Funding for this research was provided by:
Received: 11 June 2020
Accepted: 21 January 2021
First Online: 15 February 2021
Ethics approval and consent to participate
: The study was approved by the Human Research Ethics Committee of the University of Cape Town’s Faculty of Health Sciences (HREC 012/2016) as well as by the following national regulatory bodies: Ethics Unit, Office of Research and Development, University of Botswana (UBR/RES/IRB/BIO/009); Health Research and Development Division, Ministry of Health and Wellness, Republic of Botswana (HPDME: 13/18/1); Scientific and Ethics Committee, Ministry of Health and Social Welfare, Kingdom of Swaziland (no ref. number); Kenya Medical Research Institute (KEMRI/RES/7/3/1); Research and Ethics Committee, Ministry of Health, Lesotho (ID94–2017); University of Malawi, College of Medicine Research and Ethics Committee (P.01/18/2330); and the Medical Research Council of Zimbabwe (MRCZ/A/2303). Same-sex sexuality and visible gender non-conformity are criminalised in most of the study countries, and identifying/ being identified as a sexual and/or gender minority can carry significant risks of stigma, discrimination or violence. Therefore, we had to carefully consider the risks associated with participating in our study, specifically around the potential disclosure of sexual orientation or gender identity to third parties outside the study team. In order to maintain full anonymity for participants throughout the data collection process, participants were not asked to sign their name for written informed consent. This ensured that, should any of the questionnaires or other study documentation fall into the hands of state authorities or others, individual participants could not be identified. Instead, all participants provided written informed consent by ticking a box on an informed consent statement. This procedure was approved as part of our study protocol by the ethics and regulatory bodies we have listed.
: Not applicable.
: The authors declare that they have no competing interests.