Background: In Peru, the absence of laws that protect transgender communities and/or laborers in informal erotic economies, transgender women sex workers (TWSW) experience extreme social dislocation and violence.

Methods: Between October 2015-October 2016, 104 incidents of violence (IV) reported by TWSW were collected in Lima, Peru. Using critical discourse analysis, IV were thematically coded and analyzed to assess violence type perpetrated, geographic clustering, and interpersonal dynamics. IV were subsequently triangulated with data derived from discussions with 42 TWSW and local law enforcement officers. Audio files were transcribed verbatim and analyzed using Dedoose (v.6.1.18).

Results: Narratives describe high levels of structural, physical, and symbolic violence through systemic social policing practices, meaning the enactment of structural and symbolic violence by neighbors, clients, police, peers perpetrated against people who traverse multiple marginalized statuses (e.g., transgender women, sex worker, economically disenfranchised, etc.). Majority of participants described these practices as violence associated with harm to their physical and mental health, and impacted overall mistrust in social institutions, such as, healthcare. Two key themes further demonstrated the intersection between social policing and violence as a structural determinant of health for TWSW: (1) structural violence, including institutionalized surveillance and persecution resulting in arrest, incarceration, and exploitative labor practices; and (2) enacted physical and symbolic violence including assault, forced sex, kidnapping, and extortion.

Conclusion: Findings underscore the need for human rights-based public health strategies to address these emerging dimensions of structural violence (e.g., cis-/heteronormative and informal economy social policing) confronted by TWSW in Peru and globally.

Studies have shown that transgender adults report poorer health than the general population and are less likely to seek out healthcare services. Healthcare providers have started routine screening for Intimate Partner Violence (IPV), because transgender individuals are less likely to seek healthcare services, they experience additional barriers in this area as well, while having a lifetime prevalence of IPV ranging between 31-50%. While the typical types of IPV among cisgender people also take place in trans relationships, there are several additional areas of vulnerability for transgender people, for example threatening to disclose the transgender individual’s gender identity to others who may respond negatively.

This study uses a qualitative research approach in the form of 30 in-depth interviews with transgender individuals. Participants are currently being recruited in collaboration with several Virginia-based community partners that offer services to LGBTQ+ individuals.

RQ1: What are transgender individuals’ experiences and coping mechanisms with IPV?

RQ2: What impacts transgender individuals’ choice to seek or avoid help with IPV?

While this study is ongoing, the implications are already apparent: The study results will provide a greater understanding of the health care and health care delivery needs for transgender individuals related to IPV; the study participants are able to share their story and help increase knowledge about issues affecting this vulnerable population; and the collaboration with community partners provides the opportunity for the using information in future transgender messaging and intervention strategies.