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