Abstract
IntroductionDiscrimination related to gender identity may directly influence vulnerability to HIV through increased exposure to unprotected receptive anal intercourse (URAI). Little is known about the relationship between gender-based discrimination (GBD) and URAI with stable partners among transgender women.MethodsThis mixed-methods research began with a cross-sectional survey conducted between 2014 and 2016 with transgender women in Salvador, the capital city in one of the poorest regions in Brazil. Respondent-driven sampling was used to recruit the study population. GBD was defined through Latent Class Analysis. Additionally, 19 semi-structured interviews with participants were transcribed and analyzed through thematic content analysis.ResultsURAI with stable partners was commonly reported (37.3%). GDB was positively associated with URAI among stable partners (OR = 6.47; IC 95%: 1.67–25.02). The analysis of the interviews illustrated how GBD impacted transgender women in diverse ways. Experiences with GBD perpetrated by the family often initiated a trajectory of economic vulnerability that led many to engage in survival sex work. The constant experience with GBD contributed to participants feeling an immense sense of trust with their stable partners, ultimately diminished their desire to use condoms. Further, the high frequency of GBD contributed to poor mental health overall, though some participants said engagement in transgender advocacy efforts provided a vital source of resilience and support.ConclusionOur mixed-method study capitalizes upon the strengths of diverse data sets to produce a holistic understanding of GBD and URAI with stable partners. Furthermore, by confirming the association between greater GBD and URAI, we have demonstrated how GBD can impact condom negotiation in diverse relationships.
Highlights
Discrimination related to gender identity may directly influence vulnerability to HIV through increased exposure to unprotected receptive anal intercourse (URAI)
To date, the relationship between discrimination and URAI with stable partners remains unclear [7,13,29]. In response to this knowledge gap, we examined the empirical association between gender-based discrimination (GBD) and URAI with stable partners and explored their experiences of discrimination from life histories in the largest city of Northeastern Brazil
The mixed-methods data show that GBD is a complex phenomenon in Brazilian society: the quantitative data showed that it can influence the use of condoms in sex with stable sexual partners, and the qualitative data suggested that the trust that transgender women (TGW) feel for their stable partners can increase their willingness to have sex without a condom
Summary
This mixed-methods research began with a cross-sectional survey conducted between 2014 and 2016 with transgender women in Salvador, the capital city in one of the poorest regions in Brazil. Though fluid and dependent on context, Lionco [31] argues that travestis and transsexual women "are subjectively constituted as a person with a gender that does not correspond to their sex assign at birth". Both terms relay differing levels of performance as a woman and claim the legitimacy of their identity beyond the binary parameters of masculine and feminine, adequacy of their physical image and their bodies using hormone therapy and silicone, desiring to be treated in the feminine and by the name with which they identified. To acknowledge the Brazilian context, we use the term travestis and transsexual women (TrTW) in this article to reference our study participants and use TGW to refer to transgender women more broadly in the international literature
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