Background : Transgender sex workers have been involved in many political efforts in the United States even prior to the Stonewall Uprising (Stryker, 2008; Serano, 2013). Though some scholarship has explored the psychosocial experiences of trans sex workers, researchers have almost never explored the unique strengths and protective factors in this population. The purpose of the current study is to explore the role of political engagement and activism in the relation to psychological distress, poverty, and physical and sexual health outcomes among transgender sex workers.
Methods : This study uses data from the United States Transgender Survey, a nationally representative sample of transgender residents of the United States (James et al., 2016). A cluster analysis was conducted to identify heterogeneous groups within the participants who reported a history of sex work (n = 4,667, mean age = 31.92, SD = 12.3). Results identified three political groups: 1) politically disengaged participants (n = 2,115), 2) participants engaged in grassroots political efforts like protests and collective action campaigns (n = 1,204), and 3) participants engaged in traditional political activism (n = 1,234), like engagement with legislators and political campaigns. Differences between these groups were explored in the types of sex work, as well as demographics and rates of poverty, HIV testing, psychological distress, and types of political engagement.
Results : Grassroots activists reported higher rates of online advertising for sex work than either other group. Furthermore, grassroots activists reported the lowest use of informal networks/word-of-mouth advertising, followed by politically disengaged sex workers, and the highest rates reported by traditional activists. Politically disengaged participants reported higher use of escort services and webcam work than either of the two other groups, and traditionally engaged participants reported the higher rates of fetish work. Those engaged in traditional politics were significantly older than both other groups, and grassroots activists were significantly younger. Those engaged in traditional politics were the least likely to report living in poverty and reported the highest incomes. Rates of HIV testing were also highest in those engaged in traditional politics, followed by grassroots activists, and the lowest reported by politically disengaged participants. Likewise, those engaged in traditional politics reported normative rates of psychological distress, with higher rates reported by disengaged participants and the highest rates of distress reported by grassroots activists.
Conclusions : These results demonstrate heterogeneous experiences of political engagement among transgender sex workers, as well as unique risk and resilience profiles within this population. In particular, those sex workers involved in traditional political activism, such as engagement with legislators and political campaigns, report normative rates of psychological distress and the highest rates of HIV testing, as well as the greatest financial security. Grassroots activists report the greatest psychological distress and greatest financial difficulties, representing those transgender sex workers who may have the greatest need for resources and interventions, although they report higher rates of HIV testing than disengaged sex workers. These results demonstrate that even highly marginalized transgender sex workers are actively engaged in attempting to improve their economic situation. Implications for transgender healthcare will be explored.