Past-year violence experienced by transgender women living with HIV with or without recent involvement in transactional sex: the French national cross-sectional ANRS-Trans&HIV study

Introduction Stigma and violence experienced by transgender women and women engaged in transactional sex may negatively impact health and access to HIV care. We investigated typologies of past-year violence experienced by transgender women living with HIV (TWLH), with or without involvement in transactional sex (TWLH-TS and TWLH-nTS, respectively) in France. Methods We used data from the 2020–2022 French national cross-sectional ANRS-TRANS&HIV survey, which included TWLH recruited in 36 HIV care centres. We performed latent class analyses using variables representing combinations of past-year violence type and perpetrator separately for TWLH-TS and TWLH-nTS. Correlates of the resulting past-year violence typologies among TWLH-TS were assessed using multinomial logistic regression. Results Among TWLH-TS (66% of the 501 participants), three typologies emerged: low reported violence (42% of the 501 participants), multiple-perpetrator violence (8%) and client and street violence (17%). Among TWLH-nTS (34% of the 501 participants), two typologies emerged: low reported violence (30% of the 501 participants) and multiple-perpetrator violence (3%). In TWLH-TS, correlates of client and street violence were inadequate housing, ART interruption, stimulant use and daily cannabis use, while those of multiple-perpetrator violence were depression and a lack of emotional support. Client and street violence and multiple-perpetrator violence were correlated with meeting clients in outdoor locations. Conclusion TWLH in France face intersecting forms of systemic violence and structural vulnerability. One in ten experienced multi-form, multiple-perpetrator violence, regardless of transactional sex involvement, with potential consequences for mental health. Client and street violence affected one in four TWLH-TS, and was associated with precarious housing and working conditions, as well as substance use and ART adherence difficulties. Ensuring equitable access to HIV care and mental health services for transgender women is essential and inseparable from protecting their fundamental human rights and improving their socioeconomic conditions. Trial Registration NCT04849767 .