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Cited by 23LGBTQ Health, Identity, and PolicySex work and related issuesHIV/AIDS Research and Interventions

Stigma, social cohesion, and mental health among transgender women sex workers living with HIV in the Dominican Republic.

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Goldenberg, Tamar, Kerrigan, Deanna, Gomez, Hoisex, Perez, Martha, Donastorg, Yeycy, Barrington, Clare·2021·Stigma and Health
DOI 10.1037/sah0000337PMC PMC9997213
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Abstract

Globally, transgender (trans) women experience pervasive stigma, which contributes to health inequities across multiple mental health outcomes. While trans stigma has been associated with increased mental health challenges, less is known about how stigma related to sex work and HIV affect mental health. Social cohesion may ameliorate the negative health consequences of stigma, but little is known about how social cohesion is associated with mental health among trans women. Using cross-sectional survey data collected in 2019 among 100 trans women sex workers living with HIV in Santo Domingo, Dominican Republic, we examined associations between stigma (related to HIV, sex work, and trans identity), social cohesion, and depression and anxiety symptoms. In unadjusted models, enacted and internalized sex work stigma were associated with greater odds of depression and anxiety symptoms and social cohesion was associated with less depression and anxiety. Resisted sex work stigma, which captured acceptance of self and work, was associated with lower odds of depression and trans stigma was associated with increased anxiety. In adjusted models, internalized sex work stigma was associated with increased depression (aOR=1.19, p=0.018) and anxiety symptoms (aOR=1.12, p=0.021), while social cohesion was associated with reduced depression (OR=0.81, p=0.002) and anxiety symptoms (aOR=0.086, p=0.023). Findings indicate the need for interventions to focus on reducing internalized sex work stigma and promoting social cohesion to improve mental health among trans women. Additional research is needed to determine how to best measure the intersections between HIV, sex work, and trans stigma and their impact on mental health.

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  • A variety of factors inform the prevalence of mental illness among transgender FSW, including violence exposure, stigma, and substance use.

    “A variety of factors inform the prevalence of mental illness among transgender FSW, including violence exposure, stigma, and substance use.2–4,6–11”

    From Mindfulness, Mental Health, and Violence Exposure Among Transgender Female Sex Workers Living with HIV in the Dominican Republic. (2026) · cites this paper as [7]

    The Results and Discussion report associations between stigma and depression or anxiety, and between drug use and anxiety, among transgender women sex workers living with HIV in the Dominican Republic. The Discussion suggests that potential violence during sex work may increase anxiety, but the study did not establish violence exposure as a factor in the prevalence of mental illness; drug use was not significantly associated with depression. Page numbers are unavailable in our copy. (LLM, conf=0.84)

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  • One explanation for the association between higher mindfulness and reduced anxiety/depression is that mindfulness can disrupt the pathway from chronic stress, which transgender FSW face due to intersecting forms of oppression and stigmatization related to gender identity, HIV status, and sex work, to depression and anxiety.

    “One explanation for this association is that mindfulness can disrupt the pathway from chronic stress, which transgender FSWs face due to intersecting forms of oppression and stigmatization related to gender identity, HIV status, and sex work,7,8,24,34–36 to depression and anxiety.”

    From Mindfulness, Mental Health, and Violence Exposure Among Transgender Female Sex Workers Living with HIV in the Dominican Republic. (2026) · cites this paper as [7]

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Research works printed but not linked: 7

  1. Carrasco MA, Barrington C, Donastorg Y, Perez M, & Kerrigan D. (2014). Social cohesion is significantly associated with consistent condom use among female sex workers living with HIV in Santo Domingo, Dominican Republic. Paper presented at the STD Prevention Conference, Atlanta, GA.
  2. Chakrapani V, Vijin PP, Logie CH, Newman PA, Shunmugam M, Sivasubramanian M, & Samuel M. (2017). Assessment of a “Transgender Identity Stigma” scale among trans women in India: Findings from exploratory and confirmatory factor analyses. International Journal of Transgenderism, 18(3), 271– 281.
  3. Dewey JM, & Gesbeck MM. (2017). (Dys) Functional diagnosing: Mental health diagnosis, medicalization, and the making of transgender patients. Humanity & Society, 41(1), 37– 72.
  4. Link BG, & Phelan JC. (2001). Conceptualizing stigma. Annual review of Sociology, 363– 385.
  5. Matsuno E, & Israel T. (2018). Psychological interventions promoting resilience among transgender individuals: Transgender resilience intervention model (TRIM). The Counseling Psychologist, 46(5), 632– 655.
  6. Meyer IH. (2015). Resilience in the study of minority stress and health of sexual and gender minorities. Psychology of Sexual Orientation and Gender Diversity, 2(3), 209.
  7. Testa RJ, Habarth J, Peta J, Balsam K, & Bockting W. (2015). Development of the gender minority stress and resilience measure. Psychology of Sexual Orientation and Gender Diversity, 2(1), 65.

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Authors
Goldenberg, T., Kerrigan, D., Gomez, H., Perez, M., Donastorg, Y., & Barrington, C.
Affiliations
  • University of North Carolina at Chapel Hill (US)
  • George Washington University (US)
  • Instituto Dermatológico y Cirugía de Piel "Dr. Huberto Bogaert Díaz" (DO)
ORCID
Venue
Stigma and Health
Publisher
American Psychological Association (APA)
Published
2021-11
Volume
6
Issue
4
Pages
467-475
ISSN
  • 2376-6964 (ISSN-L)
  • 2376-6972
DOI
10.1037/sah0000337
PMC
PMC9997213
OpenAlex
W3199214850
Cited by
23
References
51
Citations by year
2026: 7 · 2025: 5 · 2024: 4 · 2023: 6 · 2022: 1
FWCI
2.69
Type
journal article
Language
en
Open access
Licence
Locations
  • Stigma and Health (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
  • UNC Libraries
Funders
  • National Institutes of Health (R01MH110158)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (T32 HD007168, P2C HD050924)
Topics
  • Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
  • Social Sciences › Sociology and Political Science › Sex work and related issues
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Keywords
transgender women, sex work, HIV, stigma, social cohesion, mental health, depression, anxiety, self-stigma, enacted stigma, Dominican Republic

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