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Background PrEP uptake is low among non-Belgian men and transwomen who have sex with men, although the HIV epidemic among men who have sex with men in Belgium is diversifying in terms of nationalities and ethnicity. We lack an in-depth understanding of this gap. Methods We conducted a qualitative study using a grounded theory approach. The data consists of key informants interviews and in-depth interviews with migrant men or transwomen who have sex with men. Results We identified four underlying determinants which shape our participants’ experiences and contextualize the barriers to PrEP use. These include (1) the intersectional identities of being migrant and men and transwomen who have sex with men, (2) migration related stressors, (3) mental health and (4) socio-economic vulnerability. Identified barriers include: the accessibility of services; availability of information, social resources and providers’ attitudes. These barriers influence PrEP acceptance and mediated by indivudal agency this influences their PrEP uptake. Conclusion An interplay of several underlying determinants and barriers impacts on PrEP uptake among migrant men and transwomen who have sex with men, illustrating a social gradient in access to PrEP. We need equitable access to the full spectrum of HIV prevention and care for all priority populations, including undocumented migrants. We recommend social and structural conditions that foster exercising these rights, including adapting PrEP service delivery, mental health and social support.

Introduction:The continuum of maternal care along antenatal (ANC), intrapartum, and postnatal care (PNC) is fundamental for protecting women’s and newborns’ health. The COVID-19 pandemic and accompanying mitigation measures interrupted the provision and use of these essential services globally. This study examines maternal healthcare utilisation along the continuum during the COVID-19 pandemic in the Democratic Republic of the Congo, and explores factors associated with use of the full continuum.Methods:This is a cross-sectional study using data collected on a survey of 599 households in Lubumbashi using stratified random sampling. We included 604 women (15-49 years) who were pregnant between March 2020-May 2021. A structured interview involved questions on sociodemographic characteristics, attitudes regarding COVID-19, and maternal service use and cost. Complete continuum of care was defined as receiving ANC 4+ consultations, skilled birth attendance, and at least one PNC check for both mother and newborn. Data were analysed in SPSS using descriptive statistics and multivariable logistic regression.Results:Of the women who gave birth during the COVID-19 pandemic, 61% had ANC 4+ consultations, most had a skilled birth attendant (97%), and more than half (55%) had a PNC check for themselves and the newborn. One-third (36%) of women completed the continuum of maternal healthcare. Factors significantly associated with completing the continuum included higher education (aOR=2.6; p-valueConclusion:During the COVID-19 pandemic, maternal healthcare seeking behaviours were shaped by vaccine hesitancy and care unaffordability in Lubumbashi. By disproportionately affecting women and vulnerable populations, the pandemic could exacerbate pre-existing structural barriers to maternal healthcare utilisation. Addressing the high cost of maternal healthcare and vaccine hesitancy appear essential to avoid deepening pre-existing socio-economic inequalities.