Provider discrimination and structural barriers to sexual and reproductive health services among LGBTQI + youth across 14 countries in Eastern Europe and Central Asia: A cross-national survey
- 1Correspondence to: ECOM – Eurasian Coalition on Health, Rights, Gender and Sexual Diversity, Tööstuse tn 48, Tallinn 10416, Estonia.
Abstract
Background: LGBTQI + youth in Eastern Europe and Central Asia (EECA) face intersecting barriers to sexual and reproductive health and rights (SRHR), yet multi-country evidence on their patterning and predictors is scarce. We examine SRHR barriers, provider discrimination, and their structural predictors across 14 EECA countries. Methods: We analysed a cross-sectional online survey of 1023 LGBTQI + youth aged 18–28 recruited via non-probability snowball sampling in 14 EECA countries (June–December 2024). Three primary outcomes — provider discrimination, service refusal, and past-year STI testing — were modelled with modified Poisson and logistic regression with country fixed effects. Adjusted prevalence ratios (aPRs) are the primary effect measure. Estimates are not nationally representative. Findings: Overall, 49.0% reported provider discrimination and 16.4% service refusal because of their LGBTQI + identity; among 428 giving a definitive response, 68.7% found gender-affirming care “not easy.” After adjustment, transgender men (aPR 2.05, 95% CI 1.67–2.51) and transgender women (1.79, 1.43–2.23) faced more discrimination than cisgender men, with service-refusal aPRs of 3.94 (2.47–6.29) and 3.30 (2.02–5.37). STI testing was lower with rural residence (0.61, 0.43–0.85), higher with income (1.16 per step, 1.10–1.21), and lower among cisgender women, transgender women, and non-binary respondents. Interpretation: Discrimination concentrated among transgender people after adjustment for country, income, and location, consistent with a health-workforce accountability failure, whereas preventive-service use reflected structural barriers and a gender-targeting effect — mechanisms requiring differentiated responses. A 50-percentage-point gap between PrEP awareness (57.6%) and use (7.2%) signals limited HIV prevention reach among cisgender women and non-binary respondents.
Related
- What are structural barriers and facilitators to accessing habilitation or rehabilitation among children with cerebral palsy in low- and middle-income countries? A scoping review.
- Barriers to Effective Type 2 Diabetes Care in a Conflict-Affected Region of Syria: A Qualitative Study of Health Care Provider Perspectives
- A decade of implementing comprehensive child development services in Northwest Iran: a qualitative study of provider perspectives on barriers and facilitators
- Community and healthcare provider perspectives on HIV- and COVID-19–related stigma, fear and health-seeking barriers among pregnant and breastfeeding women in Uganda
- Barriers to substance use disorder treatment among Asian Americans in New York City: A qualitative study of provider perspectives
BibTeX
@article{batyr2026provider,
title = {{Provider discrimination and structural barriers to sexual and reproductive health services among LGBTQI + youth across 14 countries in Eastern Europe and Central Asia: A cross-national survey}},
author = {Uluk Batyr},
journal = {SSM - Health Systems},
year = {2026},
month = nov,
doi = {10.1016/j.ssmhs.2026.100335},
url = {https://doi.org/10.1016/j.ssmhs.2026.100335},
note = {CC BY},
}
RIS
TY - JOUR
TI - Provider discrimination and structural barriers to sexual and reproductive health services among LGBTQI + youth across 14 countries in Eastern Europe and Central Asia: A cross-national survey
AU - Uluk Batyr
PY - 2026
DA - 2026/11/07
JO - SSM - Health Systems
DO - 10.1016/j.ssmhs.2026.100335
UR - https://doi.org/10.1016/j.ssmhs.2026.100335
AB - Background: LGBTQI + youth in Eastern Europe and Central Asia (EECA) face intersecting barriers to sexual and reproductive health and rights (SRHR), yet multi-country evidence on their patterning and predictors is scarce. We examine SRHR barriers, provider discrimination, and their structural predictors across 14 EECA countries. Methods: We analysed a cross-sectional online survey of 1023 LGBTQI + youth aged 18–28 recruited via non-probability snowball sampling in 14 EECA countries (June–December 2024). Three primary outcomes — provider discrimination, service refusal, and past-year STI testing — were modelled with modified Poisson and logistic regression with country fixed effects. Adjusted prevalence ratios (aPRs) are the primary effect measure. Estimates are not nationally representative. Findings: Overall, 49.0% reported provider discrimination and 16.4% service refusal because of their LGBTQI + identity; among 428 giving a definitive response, 68.7% found gender-affirming care “not easy.” After adjustment, transgender men (aPR 2.05, 95% CI 1.67–2.51) and transgender women (1.79, 1.43–2.23) faced more discrimination than cisgender men, with service-refusal aPRs of 3.94 (2.47–6.29) and 3.30 (2.02–5.37). STI testing was lower with rural residence (0.61, 0.43–0.85), higher with income (1.16 per step, 1.10–1.21), and lower among cisgender women, transgender women, and non-binary respondents. Interpretation: Discrimination concentrated among transgender people after adjustment for country, income, and location, consistent with a health-workforce accountability failure, whereas preventive-service use reflected structural barriers and a gender-targeting effect — mechanisms requiring differentiated responses. A 50-percentage-point gap between PrEP awareness (57.6%) and use (7.2%) signals limited HIV prevention reach among cisgender women and non-binary respondents.
SN - 2949-8562
ER -