History of Sex Work Is Associated with Increased Risk of Adverse Mental Health and Substance Use Outcomes in Transgender Adults

Abstract

Understanding factors influencing mental health and substance use in transgender and gender diverse people is critical to reducing disparities in this population. We sought to investigate whether a history of sex work was associated with increased prevalence of poor mental health, substance use, and a negative experience within drug and alcohol treatment facilities. We conducted a secondary analysis of the data of 25,204 transgender respondents of the 2015 United States Transgender Survey. We estimated multiple logistic regressions to assess the association between a history of sex work and adverse mental health and substance use outcomes. We then estimated mean prevalence of adverse outcomes by type of sex work. Finally, we performed chi-square analysis to explore differences in mistreatment at drug and alcohol treatment facilities. Respondents with a history of sex work were significantly more likely to have poorer psychological health, suicidality, and substance use after adjusting for covariates. Among those who visited drug and alcohol treatment facilities, those with a history of sex work were significantly more likely to report adverse experiences (26.34% vs. 11.63%). Our findings highlight the increased risk of adverse outcomes in transgender sex workers and emphasize the need for interventions targeting this subgroup of transgender people.

Sex Work and Health Problems in the Sexual and Gender Minority Population: Analysis of a Population Survey in Peru

“…Te present study found an association between the history of sex work and chronic diseases, infectious diseases, and mental health problems in the SGM population from Peru. According to the literature, it is known that sex work exposes people to a higher risk of diseases and substance abuse, causing the deterioration of physical and mental health [12].…”

“…A study conducted in Lima, the capital of Peru, revealed that HIV prevalence is 4.5% among male sex workers, mostly bisexuals, and reaches 16.6% among transgender women, mostly homosexuals [11]. It is known that sex work increases the prevalence of chronic diseases and mental health problems [12,13]; however, in Peru, the available scientifc evidence is limited.…”

Exploring the Relationship between Mental Health and Substance Use, Stable Housing, and Completion of the RISE Court Program

“…Per these findings, the first hypothesis, that mental health would decrease the likelihood of program completion, was not supported in the bivariate correlation analysis nor the logistic regression model for program completion. This was somewhat unexpected due to the extensive bodies of research which discuss the prevalence of mental illness within the sex work community (Benoit et al, 2015;Chudakov et al, 2002;Miller et al, 2020;Pandey & Seelman, 2022;Puri, 2017). It was hypothesized that the strain stemming from adverse mental health would impact a participant's overall success, but having a mental health diagnosis did not significantly impact program completion.…”