Beyond a deficit-based approach: Characterizing typologies of assets for cisgender and transgender female sex workers and their relationship with syndemic health outcomes

Authors

Beth J. Maclin, Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America.
Yan Wang, Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America.
Carlos Rodriguez-Diaz, Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America.
Yeycy Donastorg, Instituto Dermatológico y Cirugía de la Piel, HIV Vaccine Trials Research Unit, Santo Domingo, Dominican Republic.
Martha Perez, Instituto Dermatológico y Cirugía de la Piel, HIV Vaccine Trials Research Unit, Santo Domingo, Dominican Republic.
Hoisex Gomez, Instituto Dermatológico y Cirugía de la Piel, HIV Vaccine Trials Research Unit, Santo Domingo, Dominican Republic.
Clare Barrington, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America.
Deanna Kerrigan, Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America.

Document Type

Journal Article

Publication Date

1-1-2023

Journal

PLOS global public health

Volume

3

Issue

8

DOI

10.1371/journal.pgph.0002314

Abstract

Female sex workers (FSWs) live and work at the intersection of multiple marginalized identities that place them at greater risk for various negative health outcomes. Resilience theory asserts that an individual or community needs assets from which they can draw in response to stressors, such as chronic discrimination and abuse. This study characterizes and compares patterns of assets among cisgender and transgender FSWs living with HIV in the Dominican Republic and their relations with syndemic health outcomes. With Latent Class Analysis, we used companion cross-sectional datasets comprised of cisgender and transgender FSWs (N = 211 and 100, respectively) to estimate typologies of interpersonal, community, and institutional assets. We used multivariate logistic regression to model the relationship between class membership and HIV care and treatment, mental health, violence exposure, and substance use outcomes, respectively. Among cisgender FSWs, we identified three classes: Internal and External Multilevel Assets (Class 1); External Institutional Assets (Class 2); and Low Reported Assets (Class 3). Compared to Class 3, Class 1 membership among cisgender FSWs was significantly associated with ART adherence and marginally associated with viral suppression, and Class 2 membership was marginally associated with currently taking ART. We identified two classes in the transgender sample: Internal and External Multilevel Assets (Class 1) and External Institutional Assets (Class 2). Class 1 membership among transgender FSWs was significantly associated with ART adherence and marginally associated with current ART use and physical or sexual violence, compared to Class 2. Having a variety of assets may explain the ability of some FSWs to more effectively engage with healthcare and maintain their HIV medication regimen. Future interventions should seek to expand FSWs' interpersonal and community assets, both from within and outside of the sex worker community, to bolster their ability to care for themselves and their community.

APA Citation

Maclin, Beth J.; Wang, Yan; Rodriguez-Diaz, Carlos; Donastorg, Yeycy; Perez, Martha; Gomez, Hoisex; Barrington, Clare; and Kerrigan, Deanna, "Beyond a deficit-based approach: Characterizing typologies of assets for cisgender and transgender female sex workers and their relationship with syndemic health outcomes" (2023). GW Authored Works. Paper 3190.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3190

Department

Prevention and Community Health