support and the essential role of NGOs in advancing education and awareness. However, the influence of broadcast media, particularly through music and radio personalities, presents a major challenge. The government’s lack of active support and limited initiatives for the LGBTQ + community further hinder progress in creating social change. Of particular interest is the trans community exclusion from educational and workspaces. The trans community remains heavily stigmatized in Guyana, and our discussions revealed a level of consistent, exclusionary prejudice resulting in trans persons being forced out of the educational system and the employment system. The finding that trans persons are ostracized from family, formal education, workspaces and transportation access highlights the effective omission of this community from basic rights. This is especially concerning when it occurs in the medical community. The data suggests that the most vulnerable individuals in the sexual and gender identity minority community are a good starting point for building inclusion from the ground up to everyone ( 31 ). Despite being socially and economically disadvantaged, the sexual and gender identity minority community, especially the trans community, could only access housing, intimacy and safe transportation through costly alternatives. These costly alternatives were living in high-income neighborhoods, using hotels for intimate experiences, supporting their intimate partners, and using taxis for safe transportation. This social tax on safety is a potential violation of human rights through the so-called poverty penalty where the poor often end up paying more for access to goods and services ( 32 ). Altogether, sexual and gender identity minority individuals in Guyana exhibit resilience and strength in the face of various challenges across multiple domains. These findings underscore the need for comprehensive support and intervention strategies to address the negative aspects while capitalizing on the positive aspects to enhance the well-being and acceptance of sexual and gender identity minority individuals. Indeed, our findings confirmed those of other recent research on the experiences of the sexual and gender identity minority community in Guyana, specifically, that healthcare providers require more trauma-informed and sexual and gender identity minority-centered training to adequately address the needs of the community ( 13 ) and that stigma and discrimination remain rampant in the lives of the sexual and gender identity minority community ( 14 ). This was especially important in the mental health domain that remains taboo in a society in which medical providers still require training to understand the concept of complex trauma, developmental trauma, and historical trauma ( 33 ). As the focus groups uncovered, there are significant needs remaining in Guyanese society to promote equity and inclusion. This includes the government aligning its legal framework (Georgetown University Law Institute, 2018) with international standards to reduce barriers to basic needs and rights such as access to affordable and safe housing, transportation, healthcare, and social spaces. Collaborative initiatives involving both governmental and civil society organizations can play a vital role in dismantling the barriers that hinder social parity and advancing the rights and well-being of sexual and gender identity minorities in Guyana. Some of these initiatives can include collaborations with LGBTQ + advocacy groups to draft and pass comprehensive anti-discrimination laws that protect the rights of sexual and gender identity minorities. This legislation should encompass areas such as employment, housing, healthcare, and public services to ensure equal treatment and opportunities. They can also include creating safe, affordable, and LGBTQ + friendly housing options for individuals facing discrimination in their homes or the larger society. Government funding and support from experienced housing assistance NGOs can be integral to this effort. Additionally, Public Awareness Campaigns aim to combat stigma, educate the public about the experiences of LGBTQ + individuals, and promote acceptance of diverse sexual and gender identities. Critically, given the lack of research with sexual and gender minority populations, organizations can engage in cooperative research projects to collect data and insights into the specific needs and challenges faced by sexual and gender identity minorities. This collaborative research can inform evidence-based policies and interventions, ensuring that they are tailored to the unique experiences of LGBTQ + communities in Guyana. Although this qualitative study focused on obtaining experiential challenges and traumas that the sexual and gender identity minority community experiences in their everyday life in Guyana, our recruitment methods were affected by COVID-19, limiting our ability to recruit participants from more rural parts of the country. As a result, the experiences, and perspectives of rural village sexual and gender identity minority residents, who may face unique challenges related to race, religion, and acceptance, remain to be fully understood. This limitation in participant diversity underscores the need for caution when interpreting the findings, as they may not capture the full spectrum of experiences within the broader sexual and gender identity minority community in Guyana. This highlights the urgency for additional research that focuses specifically on the rural sexual and gender identity minority community. Future studies should aim to explore the nuanced intersections of identity, race, religion, and geographic location to gain a more comprehensive understanding of the challenges and strengths of sexual and gender identity minority individuals residing in rural areas. Such research is vital for developing tailored interventions and support mechanisms that address the distinct needs of these communities and promote inclusivity on a broader scale. Conclusion Despite strides towards wider acceptance in Guyanese society, sexual and gender identity minority individuals in Guyana remain marginalized due to enduring colonial-era laws and cultural biases, impacting their access to housing, healthcare, and employment. However, the resilience and productivity of this community, fortified by NGO support and previous government initiatives, underscore their ability to navigate centuries-old societal norms. Yet, achieving true social parity demands further concerted efforts. To foster social equity, collaborative endeavors involving both governmental bodies and civil society organizations are pivotal. These initiatives must aim to dismantle the persistent barriers hindering the rights and well-being of sexual and gender identity minorities in Guyana. Declarations Ethics Approval and Consent to Participate The study was approved by the Ministry of Health, Guyana, internal review board (IRB) Protocol #095/2023. All participants gave informed consent to participate in this study. Consent for Publication Not Applicable Availability of Data and Materials All data generated or analyzed during this study are included in this published article and its supplementary information files. Competing Interests The author declare that they have no competing interests. Funding No funding to declare. Authors’ Contributions GAK conceptualized the project. GAK and collected, curated, transcribed and coded data. GAK and DJ oversaw formal analysis for the manuscript. GAK and DJ contributed equally to the writing of the manuscript. All authors read and approved of the final manuscript. Authors’ Information Not Applicable. References Fredriksen Goldsen K, de Vries B. Global aging with pride: International perspectives on LGBT aging. Int J Aging Hum Dev. 2019;88(4):315–24. Moagi MM, van Der Wath AE, Jiyane PM, Rikhotso RS. Mental health challenges of lesbian, gay, bisexual and transgender people: An integrated literature review. Health SA Gesondheid. 2021;26(1). Groh CJ, Anthony M, Gash J. The aftermath of suicide: a qualitative study with Guyanese families. Arch Psychiatr Nurs. 2018;32(3):469–74. Nicolas G, Dudley-Grant GR, Maxie-Moreman A, Liddell-Quintyn E, Baussan J, Janac N, McKenny M. Psychotherapy with Caribbean women: Examples from USVI, Haiti, and Guyana. Women therapy. 2021;44(1–2):136–55. Contreras-Urbina M, Bourassa A, Myers R, Ovince J, Rodney R, Bobbili S. Guyana women’s health and life experiences survey report. 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NursingPlus open. 2016;2:8–14. Marks DF, Yardley L, editors. Research methods for clinical and health psychology. Sage; 2004. Divan V, Cortez C, Smelyanskaya M, Keatley J. Transgender social inclusion and equality: a pivotal path to development. J Int AIDS Soc. 2016;19:20803. Gutiérrez-Nieto B, Serrano-Cinca C, Cuéllar-Fernández B, Fuertes-Callén Y. The poverty penalty and microcredit. Soc Indic Res. 2017;133:455–75. Coventry PA, Meader N, Melton H, Temple M, Dale H, Wright K, Cloitre M, Karatzias T, Bisson J, Roberts NP, Brown JV. Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis. PLoS Med. 2020;17(8):e1003262. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4114297","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":284523602,"identity":"94edc381-5a58-4ea7-91e3-2bf75b908ddd","order_by":0,"name":"Gregory Kanhai","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIie2PIQvCQBSAnxyc5cnqBXF/wSEMxZ9i2ZWlabGKLGkZZi36F2YxDx4uajUYlIGgSREWxalDsGzaDPel78F9vHcACsWfUnABLGAsSFyUf0m49UjwhwSw+hjyE71FdBz3th1tiNfTpldHKNLSz0qMlW03/PDQFVRaNJ0wOQxte5OZeGgaO07STZKaw5NEoJmTaLGxu5GcER5qzu2LREdk+/mApE/Iovbgi6SK3CxMRiTnxE3WHgnkeX/RPRZdvJjkdE3R1Yn7Fa1IYfaWALhI/SU86/lziwvsnPpbFAqFQvHBHZpmTANpyEuNAAAAAElFTkSuQmCC","orcid":"","institution":"InUnity Alliance","correspondingAuthor":true,"prefix":"","firstName":"Gregory","middleName":"","lastName":"Kanhai","suffix":""},{"id":284523604,"identity":"68578ba2-f1a8-4684-b0e9-ca0b039bac6a","order_by":1,"name":"Drexler James","email":"","orcid":"","institution":"University of Minnesota","correspondingAuthor":false,"prefix":"","firstName":"Drexler","middleName":"","lastName":"James","suffix":""}],"badges":[],"createdAt":"2024-03-16 18:14:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4114297/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4114297/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53716635,"identity":"4f61a44e-eff5-439a-ae05-fd0a42e08bc2","added_by":"auto","created_at":"2024-03-29 09:25:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":892855,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4114297/v1/284e829c-de3a-49ba-963b-382d2d6a0600.pdf"},{"id":53716235,"identity":"047acc7f-f706-4196-8654-df6bb4667a27","added_by":"auto","created_at":"2024-03-29 09:17:54","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":36413,"visible":true,"origin":"","legend":"","description":"","filename":"Supplement.docx","url":"https://assets-eu.researchsquare.com/files/rs-4114297/v1/7b629b943ae18f9bd32f6fd9.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Unveiling the Lived Experiences of Sexual and Gender Diverse Individuals in Guyana: A Qualitative Investigation into Wellbeing","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGlobally, sexual and gender identity minority individuals are marginalized along multiple intersecting identities, making them vulnerable to extreme biopsychosocial stressors, including heterosexism, known to impact longevity, mental health, and physical health (1, 2). These disparities are likely heightened in Guyana, where cultural biases and laws continue to contribute to the marginalization of the sexual and gender identity minority community. Moreover, other disparities within Guyana\u0026rsquo;s larger society, including one of the world\u0026rsquo;s highest suicide rates, a high prevalence of inter-partner violence, and relatively high rates of mental health disorders (3, 4, 5, 6), underscore the importance of examining factors associated with the health and wellbeing of gender identity minority individuals in Guyana\u0026mdash;the primary objective of this qualitative research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHistory of Sexual and Gender Identity Minority Exclusion in Guyana\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIntolerance of sexual and gender identity minorities in Guyana, and the Caribbean more generally, can be traced to European and British cultural norms that were enforced through colonialism (7). Guyana remains a largely religious society, with 64% of Guyanese reported to belong to a Christian denomination, 25% identifying as Hindu, and 7% identifying as Muslim (8). According to the Institute on Religion and Public Policy (IRPP), the British colonial establishment supported Anglicanism as the state religion, and after independence, the Anglican Church and the Catholic Church cooperated to maintain influence in the society (9). As a result of this colonial era religious influence, the cultural norms of British colonial rule remain largely intact, both in cultural biases and law. The Constitution of Guyana includes a clause that is a barrier to revising laws that were inherited from the British Empire, even when they undermine human rights. \u0026nbsp;As a result, the so-called \u0026ldquo;buggery and gross indecency laws,\u0026rdquo; Criminal Law (Offences) Act 1893, Section 353 Buggery Under Section 353, \u0026ldquo;anyone who commits \u0026lsquo;buggery\u0026rsquo; is liable to life imprisonment,\u0026rdquo; continues to empower acts of discrimination (10).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eRecent Findings on Sexual and Gender Identity Minority Life in Guyana\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite significantly improved social circumstances for sexual and gender identity minority Guyanese (11), recent studies on the state of the Guyanese sexual and gender identity minority population have revealed a persistent lack of positive media and public messaging, as well as inertia in repealing colonial-era laws that enforce Old Testament (Levitical)-derived sexual behavior codes. A 2013 survey found that women and younger adults tend to be more tolerant of homosexuality, whereas the Evangelical Christian community and those with lower education levels are less tolerant (12). When examining the attitudes and knowledge of sexual and gender identity minority needs within the medical community, Rambarran and colleagues (13) found that medical personnel lacked community-centric knowledge and a significant reluctance to learn more about the unique needs of sexual and gender identity minorities.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, limited research has examined the experiences of sexual and gender identity minority individuals in Guyana, indicating a significant gap in our understanding of this community\u0026rsquo;s challenges and needs. One recent study by Guybow (14) found that a substantial portion of sexual and gender identity minority individuals, approximately 54%, reported struggling to meet their financial obligations. This highlights potential economic vulnerabilities within this group, suggesting that disparities may exist, which could negatively impact their overall well-being and quality of life. Additionally, the study revealed that very few individuals in this community had sought support from law enforcement (14). This reluctance to seek help implies a potential lack of trust in or fear of discrimination or mistreatment when dealing with authorities, with potential consequences for access to justice and protection from discrimination or violence for the gender and sexual identity minority community in Guyana.\u003c/p\u003e\n\u003cp\u003eMoreover, research conducted by the Georgetown University Law Center Human Rights Institute (15) found that sexual and gender identity minority individuals in Guyana face verbal and physical threats when in public. These experiences indicate significant safety concerns within this community and suggest that individuals may be at risk of harassment and violence. In light of these findings, it is clear that there are pressing issues facing sexual and gender identity minority individuals in Guyana. The limited research, economic struggles, reluctance to seek help from law enforcement, and experiences of threats in public spaces underscore the need for further research, as well as the development of policies and support systems to address these challenges and promote the well-being and safety of the community.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConceptual Approach\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo gain a comprehensive understanding of the experiences among sexual and gender identity minorities in Guyana, we use a theoretical framework that integrates the Social Determinants of Health (SDH), Well-being Domains Theory (16), and Intersectional Minority Stress Theory (17). We use this integrated theoretical framework with the goal of providing a holistic understanding of the experiences and challenges faced by sexual and gender identity minorities in Guyana by examining the interplay of social determinants of health, well-being domains, and intersectional minority stress. We believe that this integrated framework offers a more comprehensive perspective on the factors influencing well-being and health, paving the way for targeted interventions and policy initiatives to address the unique needs and challenges of sexual and gender identity minorities in Guyana.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eThe Social Determinants of Health\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Social Determinants of Health (SDH) framework acknowledges that non-medical factors profoundly impact the physical and psychological health of individuals (18, 19). SDH operates through three key mechanisms: (1) the social context during an individual\u0026rsquo;s development, (2) social stratification in adulthood affecting exposure to stressors, and (3) the differential consequences affecting mental and physical health. The World Health Organization\u0026rsquo;s (WHO) commission on social determinants of health has identified two major categories of social determinants of health that affect health equity and well-being. Structural determinants of health such as public policy, cultural and socioeconomic factors, and intermediary factors such as living circumstances and biopsychosocial factors (19). These determinants encompass structural factors, including public policy, cultural and socioeconomic conditions, and intermediary factors such as living circumstances and biopsychosocial elements. Through the lens of human rights, recognizing SDH is a means to empower governments to address health disparities among social groups. The ultimate goal is to provide marginalized communities, including sexual and gender minority individuals, with the resources to control the factors influencing their health, contingent on fair resource allocation and informed communities. Understanding well-being is central to this process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eWell-being Domains Theory\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt the individual level, SDH is better understood through objective well-being, linked to community factors that promote wellness. For sexual and gender identity minority communities facing ongoing social inequities across numerous life domains, this objective well-being perspective is essential. The Well-being Domains Theory focuses on identifying and understanding various domains or areas of life that contribute to an individual\u0026rsquo;s overall well-being and quality of life. This theory recognizes that a person\u0026rsquo;s well-being is influenced by a combination of factors and experiences in different aspects of their life (20, 21). By identifying the proximal factors affecting their well-being, we can better understand the contexts that shape their decisions and experiences.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWell-being measures provide a balanced approach to identify common domains influencing quality of life for populations worldwide (22, 23, 24, 25). Some domains of wellbeing found in multiple measures include social connectedness, mental health, physical health, and productivity (20, 21).\u0026nbsp;For the sexual and gender identity minority community in Guyana, we selected nine domains that we believe to be most appropriate: social, interpersonal, vocational, healthcare, housing, public spaces, socio-political, significant experiences, and successes. Stressors within each of these domains can collectively impact the wellness of individuals, depending on their intersections.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eIntersectional Minority Stress Theory\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultiple socially and self-stigmatized minority identities result in cumulative psychological stress that impacts wellbeing through various means such as social alienation, discrimination and self-medication (26). The intersectional ecology model of marginalized minority stress is a crucial framework to comprehend the unique stressors faced by marginalized communities, such as sexual and gender minority Guyanese individuals (17). Sexual and gender minority Guyanese experiences are situated at the crossroads of multiple identities and communities within which they reside. Factors like gender expression, sexual behavior, socioeconomic status, race, region of residence, and religious beliefs intersect to create compounding stressors that result in a unique experience for these individuals. These stressors can significantly impact both physical and psychological health. The exclusion of sexual and gender minority individuals in Guyana is deeply rooted in history, further compounding the intersectional nature of the stressors they face.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eWe used a deductive approach to data gathering (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) based on the Well-being Domain Theory and informed by previous research on the Guyanese sexual and gender identity minority. This method enabled us to investigate various life domains through the lens of multiple subjective experiences.\u003c/p\u003e \u003cp\u003eWe conducted four focus groups between December 2023 and January 2024, following the guidelines set by Krueger and colleagues (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Each focus group represented specific subsets of the sexual and gender identity minority community, including trans-identified individuals (trans), women who have sex with women (WSW), men who have sex with men with higher socio-economic status (MSM1), and men who have sex with men with lower socio-economic status (MSM2). Participants were recruited through local sexual and gender identity minority-focused non-governmental organizations (NGOs), targeting individuals open to participating in discussions about their experiences. Participants received GY \u003cspan\u003e$\u003c/span\u003e2000 (roughly \u003cspan\u003e$\u003c/span\u003e10 USD) for taking part in the study. The number of participants in each focus group ranged from 5 to 16, depending on the challenges posed by the COVID-19 pandemic in a society where transportation, inclement weather, and concerns about disclosing one\u0026rsquo;s identity are barriers to engagement.\u003c/p\u003e \u003cp\u003eWe provided participants with instructions that outlined the purpose of the focus groups, the well-being domains that would be discussed, and the expectation to share positive, neutral, or negative experiences in each life domain. They were also instructed to avoid using names and to speak from their own experiences. The facilitator guided the conversation, transitioning from one domain to another. Participants were assured that their voice recordings would be destroyed after transcription to maintain confidentiality. All recordings underwent a two-pass system involving auto-transcription software and correction by a single researcher. Recordings were deleted after the transcripts were corrected. This study was approved by the Guyana\u0026rsquo;s Ministry of Health Institutional Review Board.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis Strategy\u003c/h2\u003e \u003cp\u003eData analysis consisted of using the 9 domains of well-being (social, interpersonal, vocational, healthcare, housing, public spaces, socio-political, significant experiences, and successes) to identify themes across life experiences. Two researchers collaborated on extracting codes from the transcripts and the lead researcher compiled a codebook of the major themes (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Surface codes were then subject to another round of thematic analysis to detect themes that were not included in the domains of wellness areas.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDemographics\u003c/h2\u003e \u003cp\u003eForty-five participants over the age of 18 who identified as a sexual and/or gender minority person participated in this study. Of the 45 participants, only 40 completed the demographic questionnaire. Of these 40 respondents, 18 identified as men, 12 identified as women and 10 identified as gender non-conforming persons. Twenty-seven identified as Christian, 3 as Muslim, 2 as Hindu and 8 were non-religious. There were 6 Indo-Guyanese, 17 Afro-Guyanese, 17 Mixed-race persons, and 5 who declined to identify their race. Median income was GY\u003cspan\u003e$\u003c/span\u003e70, 000 - GY\u003cspan\u003e$\u003c/span\u003e100, 000/month (approximately \u003cspan\u003e$\u003c/span\u003e335-\u003cspan\u003e$\u003c/span\u003e479 USD/Month). The majority (48%) had completed high school, and 10% had not. See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for full demographic information.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReported Demographics of Study Respondents.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eDemographic Category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;40)*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace/Ethnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndo-Guyanese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfro-Guyanese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(42.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMixed-Race\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(42.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo data*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWoman\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-conforming\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge Range\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(67.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(7.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHindu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-religious\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMonthly Income ($GY)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e0-\u003cspan\u003e$\u003c/span\u003e70K\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e71K \u0026ndash; 100K*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e100K \u0026ndash; 200K\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e200K \u0026ndash; 400K\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e400K and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUndisclosed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eEducation Completed\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; High School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh School*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(47.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSome College\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(7.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2-yr College\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4-yr College\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(17.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaster\u0026rsquo;s Degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eLiving Situation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(32.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRelatives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(7.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRoommates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(7.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePartner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(32.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eRelocations (past 5 years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBarima-Waini (Region 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(52.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePomeroon-Supenaam Waini (Region 2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEssequibo Islands-West Demerara Waini (Region 3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(7.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDemerara-Mahaica Waini (Region 4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(7.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMahaica-Berbice Waini (Region 5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(7.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUndisclosed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e*Note: 40 out of 45 focus group participants completed the demographic questionnaire. * = location of median.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eThemes and Sub-themes Extracted from Focus Groups\u003c/h2\u003e \u003cp\u003eSee the Supplement for themes and example excerpts.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSocial Domain\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003ePositive Social Themes\u003c/h2\u003e \u003cp\u003e \u003cb\u003eSocial acceptance\u003c/b\u003e: Members of the sexual and gender identity minority community highlighted several positive aspects of their lives, demonstrating their strengths in coping with daily stressors. In the social domain, religion and social groups emerged as significant themes. Notably, non-Abrahamic religions were seen as less likely to discriminate and ostracize trans individuals. For example, the Hindu community was recognized as relatively accepting: \u0026ldquo;[sexual and gender minority] people or trans people, the Hindu community might be a little more accepting in some way or the other.\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u003cb\u003eCommunity leadership\u003c/b\u003e: Becoming a community leader in the arts or local community activism was seen as a means of gaining local community acceptance. Participants expressed feeling comfortable in such leadership roles: \u0026ldquo;I have a comfort zone as a community leader in my community.\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u003cb\u003eSexual and gender minority-focused NGOs\u003c/b\u003e: Participants emphasized the importance of sexual and gender minority-focused non-governmental organizations (NGOs) in building social contacts, identity, and well-being. These organizations were described as places where individuals could gain self-confidence, connect with like-minded people, and learn that they were not alone. They also provided opportunities for skills development: \u0026ldquo;It gives me satisfaction knowing that I am facilitating it; it gives other people a sense of community; it\u0026rsquo;s a place of learning.:\u003c/p\u003e \u003cp\u003e\u003cb\u003eInclusivity in non-sexual and gender minority social groups\u003c/b\u003e: Non-sexual and gender minority social groups were considered important for establishing a sense of connection to the larger society. One participant highlighted their involvement in a bingo community in their village, where they interacted with \u0026ldquo;straight\u0026rdquo; individuals and did not face discrimination within that setting: \u0026ldquo;I'm a part of the bingo community in the village where I come from. And it have a lot of straight people within that community, but I don't face any discrimination or anything within that setting.\u0026rdquo;\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eNegative Social Themes\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eReligious exclusion\u003c/strong\u003e \u003cp\u003eDespite the positive aspects, the religious community was identified as a major source of exclusion. Participants shared experiences of discrimination and rejection within religious contexts, which had a significant impact on their relationship with these institutions.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInter-sexual and gender minority group friction\u003c/b\u003e: Another major theme within the social domain was the presence of discrimination within sexual and gender minority communities. Participants acknowledged that discrimination among different subgroups within the sexual and gender minority community posed a significant barrier to cohesion and unity. Some individuals believed that certain subgroups received preferential treatment: \u0026ldquo;The challenges as I mentioned would be sometimes there\u0026rsquo;s a lot of in-house discrimination because you know, some of these groups would involve MSM, trans people and some of them think lesbians get an easy pass.\u0026rdquo;\u003c/p\u003e \u003cp\u003eOne other significant source was the differential experience of discrimination between gender non-conforming persons and cis-gender individuals. For instance, one participant revealed a life of relative isolation as a strategy for avoiding discrimination: \u0026ldquo;For me though. I've been living by myself since 17. Even though I live in this area, I don\u0026rsquo;t mix or meddle. Other persons can\u0026rsquo;t tell you if I'm there or where I'm living ... I don\u0026rsquo;t have any issues. In my area if a gay guy walks, he\u0026rsquo;s tormented.\u0026rdquo; This suggests that gender non-conforming individuals often face heightened discrimination compared to cis-gender members of the community. Additionally, friction within the sexual and gender identity minority community seemed to stem from issues related to gender-role normativity. Participants discussed in-house discrimination scenarios, such as becoming pregnant as a \u0026ldquo;stud\u0026rdquo; or engaging in various relationship dynamics that led to questions and judgment from others within the community. These examples highlight how gender roles and stereotypes within the community can contribute to tension and division among sexual and gender identity minority subgroups.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTrauma from discrimination\u003c/strong\u003e \u003cp\u003ePast experiences of discrimination continued to shape participants\u0026rsquo; perceptions of safety. Some expressed the need to protect themselves and others within the sexual and gender minority community when venturing into various public spaces, owing to concerns about potential discrimination and the realities of being gay.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eInterpersonal Domain\u003c/h2\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003ePositive Interpersonal Themes\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eBiological family acceptance\u003c/strong\u003e \u003cp\u003eThe most crucial positive theme in the interpersonal domain was the impact of acceptance from biological family members on the mental health and resilience of sexual and gender identity minority individuals. Participants emphasized that coming out to supportive family members, like their mothers, was significant for their well-being. Some individuals shared that they cared most about what their immediate family members thought, while opinions of others were less important.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eIntimate partners as support systems\u003c/strong\u003e \u003cp\u003eIntimate partners were identified as essential sources of support for well-being and resilience, particularly when family support was absent. Living with a partner provided a sense of security and reduced the experience of discrimination.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDiverse interpersonal supports\u003c/strong\u003e \u003cp\u003e Participants highlighted the importance of a variety of interpersonal supports in their lives. These included relationships with friends and colleagues at work. They considered these support systems crucial for balancing family issues and coping with stress in different areas of life.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eNegative Interpersonal Themes\u003c/h2\u003e \u003cp\u003e \u003cb\u003eEarly life exclusion and trauma\u003c/b\u003e: Early life exclusion was described as traumatic for trans individuals. Many felt that they had not experienced genuine love, particularly within family settings. The lack of acceptance from their biological families had a profound impact on their mental health and identity: \u0026ldquo;So when somebody come you know whether they are genuine love so many times we as LGBT and trans persons don't experience genuine love. Especially from family settings so.\u0026rdquo;\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eFew intimate partners and unstable relationships\u003c/strong\u003e \u003cp\u003e Especially within the trans community, participants noted that having few intimate partners often led to unstable relationships. Some described a competition for partners, which strained relationships and prevented them from becoming healthy. In some cases, individuals resorted to sex work due to societal condemnation.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e\u003cb\u003eFamily threats and violence\u003c/b\u003e: Family-related threats and violence were described as traumatic experiences. Participants shared instances where family members threatened their lives or subjected them to violence. These traumatic encounters had a lasting impact on their relationships with their families and their overall well-being: \u0026ldquo;When my family get to know it was a [big event]. They wanted to poison me. They wanted to kill me. One big brother pulled me down the stairs at one time, but now it\u0026rsquo;s 50/50. We still don\u0026rsquo;t get along on a regular basis.\u0026rdquo;\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eVocational Domain\u003c/h2\u003e \u003cdiv id=\"Sec20\" class=\"Section3\"\u003e \u003ch2\u003ePositive Vocational Themes\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eSupportive teachers and school friends\u003c/strong\u003e \u003cp\u003ePositive themes in the vocational domain highlighted the significance of teachers and school friends in protecting the mental health of the sexual and gender identity minority community during their school years. Teachers were recognized as potential allies against discrimination and trauma, particularly for individuals from lower socio-economic backgrounds.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAccepting workspaces for financial independence\u003c/strong\u003e \u003cp\u003eThe importance of stable and accepting work environments for achieving financial independence was emphasized. Participants noted that workplaces with policies resembling those in the United States, which create safe work environments, contributed to their well-being. Having access to unisex washrooms for trans workers was seen as a positive development.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e\u003cb\u003eAllies at work\u003c/b\u003e: Allies at the workplace were considered important for work stability and success. Participants spoke positively about their coworkers, many of whom were aware of their sexuality and treated them with respect and support: \u0026ldquo;at work?. Well, everybody treat me normal cause they Know I am gay, but they never disrespect me.\u0026rdquo;\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eNegative Vocational Themes\u003c/h2\u003e \u003cp\u003e \u003cb\u003eBullying and teacher-induced traumas during school days\u003c/b\u003e: Negative themes included the traumatic experiences of bullying and traumas caused by teachers during school days. Participants shared instances where teachers themselves contributed to traumas, either through direct actions or insensitive comments. Some described the traumatic effects of corporal punishment and being outed by teachers, which resulted in family conflicts: \u0026ldquo;When I was small before my mother found out I was gay I used to get a lot of licks [beatings]. Licks and embarrassed in school. In front of the entire school as soon as she found out that I am gay.\u0026rdquo;\u003c/p\u003e \u003cp\u003e \u003cb\u003eSchool bullying and academic impact\u003c/b\u003e: Bullying was identified as a significant problem in the school setting, leading to academic difficulties and emotional distress. Participants noted how school bullying affected their academic performance and contributed to depression. The use of derogatory terms like \u0026ldquo;anti-man\u0026rdquo; was particularly harmful: \u0026ldquo;I didn\u0026rsquo;t participate in sports, but I think I was more subject to bullying from the boys. And so, and afterwards I got depressed but I used to manage, um, with work.\u0026rdquo;\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDiscrimination in public service job settings\u003c/strong\u003e \u003cp\u003eDiscrimination in public service job settings was a key negative theme, involving bullying from co-workers and punitive transfers. Discrimination, including professional discrimination, was seen as a barrier to career advancement. Some participants felt that their hard work did not lead to promotions, and others experienced difficult working conditions, such as extended 12-hour shifts, without the option to change their schedules.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eHealthcare Domain\u003c/h2\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003ePositive Healthcare Themes\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eImportance of sexual and gender identity minority-focused NGOs\u003c/strong\u003e \u003cp\u003eOne positive theme in the healthcare domain highlighted the crucial role of sexual and gender identity minority-focused NGOs in facilitating access to safe healthcare. Participants noted that social workers from these organizations had established relationships with healthcare providers, making it easier for trans individuals to receive referrals and access care.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eGovernment-run sexually transmitted infection (STI) clinics\u003c/b\u003e: Government-run STI clinics were seen as a positive aspect of healthcare. Participants noted that these clinics provided accessible and less stressful testing experiences. They found the staff at these clinics to be friendly and the environments safe: \u0026ldquo;So I revealed my sexuality to the person during their assessment. I was comfortable with that and they, they, they had no judgment. She was that\u0026rsquo;s fine. That\u0026rsquo;s quite okay. So it was very positive. It was a positive experience at the South Road Clinic.\u0026rdquo;\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eNegative Healthcare Themes\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eVariability in medical staff professionalism\u003c/strong\u003e \u003cp\u003eThe professionalism of medical staff could vary depending on the institution contacted. Some participants expressed concerns about the lack of trauma-informed training for medical and mental health staff. For example, biased mental health professionals were described as traumatizing, as they invalidated the experiences of trans individuals living with HIV and mental health conditions.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eOnerous procedures and document-focused workflow\u003c/strong\u003e \u003cp\u003eParticipants noted that onerous procedures and document-focused workflows frustrated testing opportunities. The process for STI testing, in particular, was described as frustrating and complicated, which made it difficult for individuals to access testing services. Referral-related issues, such as the need for a stamp on referrals, added further complications to the testing process.\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eHousing Domain\u003c/h2\u003e \u003cdiv id=\"Sec26\" class=\"Section4\"\u003e \u003ch2\u003ePositive Housing Themes\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eFeeling of safety and well-being\u003c/strong\u003e \u003cp\u003eHousing was associated with a sense of safety and well-being, particularly because it allowed individuals to have intimate relationships without fear of judgment or discrimination. Having accepting and private housing spaces was seen as crucial for developing intimate relationships. Participants expressed feeling comfortable and secure in their homes, where they could host friends and romantic partners, creating a safe and private space for themselves.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eNon-housing intimate spaces\u003c/strong\u003e \u003cp\u003eFor those whose housing was not considered safe, participants identified alternative spaces for intimacy or relaxation away from judgment and harassment. These alternatives included using hotels or the homes of individuals who lived alone, though the latter was less common among people of their age.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eNegative Housing Themes\u003c/h2\u003e \u003cp\u003e \u003cb\u003eDependence on accepting family and adequate income\u003c/b\u003e: Access to stable housing was often dependent on having accepting family members and adequate income, which posed challenges for many individuals in the community. Family prejudice and rejection could result in homelessness and disrupt educational and career opportunities. Some participants described how they were put out of their homes due to family rejection, which affected their academic performance: \u0026ldquo;I was preparing to sit, CSEC [high school standardized exam], that is a time I become more flamboyant and I start to show it. So I got put out of my home, family rejection and so, I think. So I was staying between different, different homes and so forth, and I wasn\u0026rsquo;t getting any financial support.\u0026rdquo;\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDiscrimination in government housing programs\u003c/strong\u003e \u003cp\u003eGovernment housing programs were identified as discriminatory against sexual and gender identity minority persons, particularly within the trans community. Some individuals reported facing discrimination when attempting to apply for house lots through government housing programs. Discrimination based on gender identity prevented access to housing support.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003ePublic Spaces\u003c/h2\u003e \u003cdiv id=\"Sec29\" class=\"Section3\"\u003e \u003ch2\u003ePositive Changes in Public Spaces\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eIncreased visibility\u003c/strong\u003e \u003cp\u003eOne positive change in public spaces was the increased visibility of the sexual and gender identity minority community. This increase in visibility was attributed to the ongoing efforts of non-governmental organizations (NGOs) and individuals coming out. Participants noted that the growing visibility of LGBTQ\u0026thinsp;+\u0026thinsp;individuals had led to a more comfortable and accepting atmosphere in public spaces. This positive change was seen as a result of more people openly identifying as LGBTQ+.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eChallenges in Public Spaces\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eTransportation access barrier\u003c/strong\u003e \u003cp\u003eDespite the positive changes, transportation access remained a major barrier to travel, especially for the trans community. Minibuses were identified as a barrier to travel for trans individuals, with reports of conductors refusing to pick up transgender passengers. This discrimination in public transportation made travel difficult for some. Speedboat access was also identified as a barrier to free travel, particularly in the context of racial differences. Some individuals reported that the black community faced more challenges when using speedboats, while the Indian community did not encounter similar issues. This racial disparity in boat transportation was noted as a concern.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eConcerns about sexual assault\u003c/b\u003e: For women who have sex with women individuals, the threat of sexual assault remained a constant source of stress. Participants expressed concerns about the risk of sexual assault, especially during nighttime travel. This concern extended to both gender identity and being a woman, as participants feared being robbed or attacked due to their sexual and gender identities: \u0026ldquo;In the night I would travel with taxi. Not only for being gay but also a woman. Like you know, how men behave. You afraid to be robbed, or you frighten somebody hold you down. Not because of being gay, but also being a woman.\u0026rdquo;\u003c/p\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003eSocio-Political Domain\u003c/h2\u003e \u003cdiv id=\"Sec32\" class=\"Section3\"\u003e \u003ch2\u003ePositive Sociopolitical Changes\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eGovernment support\u003c/strong\u003e \u003cp\u003eOne of the most positive themes identified was the major social change facilitated by the government between 2015 and 2020. Participants mentioned that there was a notable shift in government support during this period. This change allowed for significant progress, including the organization of the first Pride event. The government\u0026rsquo;s support was also extended to training sessions for nurses and police officers, contributing to a more inclusive society.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eNGOs\u0026rsquo; role in sociopolitical change\u003c/strong\u003e \u003cp\u003e Participants highlighted the pivotal role of NGOs in driving social change in Guyana. Specifically, trans-led NGOs were credited with playing a significant role in advancing education and awareness within the community. The work of these NGOs made it easier to address challenges and promote acceptance.\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec33\" class=\"Section4\"\u003e \u003ch2\u003eChallenges in Creating Sociopolitical Change\u003c/h2\u003e \u003cp\u003e \u003cb\u003eMedia\u0026rsquo;s influence\u003c/b\u003e: One significant challenge mentioned was the influence of broadcast media, particularly the choice of music and radio personality opinions. Music from other Caribbean territories, such as Jamaica, was seen as a source of hostility and contributed to negative attitudes. Participants expressed concerns about the impact of these musical messages on local culture: \u0026ldquo;I don\u0026rsquo;t think it\u0026rsquo;s because of religion. I think the influence of the music on slangs these things that come from other Caribbean territories, for instance from Jamaica and these kinds of stuff.\u0026rdquo;\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eGovernment\u0026rsquo;s lack of active support\u003c/strong\u003e \u003cp\u003eA key challenge in creating social change was the absence of active support from the current government. Participants reported that government policies and current ministers were not inclusive of the sexual and gender minority community. While there was a symbolic act of raising the Pride flag at a United Nations event, the government did not take substantive steps to support the LGBTQ\u0026thinsp;+\u0026thinsp;community. Efforts by NGOs to engage with the Minister of Social Protection did not yield a positive response, reflecting a lack of government commitment to addressing the community\u0026rsquo;s needs.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec34\" class=\"Section3\"\u003e \u003ch2\u003eSignificant Experiences\u003c/h2\u003e \u003cdiv id=\"Sec35\" class=\"Section4\"\u003e \u003ch2\u003eStrengths and Resilience of the Community\u003c/h2\u003e \u003cp\u003e \u003cb\u003eExpertise in lived experience\u003c/b\u003e: The sexual and gender minority community\u0026rsquo;s strength is evident in their ability to work through complex traumas by becoming experts in their own lived experiences. Sharing their experiences and educating others has been a means of self-acceptance. For example, teaching family members and friends about their experiences has led to increased openness, reduced discrimination, and greater acceptance within their own households. This approach has enabled individuals to come out and express their identities more freely, such as one participant\u0026rsquo;s experience of coming out as pansexual: \u0026ldquo;And I found out the more I teach, I taught them the more open they became and the more, you know, less, you know, discrimination and what on. And that\u0026rsquo;s when I came out as pansexual. I explained to her and she was like okay. I started bringing home one two girlfriends.\u0026rdquo;\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHealthy coping mechanisms\u003c/strong\u003e \u003cp\u003eAnother reflection of the community\u0026rsquo;s strength is their practice of self-care and healthy coping habits. Engaging in these positive behaviors is an important skill in reducing stress. Participants mentioned various ways of practicing self-care, such as reading, watching movies, listening to music, singing, dancing, and even engaging in creative activities like art or music. Achieving personal milestones and professional growth also contribute to their sense of well-being. For example, overcoming suicidal tendencies, accepting themselves, and making positive changes in their lives, like quitting unhealthy habits, demonstrate their resilience.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eChallenges and Areas of Need\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eIntersection of marginalized identities\u003c/strong\u003e \u003cp\u003eDespite the strengths of the community, they still face challenges related to the intersection of marginalized identities, particularly in a society that traditionally ostracizes vulnerable individuals. Disabilities, in particular, add to the sense of exclusion and create additional stress for some members of the community. Participants reported that society\u0026rsquo;s attitudes toward disabilities can be quite harsh, making it difficult for individuals who are already marginalized due to their sexual orientation or gender identity.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eUnrecognized traumatic experiences\u003c/strong\u003e \u003cp\u003eTraumatic experiences go unrecognized and unaddressed within the community. Many individuals have experienced traumas during their upbringing, but these experiences often remain unspoken and unprocessed. These traumas can lead to ongoing emotional distress, depression, and self-harming thoughts. The lack of awareness and resources to address these issues creates a significant need for support in dealing with past traumas and building resilience.\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec37\" class=\"Section2\"\u003e \u003ch2\u003eSuccesses\u003c/h2\u003e \u003cp\u003e \u003cb\u003eImproved mental health\u003c/b\u003e: One of the most significant achievements celebrated by the community is the improvement in mental health. For example, members of the women who have sex with women community consider the ability to maintain good mental health as a major accomplishment. Being able to overcome suicidal ideation and remain emotionally strong is a remarkable achievement, as it represents a substantial victory over past challenges: \u0026ldquo;For me. Um, my biggest or greatest achievement currently is being here today because a year I go from now, I would not have been here physically [suicidal ideation]. So that's one of my greatest achievement to keep staying strong and holding it up.\u0026rdquo;\u003c/p\u003e \u003cp\u003e \u003cb\u003eEducational advancements\u003c/b\u003e: Educational achievements are a significant focus for all sexual and gender identity minority groups. Many community members have worked diligently to pursue their educational goals. For instance, one participant mentioned working hard and successfully obtaining a job promotion. Continuously striving to move forward and reach educational objectives is a source of great pride: \u0026ldquo;Oh, achievement. Oh, um, work. I work very hard. So I basically got promotion, um, outside. I\u0026rsquo;m still studying. So every day being able to move forward for my goal as an achievement to me.\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u003cb\u003eSelf-acceptance\u003c/b\u003e: Self-acceptance is another major accomplishment for individuals across all sexual and gender identity minority groups. Many have experienced personal growth and transformation, shedding shyness, and embracing a more outspoken and self-assured identity. Participants expressed a sense of pride in their ongoing journey of self-acceptance, recognizing that everyone is a \u0026ldquo;work in progress\u0026rdquo; and acknowledging the limitless potential for greater achievements: \u0026ldquo;Um, I would say I\u0026rsquo;m proud over now knowing like a few years ago, I was very shy and not so outspoken, but after coming out that has changed a lot. So I know everybody\u0026rsquo;s a work in progress and the sky is the limit. So I\u0026rsquo;m looking forward to doing greater things, even so.\u0026rdquo;\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe goal of the project was to highlight points of strength and areas for improvement for the sexual and gender identity minority community in Guyana. The frameworks of Social Determinants of Health, Domains of Well-being and Multiple Minority Stress theories allowed superimposition of internationally defined areas of wellbeing for marginalized communities, while a qualitative approach provided a deep understanding of the everyday challenges that the sexual and gender identity minority community experiences. Sexual and gender identity minority-focused NGOs have played a vital role in various aspects of Guyanese society. Through civil society training, mutual aid projects, and research initiatives, these NGOs have created spaces for personal acceptance, identity development, and skill enhancement. The work carried out during the previous government administration (2015\u0026ndash;2020) has also been instrumental in propelling social change. Additionally, the strong desire within the sexual and gender identity minority community to educate their support networks, pursue advanced education, and attain stable employment in the face of structural inequalities is noteworthy. These successes reflect remarkable resilience and resourcefulness of the sexual and gender identity minority community in Guyana.\u003c/p\u003e \u003cp\u003eThe qualitative findings reveal a complex landscape for sexual and gender identity minority individuals across various domains. In the social domain, they find strength in non-Abrahamic religious communities, particularly the Hindu community, which are seen as more accepting. Additionally, they gain acceptance by becoming leaders in local community activism and the arts, while sexual and gender minority-focused NGOs play a crucial role in building social networks and fostering self-confidence. However, religious exclusion remains a major source of discrimination and rejection, creating tension between religious institutions and these individuals. Discrimination within the sexual and gender identity minority community itself poses challenges, as unequal treatment and division sometimes arise from disparities in gender non-conformity and gender-role normativity.\u003c/p\u003e \u003cp\u003eIn the interpersonal domain, support from biological family members, particularly mothers, significantly impacts their mental health and resilience. Intimate partners also provide crucial support, reducing discrimination and creating a sense of security. Diverse interpersonal networks, including friends and colleagues, help individuals balance family issues and cope with life challenges. Nevertheless, early life exclusion and trauma, especially for trans individuals, have a profoundly negative impact, leading to a lack of genuine love and emotional distress. Intimate partner competition, unstable relationships, and family-related threats and violence further compound these negative experiences. In the vocational domain, supportive teachers and school friends protect the academic and emotional well-being of sexual and gender identity minority individuals. Accepting workplaces are crucial for financial independence, while allies at work foster respect and support. However, bullying and teacher-induced traumas during school days have a detrimental impact on academic performance and emotional well-being. Discrimination in public service job settings remains a significant barrier to career advancement.\u003c/p\u003e \u003cp\u003eIn the healthcare domain, support from sexual and gender identity minority-focused NGOs and government-run STI clinics facilitates accessible and less stressful healthcare experiences. Nevertheless, varying levels of professionalism among medical staff and onerous healthcare procedures present challenges in seeking healthcare services. Within the housing domain, feeling safe and secure in housing settings is essential for intimate relationships without fear of discrimination. Non-housing intimate spaces serve as alternatives for fostering intimacy. However, access to stable housing depends on accepting family members and adequate income, making many vulnerable to family prejudice and rejection. Discrimination within government housing programs further limits housing support for sexual and gender identity minority individuals.\u003c/p\u003e \u003cp\u003eIn public spaces, the increased visibility of sexual and gender identity minority individuals is a positive change, attributed to the efforts of NGOs and individuals coming out. Yet, transportation access remains a significant barrier, particularly for the trans community, due to discrimination in public transportation and boat transportation. Concerns about sexual assault in public spaces further compound the challenges faced by sexual and gender identity minority individuals. In the socio-political domain, positive changes include government support and the essential role of NGOs in advancing education and awareness. However, the influence of broadcast media, particularly through music and radio personalities, presents a major challenge. The government\u0026rsquo;s lack of active support and limited initiatives for the LGBTQ\u0026thinsp;+\u0026thinsp;community further hinder progress in creating social change.\u003c/p\u003e \u003cp\u003eOf particular interest is the trans community exclusion from educational and workspaces. The trans community remains heavily stigmatized in Guyana, and our discussions revealed a level of consistent, exclusionary prejudice resulting in trans persons being forced out of the educational system and the employment system. The finding that trans persons are ostracized from family, formal education, workspaces and transportation access highlights the effective omission of this community from basic rights. This is especially concerning when it occurs in the medical community. The data suggests that the most vulnerable individuals in the sexual and gender identity minority community are a good starting point for building inclusion from the ground up to everyone (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite being socially and economically disadvantaged, the sexual and gender identity minority community, especially the trans community, could only access housing, intimacy and safe transportation through costly alternatives. These costly alternatives were living in high-income neighborhoods, using hotels for intimate experiences, supporting their intimate partners, and using taxis for safe transportation. This social tax on safety is a potential violation of human rights through the so-called poverty penalty where the poor often end up paying more for access to goods and services (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAltogether, sexual and gender identity minority individuals in Guyana exhibit resilience and strength in the face of various challenges across multiple domains. These findings underscore the need for comprehensive support and intervention strategies to address the negative aspects while capitalizing on the positive aspects to enhance the well-being and acceptance of sexual and gender identity minority individuals. Indeed, our findings confirmed those of other recent research on the experiences of the sexual and gender identity minority community in Guyana, specifically, that healthcare providers require more trauma-informed and sexual and gender identity minority-centered training to adequately address the needs of the community (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) and that stigma and discrimination remain rampant in the lives of the sexual and gender identity minority community (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). This was especially important in the mental health domain that remains taboo in a society in which medical providers still require training to understand the concept of complex trauma, developmental trauma, and historical trauma (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAs the focus groups uncovered, there are significant needs remaining in Guyanese society to promote equity and inclusion. This includes the government aligning its legal framework (Georgetown University Law Institute, 2018) with international standards to reduce barriers to basic needs and rights such as access to affordable and safe housing, transportation, healthcare, and social spaces. Collaborative initiatives involving both governmental and civil society organizations can play a vital role in dismantling the barriers that hinder social parity and advancing the rights and well-being of sexual and gender identity minorities in Guyana.\u003c/p\u003e \u003cp\u003eSome of these initiatives can include collaborations with LGBTQ\u0026thinsp;+\u0026thinsp;advocacy groups to draft and pass comprehensive anti-discrimination laws that protect the rights of sexual and gender identity minorities. This legislation should encompass areas such as employment, housing, healthcare, and public services to ensure equal treatment and opportunities. They can also include creating safe, affordable, and LGBTQ\u0026thinsp;+\u0026thinsp;friendly housing options for individuals facing discrimination in their homes or the larger society. Government funding and support from experienced housing assistance NGOs can be integral to this effort. Additionally, Public Awareness Campaigns aim to combat stigma, educate the public about the experiences of LGBTQ\u0026thinsp;+\u0026thinsp;individuals, and promote acceptance of diverse sexual and gender identities. Critically, given the lack of research with sexual and gender minority populations, organizations can engage in cooperative research projects to collect data and insights into the specific needs and challenges faced by sexual and gender identity minorities. This collaborative research can inform evidence-based policies and interventions, ensuring that they are tailored to the unique experiences of LGBTQ\u0026thinsp;+\u0026thinsp;communities in Guyana.\u003c/p\u003e \u003cp\u003eAlthough this qualitative study focused on obtaining experiential challenges and traumas that the sexual and gender identity minority community experiences in their everyday life in Guyana, our recruitment methods were affected by COVID-19, limiting our ability to recruit participants from more rural parts of the country. As a result, the experiences, and perspectives of rural village sexual and gender identity minority residents, who may face unique challenges related to race, religion, and acceptance, remain to be fully understood. This limitation in participant diversity underscores the need for caution when interpreting the findings, as they may not capture the full spectrum of experiences within the broader sexual and gender identity minority community in Guyana. This highlights the urgency for additional research that focuses specifically on the rural sexual and gender identity minority community. Future studies should aim to explore the nuanced intersections of identity, race, religion, and geographic location to gain a more comprehensive understanding of the challenges and strengths of sexual and gender identity minority individuals residing in rural areas. Such research is vital for developing tailored interventions and support mechanisms that address the distinct needs of these communities and promote inclusivity on a broader scale.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDespite strides towards wider acceptance in Guyanese society, sexual and gender identity minority individuals in Guyana remain marginalized due to enduring colonial-era laws and cultural biases, impacting their access to housing, healthcare, and employment. However, the resilience and productivity of this community, fortified by NGO support and previous government initiatives, underscore their ability to navigate centuries-old societal norms. Yet, achieving true social parity demands further concerted efforts. To foster social equity, collaborative endeavors involving both governmental bodies and civil society organizations are pivotal. These initiatives must aim to dismantle the persistent barriers hindering the rights and well-being of sexual and gender identity minorities in Guyana.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ministry of Health, Guyana, internal review board (IRB) Protocol #095/2023. All participants gave informed consent to participate in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article and its supplementary information files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGAK conceptualized the project. GAK and collected, curated, transcribed and coded data. GAK and DJ oversaw formal analysis for the manuscript. GAK and DJ contributed equally to the writing of the manuscript. All authors read and approved of the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFredriksen Goldsen K, de Vries B. Global aging with pride: International perspectives on LGBT aging. Int J Aging Hum Dev. 2019;88(4):315\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoagi MM, van Der Wath AE, Jiyane PM, Rikhotso RS. Mental health challenges of lesbian, gay, bisexual and transgender people: An integrated literature review. Health SA Gesondheid. 2021;26(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGroh CJ, Anthony M, Gash J. The aftermath of suicide: a qualitative study with Guyanese families. 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Transgender social inclusion and equality: a pivotal path to development. J Int AIDS Soc. 2016;19:20803.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuti\u0026eacute;rrez-Nieto B, Serrano-Cinca C, Cu\u0026eacute;llar-Fern\u0026aacute;ndez B, Fuertes-Call\u0026eacute;n Y. The poverty penalty and microcredit. Soc Indic Res. 2017;133:455\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoventry PA, Meader N, Melton H, Temple M, Dale H, Wright K, Cloitre M, Karatzias T, Bisson J, Roberts NP, Brown JV. Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis. PLoS Med. 2020;17(8):e1003262.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"sexual and gender identity minority, Guyana, LGBTQ+, wellbeing, qualitative","lastPublishedDoi":"10.21203/rs.3.rs-4114297/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4114297/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eWhile there have been notable improvements in the social conditions of sexual and gender identity minority individuals in Guyana, recent research has identified the persistence of structural heterosexism and discrimination, including the reluctance of the Guyanese government to repeal colonial-era \u0026ldquo;anti-gay\u0026rdquo; laws that govern sexual behavior. In this qualitative study, we employed a theoretical framework integrating the Social Determinants of Health, Well-being Domains Theory, and Intersectional Minority Stress Theory to explore the positive and negative experiences of individuals from sexual and gender identity minority groups residing in Guyana.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eFour focus groups were convened that included adult non-heterosexual men, women and transgender persons (Total N\u0026thinsp;=\u0026thinsp;45). The focus groups prompted discussions about participants\u0026rsquo; experiences in various life domains, including social, interpersonal, vocational, healthcare, housing, public spaces, socio-political contexts, significant life events, and personal successes. We used thematic analysis to identify recurring patterns and themes in the participants\u0026rsquo; discussions, providing a structured framework for understanding and interpreting their experiences in the specified life domains.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eMajor positive themes included non-governmental organization support, family acceptance and healthy habit adoption to cope with stress. Negative themes included transportation inaccessibility, job discrimination, and lack of governmental support.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe Guyanese sexual and gender identity minority community is resilient and productive, despite enduring centuries-old social norms in Guyana that ostracize them. They have developed community resilience through the support of NGOs and past government initiatives, yet there remains a significant need for further efforts to achieve social parity. Collaborative initiatives involving both governmental and civil society organizations can play a vital role in dismantling the barriers.\u003c/p\u003e","manuscriptTitle":"Unveiling the Lived Experiences of Sexual and Gender Diverse Individuals in Guyana: A Qualitative Investigation into Wellbeing","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-29 09:17:49","doi":"10.21203/rs.3.rs-4114297/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-03-27T12:17:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-26T13:40:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-26T13:40:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2024-03-16T18:01:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e4cd01bd-9eb0-4a87-81e7-de5e9aefc3ec","owner":[],"postedDate":"March 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-06T14:10:05+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-29 09:17:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4114297","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4114297","identity":"rs-4114297","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}