“You Face Discrimination Five Times over”: How the Intersectionality of Cissexism, Racism, and Xenophobia Affects Latina Immigrant Transgender Women’s Engagement with HIV/STI Services In the United States.

Background: Both transgender women and Latine/x populations are disproportionately represented in new HIV diagnoses in San Francisco, California, and are underrepresented in HIV-related research. Current findings generalize both populations as monolithic in experiences, and more research is needed to better examine the diverse experience and unique vulnerability to HIV among Latina transgender women. Transgender Latinas account for both the largest percentage of new HIV diagnoses among transgender women and the largest percentage of transgender women living with HIV in San Francisco. While there is adequate sexual health care and gender-affirming care services available for transgender women, there are cultural and linguistic limitations specifically for Latina immigrant transgender women. Our research explored how intersectionality based on race/ethnicity, gender, and immigration status influenced the experience of Latina immigrant transgender women in the United States (US), including experiences with HIV/STI services.

Methods: We developed a semi-structured interview guide in English and Spanish to explore how intersectionality influences risk and protective factors associated with HIV/STI services. We recruited Latina immigrant transgender women in the San Francisco Bay Area to participate in a focus group and/or in-depth individual interview. All of the sessions were completed in person, transcribed verbatim, and rapid qualitative analysis was used to identify themes in the original language of the interview.

Results: Twenty-six participants completed a focus group (n=13; 10 transgender women, 2 cisgender male sexual minorities, and 1 cisgender male heterosexual) and/or in-depth interviews (n=13 Latina transgender women); all of the participants were born in a foreign country and completed the interviews in Spanish. The following themes emerged: 1) Structural Cissexism — Transgender Latinas described how cissexism created vulnerable conditions in their native countries and in the US that increased HIV risk factors, including limited opportunities and exposure to sex work to meet their basic needs; 2) Interpersonal Transphobia — Transgender Latinas experienced gender microaggressions from other transgender women and cisgender men that affected their well-being and reinforced Latina cultural beauty standards, hypersexuality, and heteronormativity; 3) Intersectional Discrimination — Transgender Latinas frequently encountered multiple forms of microaggressions at once based on gender, race/ethnicity, and immigration status; 4) Social Capital and Self-Assurance — Transgender Latinas shared how their lived experience facilitated access to supportive social networks, which helped them cope with microaggressions and enhance HIV resilient factors; 5) HIV/STI Exposure and Stigmatization — Transgender Latinas described how being marginalized at multiple intersections of identity increased their risk of HIV/STI exposure and amplified stigmatization of engaging in HIV/STI services.

Conclusion: Findings highlight the importance of intersectionality based on gender, race/ethnicity, and immigration status and how it affects access and engagement of HIV/STI services for Latina immigrant transgender women in the United States. Established social networks and HIV resilience developed among transgender Latinas may inform culturally-competent peer-based HIV/STI interventions to continue addressing the sexual health disparities impacting diverse immigrant and transgender communities.