Photovoice as contributing to resiliency among trans women experiencing individual and intersecting HIV and anti-trans stigma in madhesh province, Nepal

Trans women in low-income countries face high risk for HIV and poor care outcomes, often due to pervasive anti-trans and HIV-related stigma. We implemented a Photovoice intervention to explore how intersecting forms of stigma shape the lives of trans women in one of the Terai districts of Nepal and to examine how participation in the project influenced social support and community connectedness. Using a participatory mixed-methods design, fourteen trans women participated in two Photovoice workshops, completed pre- and post-intervention surveys, and engaged in photo documentation, journaling, group discussion, and interviews. Participants described experiences of internalised and familial stigma, economic exclusion, diminished family support, and social marginalisation, with photographs illustrating how stigma influenced daily life, livelihood, mobility and well-being. Following the intervention, most participants reported greater community connectedness, defined as increased feelings of interpersonal connection, emotional support, and engagement with other trans women and peer networks. These changes were reflected in participants reporting greater outreach to peers, increased emotional openness, and stronger support from relationships developed during the project. Photovoice effectively fostered social support and collective resilience, highlighting the need for structural interventions to improve HIV prevention, treatment, and wellbeing outcomes.