Background and aims: Research indicates that a significant portion of transgender women are involved in sex work, which is mostly attributed to discrimination of transgender persons on the labour market. Transition-related health risk behaviour, such as uncontrolled hormone use, auto-medication and the use of silicone injections, may lead to several adverse health outcomes for transgender persons. Transgender sex workers are a vulnerable group within the transgender population, who might be at increased risk for these health risk behaviours because of economic marginalisation. However, European research into this topic and risk population remains largely absent. This study is the first exploring these risk behaviours in a European sample of transgender sex workers, as well as the association with their socio-demographic characteristics, their work and their migration pathways.
Methods: This study explores the prevalence of uncontrolled gender-affirming hormone use among transgender sex workers working in window-based sex work in the Antwerp red light district (Belgium), as well as their socio-demographic characteristics and migration pathways. In co-operation with two outreach organizations providing sexual health services to sex workers, a face-to-face survey was carried out among 46 transgender sex workers. Descriptive analyses of this survey sample were supplemented with 9 in-depth interviews with transgender sex workers, which were analysed using Grounded Theory.
Results: The population of transgender sex workers working in the Antwerp red light district has specific socio-demographic characteristics: they are all assigned male at birth, 83% identifies as female and 76% is from Latin-American descent, mainly from Ecuador. However, a variety of migration pathways is cited, and 30% cites travelling internationally to work, which influences their access to healthcare. Transition-related health risk behaviours are prevalent: current uncontrolled hormone use rate is 32%, and a lot of participants do not follow regular hormone regimens. Engaging in sex work appears to be an important reason for this uncontrolled gender-affirming hormone use and auto-medication, as gender-affirming hormones frequently cause erectile dysfunction and an erection is often required when engaging in transgender sex work.
Conclusions: When addressing this populations health risk behaviour, the specific characteristics of this largely invisible but highly vulnerable population should be taken in account, as well as their work and migration pathways. Access to health care and social services should be ensured, and culturally tailored health interventions that take into account their social context as well as their gender identity should be developed.
21 Oct 2019
Belgian Endocrine Society