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Factors associated with sex work involvement among transgender women in Jamaica: a cross-sectional study.
J Int AIDS Soc. 2017 04 06; 20(1):21422.JI

Abstract

INTRODUCTION

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Authors+Show Affiliations

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.Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.Jamaica AIDS Support for Life, Kingston, Jamaica.Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.Jamaica AIDS Support for Life, Kingston, Jamaica.Jamaica AIDS Support for Life, Kingston, Jamaica.Jamaica AIDS Support for Life, Kingston, Jamaica.Jamaica AIDS Support for Life, Kingston, Jamaica. Women's Empowerment for Change (WE-Change), Kingston, Jamaica.Institute for Gender and Development Studies, University of the West Indies, Mona Campus, Kingston, Jamaica.Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28406598

Citation

Logie, Carmen H., et al. "Factors Associated With Sex Work Involvement Among Transgender Women in Jamaica: a Cross-sectional Study." Journal of the International AIDS Society, vol. 20, no. 1, 2017, p. 21422.
Logie CH, Wang Y, Lacombe-Duncan A, et al. Factors associated with sex work involvement among transgender women in Jamaica: a cross-sectional study. J Int AIDS Soc. 2017;20(1):21422.
Logie, C. H., Wang, Y., Lacombe-Duncan, A., Jones, N., Ahmed, U., Levermore, K., Neil, A., Ellis, T., Bryan, N., Marshall, A., & Newman, P. A. (2017). Factors associated with sex work involvement among transgender women in Jamaica: a cross-sectional study. Journal of the International AIDS Society, 20(1), 21422. https://doi.org/10.7448/IAS.20.01/21422
Logie CH, et al. Factors Associated With Sex Work Involvement Among Transgender Women in Jamaica: a Cross-sectional Study. J Int AIDS Soc. 2017 04 6;20(1):21422. PubMed PMID: 28406598.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Factors associated with sex work involvement among transgender women in Jamaica: a cross-sectional study. AU - Logie,Carmen H, AU - Wang,Ying, AU - Lacombe-Duncan,Ashley, AU - Jones,Nicolette, AU - Ahmed,Uzma, AU - Levermore,Kandasi, AU - Neil,Ava, AU - Ellis,Tyrone, AU - Bryan,Nicolette, AU - Marshall,Annecka, AU - Newman,Peter A, PY - 2017/4/14/entrez PY - 2017/4/14/pubmed PY - 2017/5/23/medline KW - HIV KW - Jamaica KW - sex work KW - structural drivers KW - transactional sex KW - transgender KW - transgender women KW - violence SP - 21422 EP - 21422 JF - Journal of the International AIDS Society JO - J Int AIDS Soc VL - 20 IS - 1 N2 - INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. SN - 1758-2652 UR - https://www.unboundmedicine.com/medline/citation/28406598/Factors_associated_with_sex_work_involvement_among_transgender_women_in_Jamaica:_a_cross_sectional_study_ L2 - https://doi.org/10.7448/IAS.20.01/21422 DB - PRIME DP - Unbound Medicine ER -