Resum
Background: Transgender women experience gender-based violence (GBV) from an early age and face barriers to accessing services, resulting in poor health outcomes including the highest HIV prevalence of any key population. To inform HIV policies and services, trans women worked with LINKAGES (led by FHI 360, supported by USAID and PEPFAR), UNDP, and University of the West Indies to document GBV and transphobia in healthcare, education, and legal settings.
Methods: Trans women, trained as data collectors, conducted 74 structured interviews in El Salvador, Trinidad and Tobago, Barbados, and Haiti in 2016. We conducted qualitative applied thematic analysis to understand the nature and consequences of GBV and transphobia and descriptive quantitative analysis to identify the proportion who experienced GBV in each setting.
Results: A high proportion experienced GBV in education (85.1%), healthcare (82.9%), police/judicial system (80.0%), and other state institutions (66.1%). Emotional abuse was the most common in all settings; participants also experienced economic, physical, and sexual violence, and other human rights violations. Emotional abuse included gossiping, insults, and refusal to use their chosen name. At school, participants were physically threatened and assaulted, harassed in bathrooms, and denied education. In healthcare, participants were given lower priority and received substandard care. Healthcare workers and police blamed participants'' health and legal problems on them “because of the way I am” and denied them services. From police, participants also experienced physical and sexual assault, theft, extortion for sex or money, and arbitrary arrest and detention. Participants had difficulty obtaining and using identification cards and passports, sometimes being forced to alter their appearance or being denied an identification card. All violence was clearly linked to gender identity and expression.
Conclusions: These findings demonstrate a need for policies protecting trans women''s rights and interventions addressing GBV against trans women. Given that GBV increases HIV risk, decreases HIV treatment adherence, and prevents trans women from accessing health services, HIV service providers need training to provide nondiscriminatory services and screen for and address GBV among trans clients. Integrated interventions addressing both HIV and GBV could help reduce KPs'' burden of HIV, increase service utilization, and respect, promote and fulfill their human rights.
Autoria:
LANHAM, Michele;
RIDGEWAY, Kathleen;
DAYTON, Robyn;
CASTILLO, Britany M.;
BRENNAN, Claire;
DAVIS, Dirk A.;
EMMANUEL, Dadrina;
CHERIRISER, Clifford;
RODRÍGUEZ, Brandy;
MORALES, Giuliana J.;
PARKER, Caleb;
COOKE, Juana;
SANTI, Karin;
EVENS, Emily