Damian Sendler: Using binary logic, the concept of “gender” is defined as a set of socially imposed behaviors that determines whether or not someone is a man or a woman (1). The subjective and dynamic nature of one’s self-perception is complicated by this definition. These values, motivations and experiences all contribute to the development of gender identity as a whole. People who identify as cisgender or cis men or women, whose gender identity and expression correspond to biological sex, identify with the patterns of appearance and behavior that are culturally imposed on biological sex (1,2,3). Transgender or trans people do not identify with the gender assigned at birth, which is legitimized through anatomical sexual characteristics, in Western society because of the linearity between body-sex-gender. Consequently, transgender women do not recognize their own gender as men, but rather as transsexual or transvestite women throughout their lives (2,3).
Damian Jacob Sendler: Discrimination against transgender women is common in society because of a history of medical science pathologizing their identities (3). There is a lack of preparedness and awareness on the part of health care professionals when it comes to welcoming and meeting the needs of those seeking hormones or even surgical procedures to achieve a female body image. This can lead to abuse, neglect, as well as conditions that are detrimental to a person’s mental, physical and sexual well-being (4,5).
Dr. Sendler: Because they are female, transgender and cisgender people face an increased risk of violence throughout their lives (6). Those in precarious socioeconomic situations, those who use psychoactive substances and those who are sex workers are more vulnerable to gender violence as a result of their exposure to historical processes (7).
In addition, it should be noted that three social structures – patriarchy, machismo, and capitalism – are implicated in gender violence, all of which act insidiously and employ logics that dehumanize people’s bodies and lives (8). Gender-based violence against trans women is fueled by the power imbalances that exist in families and society as a whole, which take advantage of the patriarchal system’s insistence on male dominance. There is a wide range of violence that can occur as a result of this violence, including murder, rape, physical, verbal and psychological aggression, coercion, attacks in public or private environments, and discrimination in formal workplaces, health services and educational institutions (9).
Institutionalized transphobia is a structure of oppression that perpetuates gender violence against transgender women in health care settings, where a binary and discriminatory care practice is reproduced. As a result of these situations, trans women’s needs are not met, their specificities are ignored, and the non-search for health care is favored (9).
It is stated in the guidelines and responsibilities of the Ministry of Health that the National Comprehensive Health Policy for Lesbian, Gay, Bisexual, Transvestite, and Transsexuals recognizes that stigma, discrimination, domestic and sexual violence they cause illness and require strategies for coping and care in an intra- and inter-sectorial manner, as stated in the policy (10).
Since trans women experience gender violence on a daily basis, it is critical for nurses to have a thorough understanding of this phenomenon in order to better serve their patients’ social and health needs. Furthermore, the acquisition or expansion of knowledge necessary for comprehensive health care can contribute to the reduction of new instances of violence in health services and enable visibility through the debate on the topic in social and political arenas.
All of the 16 articles (100%) were written in English, Spanish, and Portuguese, as follows: 14 (87.5%) in English; 1 (6.25%) in Spanish; and 1 (6.25%) in Portuguese; US, Canada, and Mexico each had three publications; the other countries each had one, including Brazil, Colombia (one each), Costa Rica (one each), and Nepal (one each) (6.25 percent ).
There were 10 universities, three institutions promoting health research, one institution of research in multiple areas and one unidentified institution involved in the prevention and combating of crime that were registered as the institutions that conducted the studies, according to a press release.
The most articles were published in 2019, with five (31.25%), followed by two (12.5%) in each of the following three years: 2016, 2017 and 2020; one (6.25%) in each of the following years; and one in 1995. More than half of the 16 articles found were published in 13 journals, including five in the health field, one in nursing, and the rest in the multidisciplinary fields of social work, immigration, and violence. More than 80% of the evidence was found to be in the form of a combination of mixed methods, descriptive, and qualitative studies.
Many different aspects of gender violence against trans women were discussed, including HIV/AIDS (25%), the social context (18.75%], mental health (12.5%), public service provider access (12.5%), immigration (12.5%), the penitentiary system (12.5%), human rights (12.5%), sex work (12.5%), and intimate relationships (12.5%); at times, these perspectives were combined.
More than half of the articles (50 percent) reported on sexual violence, followed by physics (75 percent), verbal (60 percent), psychological (50 percent), and financial (four percent) (25 percent ). The sexual form of violence accounted for 6.25 percent of the total in one article, but there were multiples in the others.
Aggressors included police officers (37.5 percent) and medical professionals (18.75 percent) in six studies, along with intimate partners (31.25%), family members (43.75%), friends or acquaintances (18.75 percent), next-door neighbors (12.5 percent), and others who were not named (43.75 percent ). In two studies, criminals were not included (12.5 percent ).
Gender violence gives the victim, usually a woman, the distorted impression that they have less power and control over themselves in comparison to a dominant figure, almost always a man. Those who hold this view believe that they have the power to exert control over those whose lives they view as less valuable, which puts trans women at greater risk of contracting diseases like HIV and other communicable diseases. As the context of exclusion and stigma surrounding transgender people continues to worsen, gender violence against trans women is being legitimized by female behavior and the expression of this woman’s identity (36).
When trans women are rejected because of their gender identity, whether in the public or private sphere, from childhood or adolescence, marginalized communities, educational evasion, and precarious economic conditions are all possible outcomes (37). Because of their race (blackness) and class (low socioeconomic status), trans women with physical or mental disabilities may be more vulnerable to violence, including that perpetrated by mental health services for people who have experienced sexual violence, domestic violence, chemical dependency, or other forms of mental illness. This serves as an example of institutionalized racism and social exclusion (22,32).
Damian Sendler
Regardless of their nationality, trans women living with HIV may face a double stigma when seeking care in reference health facilities. Because they identify as female and have the virus, they find themselves in a situation where they have to deal with the consequences of sexual violence. When trans women seek treatment, they expect it to be confidential, private, and dignified. But their serology is exposed, and they are the victims of physical and symbolic violence (19,20,25,28,29,32). Treatment delays and health disparities are worsened because of gender violence in health care, which affects trans women the most (34).
It is possible for trans women to be exposed to HIV in a context that is closely linked to violence, and this exposure can continue throughout their lives. Sexually transmitted diseases and other health issues can result from forced sex initiation and from family and social rejection of her identity, which drives her to sex work for survival. Clients and/or ruffians may become more aggressive and extortionate as a result of this.
Viral infections can also occur as a result of sexually transmitted diseases (STIs) such as HIV and hepatitis C. An additional factor that should be taken into consideration is illegal migration, where the risk of rape is extremely high and people are afraid they will be murdered if they request condoms or seek legal or health support.
Unprotected oral or anal sex is prevalent in the lives of trans women regardless of sex work, and is used as a way to reinforce male superiority and control over women. Verbal aggression, intimidation, threats, beatings, and extortion are common accompaniments (25,35).
Fear of retaliation when reporting incidents of violence, or stigmatization and further violence when seeking support, silences trans women, resulting in suffering and mental and psychological illnesses such as depression, post-traumatic stress disorder, suicidal ideation, as well as favoring greater exposure to STDs (23,33).
Sexual violence and violence by intimate partners are two times more common for transgender people than for cisgender people; they have a 90 percent to 100 percent chance of experiencing traumatic events (38). It is possible for them to become the aggressors as well as the victims in a relationship where violence is reciprocated (24). It’s worth noting that the use of alcohol and other psychoactive substances by intimate partners against trans women exacerbates the effects of gender-based violence. The most common forms of aggression are psychological and physical, with sexual coercion rounding out the top three (24).
The low demand for services in which nursing plays an important role in health promotion and the prevention of injuries as a result of violence, such as HIV and other morbidities, is caused by authorities’ fear of stigmatization, discrimination, and discredit(37).
Discrimination, prejudice, rejection, physical and mental violence, and abusive relationships committed by family members force many young trans women to leave their homes. Because of threats to their lives and the lives of their families from gangs or groups of lawbreakers, they may also flee their homes and cities in search of a better life for themselves and their families.
Damian Jacob Sendler
It is possible for trans women to receive support from other trans women, but this activity may be restricted by the police because of their gender identity; and they can also be victims of aggression from clients. Violence against trans women is exacerbated by factors such as poverty, racism, and a lack of educational opportunity (39).
Damian Jacob Markiewicz Sendler: When trans women are detained, they are placed in male penitentiaries, where they are vulnerable to both the aggressions of other detainees and the employees of the institution (30). Verbal attacks against trans women are more common in the context of deprivation of liberty. A number of other crimes, such as rape and the use of a person’s body as a vehicle for the transportation of illegal substances or telephone devices, are also reported, including extortion and the exploitation of sex workers (30).
Hostile and transgressive police tactics have been used in countries like Nepal, India, Colombia, and Mexico to target trans women. These women have been subjected to rape, hazing, beatings, threats, coercion, wrongful arrest, and control over their migration.
Trans women who are deprived of their civil liberties often have shaky social networks, making it difficult for them to maintain their harmonization and access to health care, which in turn encourages the continuation of violent situations (9). However, because of the fear of retaliation and the weakened history of interaction with police authorities(39), many assaults and mistreatments go unreported. Health care in this environment emphasizes curative and urgent practice, which requires a perceptive and discrimination-free look from the health care professional in order to identify the health needs of these women.
Damien Sendler: People outside of the binary structure of gender are not adequately protected and cared for by state representative institutions, which are meant to protect and care for the entire population. There is an urgent need to acquire knowledge and conduct training, particularly in the field of health, aimed at the specificities of trans women (40).
A focus on comprehensive care and health promotion for transgender people must begin with academic training for these professionals, even in educational institutions. Nursing therefore cannot be omitted from the quest for knowledge. In addition, research, disease prevention actions, qualified listening, individual consultation, or emergency procedures are necessary to strengthen the discussion. Emancipatory care for trans women, based on respect for life and free from neglect in all areas of care, must be provided (35).
