Mapping Multilevel Contributions to the Sexual Victimization of Trans Women and Trans Feminine People: A Qualitative Intersectional Stigma Analysis.

We aimed to characterize and conceptually organize multilevel factors associated with the sexual victimization experiences of trans women and trans feminine people to advance violence prevention interventions for health-equity. Between October 2020 and July 2021, we conducted in-depth interviews with 17 expert informants in New York City, which we transcribed, coded, and analyzed. Qualitative insights were derived through an intensive, team-based iterative coding strategy resulting in the development of an exhaustive set of consensus codes which were organized and interpreted in a multi-level structure. Findings revealed a complex constellation of intersecting macro- and micro-structural mechanisms reinforcing sexual violence. Unique characteristics of this violence were characterized hierarchically in terms of: 1) violence forms (e.g. murder, fetishization), 2) perpetrators (e. g. safety-staff; group assault), 3) contexts (e.g. public accommodations), 4) functions (e.g. gender policing), 5) ideological reinforcers (e.g. transphobia, racism), and 6) structural reinforcers (e.g. legislation; linking access to material means of survival to poverty/illness). Results indicate that acute incidents of sexual victimization are "the tip of the iceberg" of the violence impacting trans communities. The community experts we interviewed (e.g. trans women, violence prevention practitioners, social workers) understand chronic functional, ideological, and structural oppression as inextricable from sexual violence. Multi-level determinants of violence therefore constitute essential targets of sexual violence prevention intervention for this population.