Sexual health, transition-related risk behavior and need for health care among transgender sex workers

Abstract

Background: Research has shown that sexual risk behavior, as well as transition-related risk behavior, such as uncontrolled hormone use, auto-medication, and silicone injections, may lead to several adverse health outcomes for transgender persons. Transgender sex workers are a vulnerable group within the transgender population, who are at increased risk for these health risk behaviors. However, European research into this topic and risk population remains largely absent.

Aim: This study explores the prevalence of uncontrolled gender-affirming hormone use, silicone injections, and inconsistent condom use among transgender sex workers working in Antwerp, Belgium.

Methods: A descriptive analysis of a survey sample of 46 transgender sex workers, supplemented with nine in-depth interviews with transgender sex workers.

Results: This population of transgender sex workers has specific socio-demographic characteristics: they are all assigned male at birth, 83% identifies as female and 76% is from Latin-American descent, mainly from Ecuador. Transition-related and sexual risk behaviors are prevalent. Current uncontrolled hormone use rate is 32%, which should be seen in light of their work as well as their migration status. Inconsistent condom use with clients is reported by 33% of the sample. Of all participants, 65% has silicone injections in one or more parts of the body, and 43% of them cites health problems due to these injections.

Conclusion: The specific characteristics of this largely invisible but highly vulnerable population should be taken in account when addressing this population’s health risk behavior. Access to health care and social services should be ensured, and culturally tailored health interventions that take into account their social context as well as their gender identity should be developed.

Keywords:

• hormone use
• sex work
• sexual health
• silicone injections
• transgender
• risk behavior

Disclosure statement

No potential conflict of interest was reported by the authors.

Acknowledgments

The authors thank Cosmin Morari, Veerle Doossche, Caroline Mannaerts and Katleen Peleman of Ghapro, and Jasper Kerremans of Boysproject for their involvement in the data collection for this study. The study has been conducted in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki. Ethical approval for the study was obtained from the Ghent University Hospital Ethical Committee in Ghent, Belgium.