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

Deepika Ganju,Niranjan Saggurti

doi:10.1080/13691058.2016.1271141

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.

Highlights

Transgender persons, whose gender identity or expression differs from their biological sex, are amongst the population groups most affected by HIV
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 nonconforming persons; lack of community support; police harassment; health provider discrimination and the sex work environment create a context for HIV vulnerability
Micro experiences of felt and internalised stigma were associated with psycho-social distress and low self-efficacy to challenge abuse and negotiate condom use

Summary

Introduction

Transgender persons, whose gender identity or expression differs from their biological sex, are amongst the population groups most affected by HIV. Physical and sexual violence is associated with inconsistent condom use, and increased HIV/sexually transmitted infection (STI) vulnerability among sex workers (Beattie et al 2010), while stigma is linked to adverse mental and physical health outcomes, and housing, healthcare and employment inequities among transgender persons (White Hughto, Reisner, and Pachankis 2015). Among transgender persons and other marginalised communities, multiple stigmas intersect with socio-structural inequities (Logie et al 2011), increasing vulnerability to violence, HIV and negative health outcomes (Baral et al 2013; Bockting et al 2013; Poteat et al 2015; Sugano, Nemoto, and Operario 2006)

Methods

Results

Discussion

Conclusion