Stigma, violence and HIV vulnerability among transgender persons in sex work in Maharashtra, India

Abstract

Among marginalised groups in India, HIV prevalence is highest among transgender persons; however, little is known about their HIV vulnerability. This study describes transgender sex workers’ experiences of stigma and violence, a key driver of the HIV epidemic, and explores their coping responses. In-depth interviews were conducted with 68 respondents in Maharashtra state, India. Findings show that respondents face pervasive stigma and violence due to multiple marginalised social identities (transgender status, sex work, gender non-conformity), which reinforce and intersect with social inequities (economic and housing insecurity, employment discrimination, poverty), fuelling HIV vulnerability at the micro, meso and macro levels. Several factors, such as felt and internalised stigma associated with psycho-social distress and low self-efficacy to challenge abuse and negotiate condom use; clients’ power in sexual transactions; establishing trust in regular partnerships through condomless sex; norms condoning violence against gender non-conforming persons; lack of community support; police harassment; health provider discrimination and the sex work environment create a context for HIV vulnerability. In the face of such adversity, respondents adopt coping strategies to shift power relations and mobilise against abuse. Community mobilisation interventions, as discussed in the paper, offer a promising vulnerability reduction strategy to safeguard transgender sex workers’ rights and reduce HIV vulnerability.

Following the divine: an ethnographic study of structural violence among transgender jogappas in South India

“…Globally, transgender women suffer a disproportionate burden of HIV infection (Baral et al 2013). Although the last decade has seen a flurry of public health attention placed on the sexual health of transgender people in India, with respect to HIV there is a dearth of studies concerned with the overlapping social oppressions that underlie their vulnerability (for notable exception see Ganju and Saggurti 2017). Chakrapani et al (2007), however, illuminate the interlocking forms of structural violence encountered by kothis (feminine-acting men who have sex with men), showing how discriminatory practices may occur beyond the awareness of individuals, emerging at the level of social institutions such as the family, the community and the health and legal system.…”

“…Although transgender people occupy an important focus in recent parliamentary arenas, popular news media and public health discourse throughout South Asia (Hossain 2017;Khan 2017;Ganju and Saggurti 2017), scholars have long attempted to represent the lived realities of transgender people in this region, especially 'male bodied' hijra as 'one of the most iconic and popular examples of this so-called third gender' (Hossain 2017(Hossain , 1419; also see Nanda 1990). This rich body of scholarship raises important questions about how the 'third gender' has come to be reified in contemporary political and legal discourse (Hossain 2017).…”

Transexual “Womanhood” and the Emergence of Transfeminism: Rhetorics of Hiv/Aids in the Light of the Queer Theory

“…It can be seen that the overlapping of marginalized social identities of transgender women, who are sex workers, together with social inequalities (lack of housing, employment, poverty and prejudice) are factors that contribute to vulnerability to HIV / AIDS. [20][21][22] It is emphasized that sometimes the fetishization related to the bodies of transsexual women results in a vulnerability to HIV/AIDS, since these are considered products of sexual commercialization. This context makes them susceptible to all types of violence.…”

“…This context makes them susceptible to all types of violence. 21 What confuses society and destabilizes normatization is the understanding of experiences, diversities, since subjective experiences do not address the coherence and continuity between sex, gender, desire and sexual practice. 6 It is known that the use of hormones in the transitioning process, can cause erectile dysfunction and increase the probability of the transsexual woman to assume a receptive role during sexual 9/13 intercourse, difficulties related to condom use negotiating are evident, which are usually a male decision.…”

Sex Trade and Health Care Utilization Among People Living with HIV/AIDS

“…Research has documented that those involved with sex trade are less likely to seek health care, or to disclose their sex trade involvement in the context of care, due to sex trade-related stigma [16,17]. For example, outside of the US, studies show that among male and female persons engaged in sex trade, those who perceive greater sex trade-related stigma are more likely to delay or to avoid non-HIV specific services, as well as HIV counseling and testing services [18,19]. However, less is known about the association between sex trade and health care utilization among PLWH in the US.…”