Sex work, discrimination, drug use and violence: a pattern for HIV risk among transgender sex workers compared to MSM sex workers and other MSM in Guatemala

ABSTRACT

The risk of HIV infection is higher among transgender women and cisgender men who have sex with men (MSM) compared to the general population due in part to social and contextual factors. This study aimed to determine the prevalence and association of alcohol and drug abuse, discrimination and violence among transgender sex workers compared to cisgender male sex workers and cisgender men who had not received money for sex in Guatemala City. In 2010, transgender women and cisgender men who had had sex with men or transgender women were recruited into a cross-sectional behavioural survey. Among transgender women, 86% received money for sex in the past year. Transgender sex workers were more likely to use drugs and binge drink, three times as likely to be discriminated against and eight times as likely to be forced to have sex compared to non-sex worker men. Male sex workers were twice as likely to use illicit drugs or experience physical violence and six times as likely to experience forced sex compared to non-sex worker men. Transgender and male sex workers would benefit from harm reduction for substance use, violence prevention, response and strategies to mitigate discrimination.

KEYWORDS:

• Transgender Persons
• MSM
• HIV
• gender-based violence

Acknowledgments

The authors thank institutions and venue owners involved in the implementation of this study. The authors recognise the contribution of the field staff and technical consultants: Berta Alvarez, Nelson Arambú, Flor de María Hernández, José Manuel Aguilar, Sabrina Boyce, Andres Alvarado, Sonia Morales Miranda, Jessica España, Norma Zúniga, César Galindo and Andrea Kim. The authors are also grateful for the two anonymous reviewers’ valuable comments that greatly improved the manuscript.

Data availability statement

The data are not available online or to the public. Data availability was not contemplated at the time the study was approved by ethics committees and funders. Given the stigma associated with transgender and sexual minorities in Guatemala, making the data public could exposure the participants to increased stigma and discrimination, especially for a small population such as transgender women in Guatemala City.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

William M. Miller http://orcid.org/0000-0002-4140-1797

Additional information

Funding

This study was carried out in collaboration with Tephinet Inc. and the HIV Unit of the Center of Health Studies from the Universidad del Valle de Guatemala and supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC), under the terms of Cooperative Agreements SD43GH000014-05 and GH0000575. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the U.S. Centers for Disease Control and Prevention.