Age-disparate experiences and incidence of gender-based violence victimization of transgender women: findings from a cohort study in eastern and southern United States.

Abstract

Gender-based violence (GBV) is a threat to health and human rights and experiences may vary with age. We estimated the incidence and correlates of GBV in transgender women in the United States. From March 2018-August 2020, we enrolled a cohort (N = 1312) of transgender women without HIV in eastern and southern US. Participants were followed for 24-48 months via site-based and digital modes. We measured lifetime and recent (past 3 or 6 months) psychological, physical, and sexual GBV over follow-up. We calculated frequencies and incidence rates (IR) of each form of violence, stratified by age at enrollment (18-24 vs. ≥ 25 years). We used modified Poisson regression models to identify predictors of incident GBV and calculate adjusted relative risk (aRR) and 95% confidence intervals. Participants were a mean age of 31years (standard deviation: 11) and 60% identified as White race (793/1312), 15% as Black (196/1312), and 19% as Hispanic/Latine (242/1312). At baseline, 88% (1140/1312) reported any lifetime GBV and 42% (546/1312) recent GBV. Psychological violence was most common (39% [507/1312] recent, 85% [1101/1312] lifetime), followed by physical (12% [151/1312] recent, 65% [843/1312] lifetime) and sexual (7% [94/1312] recent, 43% [557/1312] lifetime). Perpetrators were most frequently family members, partners, and strangers. Incidence of GBV was higher among young adults (IR = 119·4/100 person-years, 95% CI = 107·0-132·9) compared to adults (IR = 88·5/100 person-years, 95% CI = 81·7-95·6). Among young adults, online versus site-based participants had elevated GBV risk (aRR = 1·14, 95% CI = 1·03-1·26). Among adults, food insecurity (aRR:1·13, 95% CI:1·04-1·23), higher discrimination scores (aRR:1·01, 95% CI: 1·01-1·02), psychological distress (aRR:1·08, 95% CI:1·00-1·17), and drug use disorder symptoms (aRR:1·09, 95 CI:1·01-1·18) were associated with increased GBV risk. Other predictors were observed in age-specific models for incident psychological, physical, and sexual violence. GBV is exceptionally high among US transgender women. Survivor services, protective policies, and interventions must explicitly address transgender women's needs, including age-specific GBV contexts. NIH.