Barriers and facilitators of post-violence help-seeking behavior among 21–49-year-old transgender women in Phnom Penh: A qualitative study

Abstract

Background: Transgender women are disproportionately affected by gender-based violence (GBV). However, little is known about how they respond to GBV.

Aims: This study aims to understand transgender women’s response to GBV and identify barriers and facilitators in accessing healthcare and legal aid after experiencing the violence.

Methods: We conducted a qualitative study between February to March 2020 in Phnom Penh, Cambodia. Data were collected through in-depth interviews with 20 transgender women aged between 21 and 49 who had experienced GBV or knew a peer who had experienced GBV. Thematic analysis was conducted for the coding process, and an inductive approach was used to develop a coding frame.

Results: All participants had experienced at least one form of GBV in their lifetime, and most participants had experienced multiple forms of GBV. However, most of them did not seek any services from healthcare providers, law enforcement officers, or assistance for healthcare and legal aid from non-governmental organizations (NGOs). Participants reported the following barriers to access to GBV services: anticipated stigma, the internalized stigma, which resulted in shame and low self-esteem, a lack of knowledge on NGOs’ services that can assist with healthcare and legal aid, the perception that mental health services were unavailable, a lack of social support, enacted stigma by the police, and the perceived healthcare cost. The participants reported social support and knowledge of NGOs’ services as facilitators of access to GBV service. Social media and NGO staff were reported to be preferred sources of information. Participants wanted more effective law enforcement services, comprehensive healthcare catered to the unique transgender women’s needs, and non-discriminating service providers.

Discussion: Interventions to address GBV and improve the health outcomes of transgender women should involve creating an enabling environment for help-seeking with the partnership between NGOs and different sectors and building social support.

Keywords:

• Asia
• Community violence
• gender minority
• healthcare access
• legal aid
• sexual assault
• transgender

Acknowledgements

The authors would like to thank the study participants for sharing their experiences and time with us. The authors would also like to thank the staff members of KHANA and KHANA’s implementing partners for their support in the study development and implementation.

Conflict of interests

The authors declare that they have no conflicts of interest.

Ethics approvals

The National Ethics Committee for Health Research (NECHR) of the Ministry of Health, Cambodia (015 NECHR) and the National University of Singapore Institutional Review Board (S-19-337) approved the study protocol and materials.

Informed consent

Verbal informed consent was obtained from all participants in the study.

Data availability

Data are available upon reasonable request. Data used for this study can be accessed upon request from the corresponding author (SY) at [email protected].

Additional information

Funding

Saw Swee Hock School of Public Health, National University of Singapore, supported this study as part of the first author’s Master of Public Health programme and through UHS-SSHSPH Integrated Research Programme (USIRP).