Structural Determinants of Health Among Transgender Populations: Policing, Sex Work, and HIV

Transgender (trans) populations experience disproportionately high rates of HIV infection compared to cisgender populations. Additionally, due to overlapping layers of discrimination in education, housing, healthcare, and employment, trans populations are more likely to engage in a criminalized form of work, such as sex work. Policing has been identified as a potential structural determinant of HIV infection among individuals engaging in sex work. Trans populations, including those engaging in sex work, are more likely to interact with police and experience some form of police violence. This dissertation investigated policing as a potential structural determinant of HIV status and HIV testing among trans individuals who engage in sex work. Unadjusted and adjusted logistic regression analyses were utilized to identify associations between HIV status/HIV testing and police interactions. Mediation analyses were utilized to investigate police interactions as a potential mediating variable between HIV status/HIV testing and trans individuals who have engaged in street-based sex work. Statistically significant associations were identified between police interactions and HIV status in unadjusted (OR: 2.564, 95% CI: 1.166, 5.641, p-value = 0.019) and adjusted (aOR: 12.055, 95% CI: 3.076, 47.232, p-value <0.001) logistic regression models. Additionally, police interactions were not identified as a statistically significant mediating variable between HIV status/HIV testing and trans individuals engaging in street-based sex work. These findings suggest policing may act as a contributing factor towards HIV infection among trans individuals engaged in sex work, but further research is needed to elucidate this interaction. HIV infection prevention interventions need to include an intersectional lens that incorporates trans identities and address the structural issues that trans populations experience including discrimination in housing, employment, and healthcare.