Gender violence perpetrated against trans women

integrative review, carried out in June 2020, without time frame, in the Scopus, MEDLINE, Embase, CINAHL, WoS, PsycInfo and LILACS databases. The controlled descriptors of DeCS, MeSH and their entry terms were used: “Transgender People”, “Transgender”, “Gender Identity”, “Transsexuality”, “Gender Violence”, “Aggression”, “Sexual Offenses”, “Rape”, “Violence”, “Domestic Violence”. The presentation and synthesis of the results were presented in the PRISMA-2009 flowchart.

Results:

the final sample, consisting of 16 articles, identified different types of violence (sexual, physical, verbal, psychological and financial), perpetrated by family members, strangers, police officers, intimate partners, health professionals, acquaintances, or friends.

Conclusions:

trans women suffer violence and social exclusion that result from stigma and discrimination due to gender identity and result in unrestricted damage to physical health.

Descriptors:
Transgender Persons; Gender Identity; Gender-Based Violence; Violence; Nursing

Database	Strategy
MEDLINE	((((“transgender persons”) OR transgenders) OR “gender identity”) OR transsexualism) AND ((((“gender-based violence”) OR aggression) OR “sex offenses”) OR rape) AND ((violence OR “domestic violence”)
Scopus PsycINFO	“transgender persons” OR transgenders OR “gender identity” OR transsexualism AND “gender-based violence” OR aggression OR “sex offenses” OR rape AND violence OR “domestic violence”
Embase CINAHL Web of Science	#1“transgender persons” OR transgender OR “gender identity” OR Transsexualism #2: “gender-based Violence” OR aggression OR “sex offenses” OR rape #3: violence OR “domestic Violence” strategy: #1 AND #2 AND #3
LILACS	“transgender persons” OR “transgender persons” OR “transgender persons” OR “transgender persons” OR transgender OR “gender identity” OR “gender identity” OR “gender identity” OR transsexuality OR transsexuality OR Transsexualism AND “gender violence” OR “violence of gender” OR “gender-based Violence” OR aggression OR aggression OR aggression OR “sexual offences” OR “sexual offences” OR “sex offenses” OR rape OR rape OR rape AND violence OR violence OR violence OR “domestic violence” OR “ domestic violence” OR “domestic violence” The search strategy was formulated according to the PICo strategy (P AND I AND Co) in which: P – Transgender persons OR Transgenders OR Gender identity OR Transsexualism; I – Gender based Violence OR Aggression OR Sex offenses OR Rape; Co - Violence OR Domestic Violence.

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[1] Corresponding author: Izabel Cristina Brito da Silva E-mail: izabel.cristinabrito@ufpe.br

Authors / Year / Country	Title	Study design / Level of evidence	Main results
Silva GWS, et al.(¹⁹19 Silva GWS, Souza EFL, Sena RCF, Moura IBL, Sobreira MVS, Miranda FAN. Cases of violence involving transvestites and transsexuals in a northeastern Brazilian city. Rev Gaúcha Enferm. 2016;37(2):e56407. https://doi.org/10.1590/1983-1447.2016.02.56407 https://doi.org/10.1590/1983-1447.2016.0... ) 2016 Brazil	Situations of violence against transvestites and transsexuals in a municipality in the Brazilian Northeast	Quantitative study VI	Gender identity leads transsexual and transvestite women to suffer verbal, physical, sexual violence, and neglect, including in health services.
Dayton R, et al.(²⁰20 Dayton R, Alvarez B, Morales GJ, Rojas Almonte J, Faccini M, Gomes B, et al. Assessing an inclusive model to increase access to comprehensive gender-based violence response services and improve HIV outcomes in Puerto Plata, Dominican Republic. Cult Health Sex. 2019;22(9):1001-17. https://doi.org/10.1080/13691058.2019.1647556 https://doi.org/10.1080/13691058.2019.16... ) 2020 USA	Assessing an inclusive model to increase access to comprehensive gender-based violence response services and improve HIV outcomes in Puerto Plata, Dominican Republic	Mixed methods study V	Transsexual women are exposed to gender violence: physical, psychological, sexual (often, the first sexual intercourse is under duress and occurs in adolescence), torture, attempted murder, professional or economic abuse. Gender violence increases the risk of contracting HIV.
Salazar LF, et al.(²¹21 Salazar LF, Crosby RA, Jones J, Kota K, Hill B, Masyn KE. Contextual, experiential, and behavioral risk factors associated with HIV status: a descriptive analysis of transgender women residing in Atlanta, Georgia. Int J STD AIDS. 2017;28(11):1059-66. https://doi.org/10.1177/0956462416686722 https://doi.org/10.1177/0956462416686722... ) 2017 USA	Contextual, experiential, and behavioral risk factors associated with HIV status: a descriptive analysis of transgender women residing in Atlanta, Georgia	Qualitative study VI	Transsexual women often experience abuse that can begin in childhood, in addition to intimate partner violence, police maltreatment, prisons or sex work and are at a greater chance of contracting HIV; and the same is true for those who are unemployed, those who do not attend schools and those who are homeless.
Kattari SK, et al.(²²22 Kattari SK, Walls NE, Speer SR. Differences in experiences of discrimination in accessing social services among transgender/gender nonconforming individuals by (Dis)Ability. J Soc Work Disabil Rehabil. 2017;16(2):116-40. https://doi.org/10.1080/1536710X.2017.1299661 https://doi.org/10.1080/1536710X.2017.12... ) 2017 USA	Differences in Experiences of Discrimination in Accessing Social Services Among Transgender/ Gender Nonconforming Individuals by (Dis)Ability	Quantitative study VI	Transsexual women with or without special needs, exposed to aggressions such as rape, severe intimate partner violence, verbal abuse, and physical violence, when seeking referral services for domestic and sexual violence, substance abuse, mental health services, still suffer discrimination and stigmatization, which worsen depending on factors such as race, ethnicity, color, origin, education and special needs.
Anderson RE, et al.(²³23 Anderson RE, Tarasoff LA, VanKim N, Flanders C. Differences in Rape Acknowledgment and Mental Health Outcomes Across Transgender, Nonbinary, and Cisgender Bisexual Youth. J Interpers Violence. 2021;36(13-14):NP7717-NP7739. https://doi.org/10.1177/0886260519829763 https://doi.org/10.1177/0886260519829763... ) 2019 USA	Differences in Rape Acknowledgment and Mental Health Outcomes Across Transgender, Nonbinary, and Cisgender Bisexual Youth	Mixed methods study V	Trans women who experience violence such as verbal coercion, unwanted sexual contact and rape can suffer several damages to their mental health, such as depression, post-traumatic stress disorder and anxiety.
Swan LET, et al.(²⁴24 Swan LET, Henry RS, Smith ER, Aguayo Arelis A, Rabago Barajas BV, Perrin PB. Discrimination and intimate partner violence victimization and perpetration among a convenience sample of LGBT Individuals in Latin America. J Interpers Violence. 2021;36(15-16):NP8520-NP8537. https://doi.org/10.1177/0886260519844774 https://doi.org/10.1177/0886260519844774... ) 2019 USA	Discrimination and Intimate Partner Violence Victimization and Perpetration Among a Convenience Sample of LGBT Individuals in Latin America	Quantitative study VI	Intimate partner violence can involve trans women both as a victim of verbal, psychological, physical, and sexual aggression and as a perpetrator.
Rahil GJ, eta al.(²⁵25 Rahill GJ, Joshi M, Galea J, Ollis J. Experiences of sexual and gender minorities in an urban enclave of Haiti: despised, beaten, stoned, stabbed, shot and raped. Cult Health Sex. 2020;22(6):690-704. https://doi.org/10.1080/13691058.2019.1628305 https://doi.org/10.1080/13691058.2019.16... ) 2019 USA	Experiences of sexual and gender minorities in an urban enclave of Haiti: despised, beaten, stoned, stabbed, shot and raped	Qualitative study VI	Transsexual women are at risk of physical aggression, humiliation, stoning, rape, gang rape and murder. The hostile social context with several aggressors does not allow them to react against aggression, which leads to the potential risk of injuries and infection such as HIV; the latter is still a potentiator of more stigma and various types of violence, including institutional.
Namaste K.(²⁶26 Namaste K. Genderbashing: sexuality, gender, and the regulation of public space. Environ Plan Soc Space [Internet]. 1996 [cited 2020 Aug 14];14(2):221-40. Available from: https://chisineu.files.wordpress.com/2013/03/genderbashing1.pdf https://chisineu.files.wordpress.com/201... ) 1995 Canada	Genderbashing: sexuality, gender, and the regulation of public space	Descriptive study VI	Trans women, even when adopting procedures or behaviors that make them more feminine, such as surgeries, makeup, and clothes, are still susceptible to verbal, physical and sexual aggressions in public spaces due to their identity. Furthermore, environments such as prisons are potential places for rapes.
Flores RL.(²⁷27 Leyva-Flores R, Infante C, Gutierrez JP, Quintino-Perez F, Gómez-Saldivar M, Torres-Robles C. Migrants in transit through Mexico to the US: experiences with violence and related factors, 2009-2015. PLoS ONE. 2019;14(8):e0220775. https://doi.org/10.1371/journal.pone.0220775 https://doi.org/10.1371/journal.pone.022... ) 2016 Mexico	HIV Prevalence Among Central American Migrants in Transit Through Mexico to the USA, 2009–2013	Quantitative study VI	Transsexual women in the migration process, in addition to being exposed to sexual violence, still have increased risks of contracting HIV because they cannot negotiate the use of condoms.
Ritterbusch AE.(²⁸28 Ritterbusch AE. Mobilities at gunpoint: the geographies of (im)mobility of transgender sex workers in Colombia. Ann Am Assoc Geogr. 2016;106(2):422-33. https://doi.org/10.1080/00045608.2015.1113112 https://doi.org/10.1080/00045608.2015.11... ) 2015 Colombia	Mobilities at Gunpoint: The Geographies of (Im)mobility of Transgender Sex Workers in Colombia	Qualitative study VI	In addition to being expelled from their families by paramilitary groups, the exodus and establishment of trans women in other cities are marked by police violence and situations of beatings, rapes, verbal abuse, psychological violence, sex work and stigmatization of their identities intertwined with HIV.
Krusi A, et al.(²⁹29 Krüsi A, Ranville F, Gurney L, Lyons T, Shoveller J, Shannon K. Positive sexuality: HIV disclosure, gender, violence and the law: a qualitative study. PLoS ONE. 2018;13(8):e0202776. https://doi.org/10.1371/journal.pone.0202776 https://doi.org/10.1371/journal.pone.020... ) 2018 Canada	Positive sexuality: HIV disclosure, gender, violence and the law - DA qualitative study	Qualitative study VI	The double stigma due to the gender identity of trans women and the presence of HIV contributes to them becoming silent in the face of violence such as rape, not getting the necessary help and experiencing more pain and suffering in their lives.
Neisa ASP, Chavarría DD.(³⁰30 Pineda Neisa AS, Durán Chavarría D. Progress and challenges in the Costa Rican penitentiary system on the specific needs of LGBTI persons deprived of liberty. J Criminol Res Policy Pract. 2020;6(3):243-54. https://doi.org/10.1108/JCRPP-02-2020-0024 https://doi.org/10.1108/JCRPP-02-2020-00... ) 2018 Costa Rica	Progress and challenges in the Costa Rican penitentiary system on the specific needs of LGBTI persons deprived of liberty	Qualitative study VI	Transsexual women sometimes experience police abuse because of their gender identity. And in prison institutions it is no different, as some are subjected to abusive approaches due to the stigma of transporting illicit objects rectally, in addition to having to negotiate in exchange for sexual favors or see sex work as the only source of income in prison.
Wilson E, et al.(³¹31 Wilson E, Pant SB, Comfort M, Ekstrand M. Stigma and HIV risk among Metis in Nepal. Cult Health Sex. 2011;13(3):253-66. https://doi.org/10.1080/13691058.2010.524247 https://doi.org/10.1080/13691058.2010.52... ) 2011 Nepal	Stigma and HIV risk among Metis in Nepal	Qualitative study VI	To escape from forced cultural marriages (as men), the Metis, Nepali transsexual women, run away from home and end up doing sex work to survive. In addition to all social exposure to violence, police authorities do not protect Metis’ human rights and are also perpetrators of both sexual violence and physical aggression and harassment.
Martínez DH-R.(³²32 Martínez DH-R. The other migration: Histories of discrimination of people who lived with HIV in Mexico. Salud Ment [Internet]. 2008 [cited 2020 Aug 14];31(4):253-60. Available from: http://www.scielo.org.mx/pdf/sm/v31n4/v31n4a2.pdf http://www.scielo.org.mx/pdf/sm/v31n4/v3... ) 2008 Mexico	La otra migración: Historias de discriminación de personas que vivieron con VIH en México	Qualitative study VI	Trans women in Mexico are under prejudice, violence, and rejection from within the family. In addition to being susceptible to verbal, physical, sexual violence, extortion, rejection, and death, they do not find support even in the health services, as well as, instead of being protected by the police, they end up being more victimized by them. They also face stigmatization when living with HIV.
Thompson LH.(³³33 Thompson LH, Dutta S, Bhattacharjee P, Leung S, Bhowmik A, Prakash R, et al. Violence and mental health among gender-diverse individuals enrolled in a human immunodeficiency virus program in Karnataka, South India. Transgender Health. 2019;4(1):316-25. https://doi.org/10.1089/trgh.2018.0051 https://doi.org/10.1089/trgh.2018.0051... ) 2019 Canada	Violence and Mental Health Among Gender-Diverse Individuals Enrolled in a Human Immunodeficiency Virus Program in Karnataka, South India	Quantitative study VI	Transsexual women in India are very susceptible to all types of violence (physical, sexual, stigma, sex work), including by family members and authorities, which ends up being an impediment to seeking help and rights. This leads to serious mental problems, such as low self-esteem, lack of self-confidence, sleeping difficulties, depression, and suicide.