Logie Carmen H, Wang Ying, Lacombe-Duncan Ashley, Jones Nicolette, Ahmed Uzma, Levermore Kandasi, Neil Ava, Ellis Tyrone, Bryan Nicolette, Marshall Annecka, Newman Peter A
Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.
Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Canada.
J Int AIDS Soc. 2017 Apr 6;20(1):21422. doi: 10.7448/IAS.20.01/21422.
Transgender women are disproportionately impacted by HIV. Transgender women involved in sex work may experience exacerbated violence, social exclusion, and HIV vulnerabilities, in comparison with non-sex work-involved transgender women. Scant research has investigated sex work among transgender women in the Caribbean, including Jamaica, where transgender women report pervasive violence. The study objective was to examine factors associated with sex work involvement among transgender women in Jamaica.
In 2015, we implemented a cross-sectional survey using modified peer-driven recruitment with transgender women in Kingston and Ocho Rios, Jamaica, in collaboration with a local community-based AIDS service organization. We conducted multivariable logistic regression analyses to identify factors associated with paid sex and transactional sex. Exchanging oral, anal or vaginal sex for money only was categorized as paid sex. Exchanging sex for survival needs (food, accommodation, transportation), drugs or alcohol, or for money along with survival needs and/or drugs/alcohol, was categorized as transactional sex.
Among 137 transgender women (mean age: 24.0 [SD: 4.5]), two-thirds reported living in the Kingston area. Overall, 25.2% reported being HIV-positive. Approximately half (n = 71; 51.82%) reported any sex work involvement, this included sex in exchange for: money (n = 64; 47.06%); survival needs (n = 27; 19.85%); and drugs/alcohol (n = 6; 4.41%). In multivariable analyses, paid sex and transactional sex were both associated with: intrapersonal (depression), interpersonal (lower social support, forced sex, childhood sexual abuse, intimate partner violence, multiple partners/polyamory), and structural (transgender stigma, unemployment) factors. Participants reporting transactional sex also reported increased odds of incarceration perceived to be due to transgender identity, forced sex, homelessness, and lower resilience, in comparison with participants reporting no sex work involvement.
Findings reveal high HIV infection rates among transgender women in Jamaica. Sex work-involved participants experience social and structural drivers of HIV, including violence, stigma, and unemployment. Transgender women involved in transactional sex also experience high rates of incarceration, forced sex and homelessness in comparison with non-sex workers. Taken together, these findings suggest that social ecological factors elevate HIV exposure among sex work-involved transgender women in Jamaica. Findings can inform interventions to advance human rights and HIV prevention and care cascades with transgender women in Jamaica.
跨性别女性受艾滋病毒影响的比例过高。与未从事性工作的跨性别女性相比，从事性工作的跨性别女性可能会遭受更严重的暴力、社会排斥以及感染艾滋病毒的风险。在包括牙买加在内的加勒比地区，针对跨性别女性性工作的研究极少，而在牙买加，跨性别女性报告称普遍存在暴力现象。本研究的目的是调查牙买加跨性别女性中与从事性工作相关的因素。
2015年，我们与当地一个社区艾滋病服务组织合作，在牙买加金斯敦和奥乔里奥斯对跨性别女性实施了一项横断面调查，采用改良的同伴驱动招募方法。我们进行了多变量逻辑回归分析，以确定与有偿性行为和交易性行为相关的因素。仅以口交、肛交或阴道交换取金钱被归类为有偿性行为。为生存需求（食物、住所、交通）、毒品或酒精，或为金钱以及生存需求和/或毒品/酒精而进行性行为被归类为交易性行为。
在137名跨性别女性（平均年龄：24.0[标准差：4.5]）中，三分之二报告居住在金斯敦地区。总体而言，25.2%报告感染了艾滋病毒。约一半（n = 71；51.82%）报告有任何性工作经历，这包括以性行为换取：金钱（n = 64；47.06%）；生存需求（n = 27；19.85%）；以及毒品/酒精（n = 6；4.41%）。在多变量分析中，有偿性行为和交易性行为均与以下因素相关：个人因素（抑郁）、人际因素（社会支持较低、强迫性行为、童年性虐待、亲密伴侣暴力、多个伴侣/多配偶制）以及结构因素（跨性别歧视、失业）。与未从事性工作的参与者相比，报告有交易性行为的参与者因跨性别身份、强迫性行为、无家可归以及恢复力较低而被监禁的几率也更高。
研究结果显示牙买加跨性别女性的艾滋病毒感染率很高。从事性工作的参与者经历了艾滋病毒的社会和结构驱动因素，包括暴力、歧视和失业。与非性工作者相比，从事交易性行为的跨性别女性还面临着较高的监禁率、强迫性行为和无家可归率。综上所述，这些研究结果表明社会生态因素增加了牙买加从事性工作的跨性别女性感染艾滋病毒的风险。研究结果可为促进牙买加跨性别女性的人权以及艾滋病毒预防和护理级联反应的干预措施提供参考。
