Context, Types, and Consequences of Violence Across the Life Course: A Qualitative Study of the Lived Experiences of Transgender Women Living With HIV

Abstract

<jats:p> Violence is a known driver of HIV vulnerability among transgender (trans) women, who are disproportionately impacted by HIV globally. Violence is also a barrier to accessing HIV prevention, treatment, and support. Yet, little is known about the everyday experiences of violence faced by trans women living with HIV, who live at the intersection of a marginalized gender identity and physical health condition. To address this gap, this study draws on semi-structured, individual interviews conducted 2017–2018 with a purposive sample (selected based on diverse identities) of trans women living with HIV ( n = 11) participating in a large, community-based cohort study in three Canadian provinces. Framework analysis was used to identify key themes, patterns within themes between participants, and patterns across themes among participants. Findings showed that trans women living with HIV experience specific contexts of violence shaped at the intersection of stigma based on gender identity, gender expression, and HIV status, among other identities/experiences. Violence experienced in childhood (e.g., familial rejection, bullying) increased trans women’s likelihood of being exposed to a violent social context in young adulthood (e.g., state violence perpetuated by the police, interpersonal violence perpetuated by sexual partners, and community violence perpetuated by society-at-large/the general public), which increased trans women’s HIV vulnerability; once living with HIV trans women were subjected to discursive violence from healthcare providers. These multiple forms of violence have serious consequences for trans women living with HIV’s ongoing social, mental, and physical well-being. The findings suggest that interventions are urgently needed to reduce violence against trans women in childhood and young adulthood, in addition to reducing violence against trans women living with HIV perpetuated by healthcare providers in adulthood, to both proactively and responsively promote their safety, health, and well-being. </jats:p>

Brief Report: Role of Gender-Affirming Hormonal Care in HIV Care Continuum Outcomes When Comparing Transgender Women With Cisgender Sexual Minority Men

“…[39][40][41][42][43] Transwomen also had higher rates of mental health diagnoses, which are well-documented and attributed to the effects of minority stress, socioeconomic disparities, violence, family rejection, and gender dysphoria. 14,42,[44][45][46][47][48][49][50][51][52][53] Mental health diagnoses have also been identified as a barrier to successful treatment of HIV. 42,54 Furthermore, transwomen had significantly more SUD diagnoses than cis-SMM.…”

Race, criminalization and urban mental health in the United States

“…Since 2020, several studies have documented associations between personal encounters with the police and negative mental health outcomes in multiple populations (Table 3) [29,33,38,61–64,65 ▪▪ ,66–70,71 ▪ ,72,73 ▪▪ ]. Remch et al [65 ▪▪ ] found that in a longitudinal cohort of Black MSM ( n = 1155), those who experienced police harassment in the past 6 months had a 1.63 (95% CI 1.32–2.02) times higher rate of psychological distress, but not a higher rate of depressive symptoms.…”

A Qualitative Inquiry of Associations Between Family Environment and Suicidality for Transgender Youth Experiencing Homelessness

“…Research with transgender women living with HIV found that when trans participants had to leave home because of family violence, which was often driven by transphobia, they were then unable to find employment because of transphobic discrimination, which ultimately led to homelessness and engagement in sex work (Lacombe-Duncan & Olawale, 2022). Homelessness and engagement in sex work then increased these women's vulnerability to police violence and HIV (Lacombe-Duncan & Olawale, 2022). In one study comparing healthcare outcomes and access for transgender and cisgender adolescents who had run away from home, transgender adolescents reported worse overall health, were more likely to have forgone needed medical care, and received less helpful care from medical providers than their cisgender peers (M. Ferguson et al, 2022).…”