Experiences of gender-based violence among female sex workers, men who have sex with men, and transgender women in Latin America and the Caribbean: a qualitative study to inform HIV programming

Abstract

Background Female sex workers, MSM, and transgender women—collectively referred to as key populations (KPs)—are disproportionately affected by gender-based violence (GBV) and HIV, yet little is known about the violence they face, its gender-based origins, and responses to GBV. The purpose of this study was to understand the nature and consequences of GBV experienced, to inform HIV policies and programming and to help protect KPs’ human rights. Methods Using a participatory approach, FSWs, MSM, and transgender women in Barbados, El Salvador, Trinidad and Tobago, and Haiti conducted 278 structured interviews with peers to understand their experiences of and responses to GBV. Responses to open-ended questions were coded in NVivo and analyzed using an applied thematic analysis. Results Nearly all participants experienced some form of GBV. Emotional and economic GBV were the most commonly reported but approximately three-quarters of participants reported sexual and physical GBV and other human rights violations. The most common settings for GBV were at home, locations where sex work took place such as brothels, bars and on the street; public spaces such as parks, streets and public transport, health care centers, police stations and—for transgender women and MSM—religious settings and schools. The most common perpetrators of violence included: family, friends, peers and neighbors, strangers, intimate partners, sex work clients and other sex workers, health care workers, police, religious leaders and teachers. Consequences included emotional, physical, and sexual trauma; lack of access to legal, health, and other social services; and loss of income, employment, housing, and educational opportunities. Though many participants disclosed experiences of GBV to friends, colleagues and family, they rarely sought services following violence. Furthermore, less than a quarter of participants believed that GBV put them at risk of HIV. Conclusions Our study found that across the four study countries, FSWs, MSM, and transgender women experienced GBV from state and non-state actors throughout their lives, and much of this violence was directly connected to rigid and harmful gender norms. Through coordinated interventions that address both HIV and GBV, this region has the opportunity to reduce the national burden of HIV while also promoting key populations’ human rights.

Epidemiological Findings of Alcohol Misuse and Dependence Symptoms among Adolescent Girls and Young Women Involved in High-Risk Sexual Behavior in Kampala, Uganda

“…The findings of the present study also showed that IPV was significantly associated with the alcohol misuse and dependence symptom outcomes. High-risk women generally experience high levels of IPV [ 29 ]. Acts of IPV remain unreported due to the criminalization of sex work in many parts of SSA [ 30 ]; disclosure rates are therefore low [ 31 ] and this undermines their ability to interact with society including community rehabilitation facilities where they could seek help.…”

Experiences and challenges of Prostitute Women in Iran: A phenomenological qualitative study

“…Ramaiah S 2006 and Weitzer R 2009 pointed out that prostituted women access to welfare, health care services, and the right to have healthy reproduction is compromised [ 37 , 38 ]. In other studies, women have pointed out that there is no proper help and support for women involved in prostitution [ 3 , 15 , 55 , 56 ]. In the study of Asadi-Aliabadi M et al., 2018 in Iran, the results showed that prostitutes are less likely to receive health services, and they are less inclined to perform medical tests and receive health care due to the restrictions and pressures on them [ 57 ].…”

“…Health problems such as fatigue, viral diseases, backache, depression, headaches, etc., are also very prominent in prostituted women, and they may even be killed [ 13 , 14 ]. Evans E et al., 2019 studied prostitutes in El Salvador and highlighted problems like emotional and economic violence, lack of access to legal, health social services, and loss of income, job, housing, and educational opportunities [ 15 ]. Duff P et al., 2017 showed in a study in Uganda that prostitutes had several health needs in pregnancy and HIV fields in particular and Unplanned pregnancy was one of the main issues [ 16 ].…”

Covid-19 and Gender in LMICs: Potential Lessons from HIV Pandemic

“…Women who are abused may not ask their partner to use a condom, nor have the efficacy to say no to sex if their abusive partner does not want to use protection, which will put abused women at a higher risk for HIV. Additionally, women who are transgender and are living with HIV are disproportionately impacted by intimate partner violence [24], stay at home COVID-19 orders could exacerbate their wellbeing.…”