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Multi-level Risks Associated with Partner and Client Violence Among Trans Women Who Do Sex Work in San Francisco,
Iris R O'Neal1, Erikka Palafox1, Bow Suprasert1
1San Francisco Department of Public Health, San Francisco, CA, USA.
AIDS and Behavior
|April 29, 2026
Summary
Trans women in sex work face higher rates of violence, particularly interpersonal violence (IPV). Younger age and methamphetamine use correlate with increased IPV risk, highlighting a need for targeted support services.
Area of Science:
- Public Health
- Sociology
- Gender Studies
Background:
- Syndemic conditions linking sex work and violence increase HIV risk for transgender women.
- Limited understanding exists regarding the specific types of violence experienced by transgender women involved in sex work.
Purpose of the Study:
- To examine the prevalence of different types of violence experienced by transgender women engaged in sex work.
- To identify correlates of interpersonal violence (IPV) among this population.
Main Methods:
- Data collected from the National HIV Biobehavioral Surveillance among transgender women in San Francisco (2023-2024).
- Self-reported data on demographics, substance use, sex work involvement, and IPV.
- Multivariable logistic regression used to determine factors associated with IPV.
Main Results:
- Transgender women in sex work reported higher rates of sexual assault by steady partners and physical attacks by casual and steady partners compared to those not in sex work.
- Among transgender women in sex work, younger age (18-39 years) and methamphetamine use were significantly associated with higher odds of experiencing IPV.
- A majority of transgender women in sex work were aged 18-39, Hispanic/Latina, US-born, had a high school education or less, and earned less than $40,000 USD annually.
Conclusions:
- There is a significant unmet need for IPV and trauma-informed services tailored to transgender women involved in sex work.
- Economic interventions aimed at reducing financial reliance on sex work may be crucial for violence prevention in this community.
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