Exposure to gender-based violence and depressive symptoms among transgender women in Cambodia: findings from the National Integrated Biological and Behavioral Survey 2016

Abstract

BackgroundTransgender women are at significant risk of HIV, and they face intersecting barriers to health, social, and legal services. However, data regarding the unique needs and experiences of transgender women are globally scant. This study examined the relationship between gender-based violence and depressive symptoms among transgender women in Cambodia.MethodsThis cross-sectional study included 1375 sexually active transgender women recruited by using the respondent-driven sampling method in the capital city of Phnom Penh and 12 provinces between December 2015 and February 2016. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale (CES-D). Multivariate regression analysis was conducted to explore factors independently associated with depressive symptoms.ResultsOf total, 45.0% of the participants had depressive symptoms, and 21.8% had severe depressive symptoms. After controlling for potential confounders, transgender women with depressive symptoms remained significantly more likely to report several negative experiences of gender-based violence such as a feeling that co-workers or classmates were not supportive regarding their transgender identity (AOR = 2.00, 95% CI = 1.22–3.28), having difficulties in getting a job (AOR = 1.67, 95% CI = 1.29–2.16), having been denied or thrown out of housing (AOR = 1.53, 95% CI = 1.02–2.26), having difficulties in getting health services (AOR = 2.40, 95% CI = 1.50–3.82), having been physically abused (AOR = 1.54, 95% CI = 1.15–2.08), and having been fearful of being arrested by police or authorities (AOR = 2.18, 95% CI = 1.64–2.91) because of their transgender identity. Regarding their childhood experiences, transgender women with depressive symptoms remained significantly more likely to report that someone had tried to touch them or make them touch in a sexual way when they were growing up (AOR = 2.08, 95% CI = 1.61–2.68).ConclusionsTransgender women in Cambodia experience high levels of gender-based violence and depressive symptoms. To address these concerns, a combination of service and policy interventions are required. These may include training and sensitization of trained and lay health providers in screening for depressive symptoms and integration of mental health services into facility- and community-based HIV services with enforcement of policies and laws that protect the rights of transgender women against gender-based violence.

HIV risks and recent HIV testing among transgender women in Cambodia: Findings from a national survey

“…Our previous studies showed that transgender women in Cambodia also experience other issues in their daily life. They include gender-based violence, social stigma, and discrimination in different settings, substance abuse, social marginalization, and subsequent mental health problems [8,19,20]. These issues may create significant barriers to receiving regular HIV testing and early treatment.…”

“…This means transgender women were about 49 times more likely to be infected with HIV than the general adult population [ 2 ]. In addition, transgender women face many health and non-health issues, including poor sexual and reproductive health, barriers in accessing health services due to stigma and discrimination, mental health problems, limited social support, and limited employment opportunities [ 5 – 8 ]. To address these concerns, urgent interventions have been suggested for HIV prevention and linkage to care and treatment services for transgender women globally [ 7 , 9 ].…”

Access to community-based HIV services among transgender women in Cambodia: findings from a national survey

“…Transgender women experience multiple, intersecting socio-structural risks that increase their vulnerability to HIV, including stigma and discrimination, gender-based violence, lack of social and legal recognition of their affirmed gender, and exclusion from employment and educational opportunities [3, 4]. These situations may expose them to subsequent mental health problems or vice versa [5–7]. Among transgender women living with HIV, these systems of oppression can seriously compromise their sustained access to life-saving treatment and care [3, 8].…”

Sexual behavior stigma and depression among transgender women and cisgender men who have sex with men in Côte d'Ivoire

“…Enacted, perceived, and anticipated sexual behavior stigmas were common and greater exposure to stigma accounted for the observed inequality in depression between TGW and cisMSM. Associations between stigma and depression among TGW are well-established (9,14,17,36). However, there are few studies that include both cisgender comparison groups as well as stigma measures (39), traditionally precluding tests of the hypothesis that stigma mediates mental health inequalities (40).…”

“…Minority stress theory posits that stigma potentiates depression and other negative mental health outcomes among sexual and gender minorities (11)(12)(13). Indeed, associations between stigma and psychological distress or depression have been established among TGW and cisMSM in a number of countries (9,(14)(15)(16)(17).…”