VULNERABILIDADES EM SAÚDE DAS PESSOAS TRANSGÊNERO PROFISSIONAIS DO SEXO: REVISÃO INTEGRATIVA

Santana, Alef Diogo da Silva; Araújo, Ednaldo Cavalcante de; Abreu, Paula Daniella de; Lyra, Jorge; Lima, Marcos Soares de; Moura, Jefferson Wildes da Silva

Acessibilidade / Reportar erro

Brasil

Texto & Contexto - Enfermagem

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Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Revisão de Literatura • Texto contexto - enferm. 30 • 2021 • https://doi.org/10.1590/1980-265X-TCE-2020-0475 copiar

VULNERABILIDADES EM SAÚDE DAS PESSOAS TRANSGÊNERO PROFISSIONAIS DO SEXO: REVISÃO INTEGRATIVA

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo:

identificar as vulnerabilidades em saúde das pessoas transgênero profissionais do sexo.

Método:

revisão integrativa realizada em julho de 2020 nas bases PubMed, Web of Science, SCOPUS, CINAHL, IBECS e LILACS, sem restrição de idioma e tempo. Utilizaram-se os descritores indexados no DECS e MESH e seus respectivos sinônimos: “Pessoas transgênero”, “Profissionais do sexo” e “Vulnerabilidade em Saúde”. Os dados foram analisados a partir da análise temática.

Resultados:

foram resgatados 547 artigos e, após o processo de seleção e análise, 34 compuseram esta revisão. Quatro classes temáticas emergiram: “O conhecimento, prevenção e exposição às ISTs no trabalho sexual”; “O uso (e abuso) de substâncias ilícitas e o álcool”; “A dimensão social e estrutural das vulnerabilidades: das redes de apoio fragilizadas às violências reproduzidas contra os corpos dissidentes.” e “As doenças psicossociais, discriminação e desafios das pessoas trans profissionais do sexo”.

Conclusão:

as vulnerabilidades em saúde vivenciadas pelas pessoas trans profissionais do sexo são marcadas pela discriminação, exclusão social, estigma, contextos de encarceramento, violência física, psicológica e sexual, uso de substâncias ilícitas e álcool, além das dificuldades de acesso aos serviços essenciais como saúde, educação e lazer.

DESCRITORES:
Pessoas transgênero; Profissionais do sexo; Vulnerabilidade em saúde; Minorias sexuais e de gênero; Enfermagem

Base de Dados	Estratégia
PUBMED, SCOPUS	(((("transgender persons") OR transgenders) OR "Person, Transgender") OR Persons, Transgender OR Transgenders) OR Transgender) OR Transsexual Persons AND (((("Health Vulnerability") AND ((Sex Work") OR Work, Sex) OR Sex Industry) OR Prostitution)
CINAHL WEB OF SCIENCE	#1“transgender persons” OR transgender OR “Person, Transgender” OR “Persons, Transgender” OR “Transgenders” OR “Transsexual Persons” #2: “Health Vulnerability” #3: “Sex Work” OR “Work Sex” OR “Sex Industry” OR “Prostitution” Estratégia: #1 AND #2 AND #3
LILACS, IBECS	“Pessoas transgênero” OR “Pessoa trans” OR “Pessoas transexuais” OR “Transexual” OR “Transgênero” OR “Transgêneros” OR “personas transgénero” OR “transgender persons” OR “transgenders” OR “Person, transgender” OR “Transsexual Persons” AND “Vulnerabilidade em Saúde” OR “Vulnerabilidad en Salud” OR “Health Vulnerability” AND “Profissionais do sexo” OR “Trabajadores Sexuales” OR “Sex Workers” OR “Sex Industry” OR “Prostitution”

Autoria	Ano de publicação	Delineamento da pesquisa	Nível de evidência
Russi JC et al.2424. Russi JC, Serra M, Vinõles J, Pérez MT, Ruchansky D, Alonso G, et al. Sexual transmission of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus type 1 infections among male transvestite commercial sex workers in Montevideo, Uruguay. Am J Trop Med Hyg [Internet]. 2003 [cited 2020 June 18];68(6):716-20. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12887033 https://www.ncbi.nlm.nih.gov/pubmed/1288...	2003	Quantitativo - Epidemiológico, descritivo	V
Sausa LA et al.2525. Sausa LA, Keatley JA, Operario D. Perceived risks and benefits of sex work among transgender women of color in San Francisco. Arch Sex Behav [Internet]. 2007 [cited 2020 June 20];36(6):768-77. Available from: https://doi.org/10.1007/s10508-007-9210-3 https://doi.org/10.1007/s10508-007-9210-...	2007	Qualitativo	VI
Reisner SL et al.2626. Reisner SL, Mimiaga MJ, Bland S, Mayer KH, Perkovich B, Safren SA. HIV risk and social networks among male-to-female transgender sex workers in Boston, Massachusetts. J Assoc Nurses AIDS Care [Internet]. 2009 [cited 2020 June 18];20(5):373-86. Available from: https://doi.org/10.1016/j.jana.2009.06.003 https://doi.org/10.1016/j.jana.2009.06.0...	2009	Misto	V, VI
Wilson EC et al.2727. Wilson EC, Garafalo R, Harris RD, Herrick A, Martinez M, Martinez J, et al. Transgender female youth and sex work: HIV risk and a comparison of life factors related to engagement in sex work. AIDS Behav [Internet]. 2009 [cited 2020 June 18];13(5):902-13. Available from: https://doi.org/10.1007/s10461-008-9508-8 https://doi.org/10.1007/s10461-008-9508-...	2009	Quantitativo - Transversal, descritivo.	V
Infante C et al.2828. Infante C, Sosa-Rubi SG, Cuadra SM. Sex work in Mexico: Vulnerability of male, transvestite, transgender and transsexual sex workers. Cult Health Sex [internet]. 2009 [cited 2020 June 23];11(2):125-37. Available from: https://doi.org/10.1080/13691050802431314 https://doi.org/10.1080/1369105080243131...	2009	Qualitativo	VI
Farias MSR et al.2929. Farías MS dos R, García MN, Reynaga E, Romero M, Vaulet MLG, Fermepín MR, et al. First report on sexually transmitted infections among trans (male to female transvestites, transsexuals, or transgender) and male sex workers in Argentina: high HIV, HPV, HBV, and syphilis prevalence. Int J Infect Dis [Internet]. 2011 [cited 2020 June 18];15(9)e635-640. Available from: https://doi.org/10.1016/j.ijid.2011.05.007 https://doi.org/10.1016/j.ijid.2011.05.0...	2011	Quantitativo - Epidemiológico, descritivo	V
Farias MSR et al.3030. Farías MS dos R, Picconi MA, García MN, González JV, Basiletti J, Pando ML, et al. Human Papilloma virus genotype diversity of anal infection among trans (male to female transvestites, transsexuals or transgender) sex workers in Argentina. J Clin Virol [Internet]. 2011 [cited 2020 June 18];51(2):96-9. Available from: https://doi.org/10.1016/j.jcv.2011.03.008 https://doi.org/10.1016/j.jcv.2011.03.00...	2011	Quantitativo - Epidemiológico, descritivo	V
Cortez FCP et al.3131. Cortez FCP, Boer DP, Baltieri DA. A psychosocial study of male-to-female transgendered and male hustler sex workers in São Paulo, Brazil. Arch Sex Behav [Internet]. 2011 [cited 2020 June 20];40(6):1223-31. Available from: https://doi.org/10.1007/s10508-011-9776-7 https://doi.org/10.1007/s10508-011-9776-...	2011	Quantitativo - Transversal, descritivo	V
Nemoto B et al.3232. Nemoto T, Bödeker B, Iwamoto M. Social support, exposure to violence and transphobia, and correlates of depression among male-to-female transgender women with a history of sex work. Am J Public Health [Internet]. 2011 [cited 2020 June 22];101(10):1980-8. Available from: https://doi.org/10.2105/AJPH.2010.197285 https://doi.org/10.2105/AJPH.2010.197285...	2011	Quantitativo - Coorte	VI
Altaf A et al.3333. Altaf A, Zahidie A, Agha A. Comparing risk factors of HIV among hijra sex workers in Larkana and other cities of Pakistan: an analytical cross sectional study. BMC Public Health [Internet]. 2012 [cited 2020 June 23];12:279. Available from: https://doi.org/10.1186/1471-2458-12-279 https://doi.org/10.1186/1471-2458-12-279...	2012	Quantitativo - Transversal analítico	V
Nurena CR et al.3434. Nurena CR, Brown B, Galea JT, Sánchez H, Blas MM. HPV and genital warts among Peruvian men who have sex with men and transgender people: knowledge, attitudes and treatment experiences. PLoS One [Internet]. 2013 [cited 2020 June 1];8(3):e58684. Available from: https://doi.org/10.1371/journal.pone.0058684 https://doi.org/10.1371/journal.pone.005...	2013	Qualitativo	VI
Nemoto T et al.3535. Nemoto T, Iwamoto M, Perngparn U, Areesantichai C, Kamitani E, Sakata M. HIV-related risk behaviors among kathoey (male-to-female transgender) sex workers in Bangkok, Thailand. AIDS Care [Internet]. 2012 [cited 2020 June 18];24(2):210-9. Available from: https://doi.org/10.1080/09540121.2011.597709 https://doi.org/10.1080/09540121.2011.59...	2013	Misto	VI
Cai Y et al.99. Cai Y, Wang Z, Lau JT, Li J, Ma T, Liu J. Prevalence and associated factors of condom less receptive anal intercourse with male clients among transgender women sex workers in Shenyang, China. J Int AIDS Soc [Internet]. 2016 [cited 2020 June 18];19(3 Suppl 2):20800. Available from: https://doi.org/10.7448/IAS.19.3.20800 https://doi.org/10.7448/IAS.19.3.20800...	2016	Quantitativa - Transversal, descritivo	V
Giguere R et al.3636. Giguere R, Lopez-Rios J, Frasca T, Lentz C, Balán IC, Dolezal C, et al. Use of HIV self-testing kits to screen clients among transgender female sex workers in New York and Puerto Rico. AIDS Behav [Internet]. 2020 [cited 2020 June 22];24(2):506-15. Available from: https://doi.org/10.1007/s10461-019-02730-2 https://doi.org/10.1007/s10461-019-02730...	2016	Quantitativo - Ensaio clínico randomizado	II
Logie CH et al.1010. Logie CH, Wang Y, Lacombe-Duncan A, Jones N, Ahmed U, Levermore K, et al. Factors associated with sex work involvement among transgender women in Jamaica: a cross-section study. J Int AIDS Soc [Internet]. 2017 [cited 2020 June 15];20(1):21422. Available from: https://doi.org/10.7448/IAS.20.01/21422 https://doi.org/10.7448/IAS.20.01/21422...	2017	Quantitativa - Transversal, descritivo	V
Budhwani H et al.1313. Budhwani H, Hearld KR, Hasbun J, Charow R, Rosario S, Tillotson L, et al. Transgender female sex workers’ HIV knowledge, experienced stigma, and condom use in the Dominican Republic. PloS One [Internet]. 2017 [cited 2020 June 17];12(11):e0186457. Available from: https://doi.org/10.1371/journal.pone.0186457 https://doi.org/10.1371/journal.pone.018...	2017	Quantitativo - Transversal, descritivo	V
Nuttbrock LA et al.3737. Nuttbrock LA, Hwahng SJ. Ethnicity, sex work, and incident HIV/STI among transgender women in New York City: a three year prospective study. AIDS Behav [Internet]. 2017 [cited em 19 Jun 2020];21(12):3328-35. Available from: https://doi.org/10.1007/s10461-016-1509-4 https://doi.org/10.1007/s10461-016-1509-...	2017	Quantitativo - Longitudinal, prospectivo.	V
Lyons T et al.3838. Lyons T, Krüsi A, Pierre L, Kerr T, Pequeno W, Shannon K. Negotiating violence in the context of transphobia and criminalization: the experiences of trans sex workers in Vancouver, Canada. Qual Health Res [internet]. 2017 [cited 2020 June 20];27(2):182-90. Available from: https://doi.org/10.1177/1049732315613311 https://doi.org/10.1177/1049732315613311...	2017	Qualitativo	VI
Lyons T et al.3939. Lyons T, Krüsi A, Pierre L, Small W, Shannon KE. The impact of construction and gentrification on an outdoor trans sex work environment: Violence, displacement and policing. Sexualities [Internet]. 2017 [cited 2020 June 20];20(8):881-903. Available from: https://doi.org/10.1177/1363460716676990 https://doi.org/10.1177/1363460716676990...	2017	Qualitativo	VI
Samudzi Z et al.4040. Samudzi Z, Mannell J. Cisgender male and transgender female sex workers in South Africa: gender variant identities and narratives of exclusion. Cult Health Sex [Internet]. 2016 [cited 2020 June 20];18(1):1-14. Available from: https://doi.org/10.1080/13691058.2015.1062558 https://doi.org/10.1080/13691058.2015.10...	2017	Qualitativo	VI
Ganju S et al.4141. Ganju D, Saggurti N. Stigma, violence and HIV vulnerability among transgender persons in sex work in Maharashtra, India. Cult Health Sex [Internet]. 2017 [cited 2020 June 22];19(8):903-17. Available from: https://doi.org/10.1080/13691058.2016.1271141 https://doi.org/10.1080/13691058.2016.12...	2017	Qualitativo	VI
Budhwani H et al.4242. Budhwani H, Hearld KR, Hasbun J, Charow R, Rosario S, et al. Transgender women’s drug use in the Dominican Republic. Transgender Health [Internet]. 2017 [cited 2020 June 23];2(1):188-94. Available from: https://doi.org/10.1089/trgh.2017.0032 https://doi.org/10.1089/trgh.2017.0032...	2017	Quantitativo - Transversal, descritivo	V
Wickersham JA et al.4343. Wickersham JA, Gibson BA, Bazazi AR, Pillai V, Pedersen CJ, Meyer JP, et al. Prevalence of human immunodeficiency virus and sexually transmitted infections among cisgender and transgender women sex workers in greater Kuala Lumpur, Malaysia: Results from a respondent-driven sampling study. Sex Transm Dis [Internet]. 2017 [cited 2020 June 18];44(11):663-70. Available from: https://doi.org/10.1097/OLQ.0000000000000662 https://doi.org/10.1097/OLQ.000000000000...	2018	Quantitativo - Epidemiológico, descritivo	VI
Matthen P et al.4444. Matthen P, Lyons T, Taylor M, Jennex J, Anderson S, Jollimore J, et al. “I walked into the industry for survival and came out of a closet”: how gender and sexual identities shape sex work experiences among men, two spirit, and trans people in Vancouver. Men Masc [Internet]. 2018 [cited 2020 June 23];21(4):479-500. Available from: https://doi.org/10.1177/1097184X16664951 https://doi.org/10.1177/1097184X16664951...	2018	Mista	V, VI
Degtyar A, et al.4545. Degtyar A, George P, Mallma P, Díaz D, Cárcamo C, García P, et al. Sexual risk, behavior, and HIV testing and status among male and transgender women sex workers and their clients in Lima, Peru. Int J Sex Health [Internet]. 2018 [cited 2020 June 23];30(1):81-91. Available from: https://doi.org/10.1080/19317611.2018.1429514 https://doi.org/10.1080/19317611.2018.14...	2018	Qualitativo	VI
Khalid M et al.4646. Khalid H, Martin EG. Relationship between network operators and risky sex behaviors among female versus transgender commercial sex workers in Pakistan. AIDS Care [Internet]. 2019 [cited 2020 June 22];31(6):767-76. Available from: https://doi.org/10.1080/09540121.2018.1557317 https://doi.org/10.1080/09540121.2018.15...	2019	Quantitativo - Transversal, descritivo	V
Sherman SG et al.4747. Sherman SG, Park JN, Galai N, Allen ST, Huettner SS, Silberzahn BE. Drivers of HIV infection among cisgender and transgender female sex worker populations in Baltimore City: Results from the SAPPHIRE Study. J Acquir Immune Defic Syndr [internet]. 2019 [cited 2020 June 22];80(5):513-21. Available from: https://doi.org/10.1097/QAI.0000000000001959 https://doi.org/10.1097/QAI.000000000000...	2019	Quantitativo - Coorte	IV
Jarrett D et al.4848. Jarrett D, Miles G, Quinley JH. “Same same, but different”: A baseline study on the vulnerabilities of transgender sex workers in the sex industry in Bangkok, Thailand. Int J Sociol Soc Policy [Internet]. 2019 [cited 2020 June 23];39(7/8):550-73. Available from: https://doi.org/10.1108/IJSSP-01-2019-0022 https://doi.org/10.1108/IJSSP-01-2019-00...	2019	Qualitativo	VI
Guler E et al.4949. Guler E. A divided sisterhood: support networks of trans sex workers in urban Turkey. AAPSS [internet]. 2020 [cited 2020 June 22];689(1):149-67. Available from: https://doi.org/10.1177/0002716220919745 https://doi.org/10.1177/0002716220919745...	2020	Qualitativo	VI
Wang Q et al.5050. Wang Q, Chang R, Wang Y, Jiang X, Chang S, Shen Q, et al. Correlates of alcohol and illicit drug use before commercial sex among transgender women with a history of sex work in China. Sexual Health [Internet]. 2019 [cited 2020 June 22];17(1):45-52. Available from: https://doi.org/10.1071/sh18194 https://doi.org/10.1071/sh18194...	2020	Quantitativo - Transversal, descritivo	V
Drückler S et al.5151. Drückler S, Van Rooijen MS, Vries HJC. Substance use and sexual risk behavior among male and transgender women sex workers at the prostitution outreach center in Amsterdam, the Netherlands. Sex Transm Dis [Internet]. 2020 [cited 2020 June 22];47(2):114-21. Available from: https://doi.org/10.1097/OLQ.0000000000001096 https://doi.org/10.1097/OLQ.000000000000...	2020	Quantitativo - Transversal, descritivo	V
Miller WM et al.5252. Miller WM, Miller WC, Barrington C, Weir SS, Chen SY, Emch ME, et al. Sex work, discrimination, drug use and violence: a pattern for HIV risk among transgender sex workers compared to MSM sex workers and other MSM in Guatemala. Glob Public Health [Internet]. 2020 [cited 2020 June 22];15(2):262-74. Available from: https://doi.org/10.1080/17441692.2019.1671984 https://doi.org/10.1080/17441692.2019.16...	2020	Quantitativo - Transversal, descritivo	V
Poteat T et al.5353. Poteat T, White RH, Footer KHA, Park NJ, Galai N, Huettner S. Characterising HIV and STIs among transgender female sex workers: A longitudinal analysis. Sex Transm Infect [Internet]. 2021 [cited 2020 June 23];97:226-31. Available from: https://doi.org/10.1136/sextrans-2019-054414 https://doi.org/10.1136/sextrans-2019-05...	2020	Quantitativo - Coorte	IV
Capous-Desyllas M et al.5454. Capous-Desyllas M, Loy V. Navigating intersecting identities, self-representation, and relationships: a qualitative study with trans sex workers living and working in Los Angeles. Sociological Inquiry [Internet]. 2020 [cited 2020 June 23];90(2):339-70. Available from: https://doi.org/10.1111/soin.12350 https://doi.org/10.1111/soin.12350...	2020	Qualitativo	VI

Categorização Temática	Síntese das Vulnerabilidades em Saúde das pessoas trans profissionais do sexo.
O conhecimento, a prevenção e a exposição às ISTs no trabalho sexual.	Revelaram-se o desconhecimento sobre a transmissão do vírus do HIV e os frágeis conhecimentos sobre a identificação de sinais e sintomas de algumas ISTs, como as verrugas do HPV. Os “acordos sexuais” favorecem a baixa adesão ao uso do preservativo. Identificou-se a realização de prática sexual anal (insertivo e receptivo) e da ejaculação na boca sem preservativo e como a feminilização das mulheres transexuais pode influenciar no uso ou não do preservativo. Foi possível evidenciar, ainda, altas prevalências de HIV, Hepatite B e sífilis, além dos genótipos de alto risco do HPV99. Cai Y, Wang Z, Lau JT, Li J, Ma T, Liu J. Prevalence and associated factors of condom less receptive anal intercourse with male clients among transgender women sex workers in Shenyang, China. J Int AIDS Soc [Internet]. 2016 [cited 2020 June 18];19(3 Suppl 2):20800. Available from: https://doi.org/10.7448/IAS.19.3.20800 https://doi.org/10.7448/IAS.19.3.20800... ^,1313. Budhwani H, Hearld KR, Hasbun J, Charow R, Rosario S, Tillotson L, et al. Transgender female sex workers’ HIV knowledge, experienced stigma, and condom use in the Dominican Republic. PloS One [Internet]. 2017 [cited 2020 June 17];12(11):e0186457. Available from: https://doi.org/10.1371/journal.pone.0186457 https://doi.org/10.1371/journal.pone.018... ^,2626. Reisner SL, Mimiaga MJ, Bland S, Mayer KH, Perkovich B, Safren SA. HIV risk and social networks among male-to-female transgender sex workers in Boston, Massachusetts. J Assoc Nurses AIDS Care [Internet]. 2009 [cited 2020 June 18];20(5):373-86. Available from: https://doi.org/10.1016/j.jana.2009.06.003 https://doi.org/10.1016/j.jana.2009.06.0... ^,2929. Farías MS dos R, García MN, Reynaga E, Romero M, Vaulet MLG, Fermepín MR, et al. First report on sexually transmitted infections among trans (male to female transvestites, transsexuals, or transgender) and male sex workers in Argentina: high HIV, HPV, HBV, and syphilis prevalence. Int J Infect Dis [Internet]. 2011 [cited 2020 June 18];15(9)e635-640. Available from: https://doi.org/10.1016/j.ijid.2011.05.007 https://doi.org/10.1016/j.ijid.2011.05.0... ^-3030. Farías MS dos R, Picconi MA, García MN, González JV, Basiletti J, Pando ML, et al. Human Papilloma virus genotype diversity of anal infection among trans (male to female transvestites, transsexuals or transgender) sex workers in Argentina. J Clin Virol [Internet]. 2011 [cited 2020 June 18];51(2):96-9. Available from: https://doi.org/10.1016/j.jcv.2011.03.008 https://doi.org/10.1016/j.jcv.2011.03.00... ^,3333. Altaf A, Zahidie A, Agha A. Comparing risk factors of HIV among hijra sex workers in Larkana and other cities of Pakistan: an analytical cross sectional study. BMC Public Health [Internet]. 2012 [cited 2020 June 23];12:279. Available from: https://doi.org/10.1186/1471-2458-12-279 https://doi.org/10.1186/1471-2458-12-279... ^-3737. Nuttbrock LA, Hwahng SJ. Ethnicity, sex work, and incident HIV/STI among transgender women in New York City: a three year prospective study. AIDS Behav [Internet]. 2017 [cited em 19 Jun 2020];21(12):3328-35. Available from: https://doi.org/10.1007/s10461-016-1509-4 https://doi.org/10.1007/s10461-016-1509-... ^,4141. Ganju D, Saggurti N. Stigma, violence and HIV vulnerability among transgender persons in sex work in Maharashtra, India. Cult Health Sex [Internet]. 2017 [cited 2020 June 22];19(8):903-17. Available from: https://doi.org/10.1080/13691058.2016.1271141 https://doi.org/10.1080/13691058.2016.12... ^,4343. Wickersham JA, Gibson BA, Bazazi AR, Pillai V, Pedersen CJ, Meyer JP, et al. Prevalence of human immunodeficiency virus and sexually transmitted infections among cisgender and transgender women sex workers in greater Kuala Lumpur, Malaysia: Results from a respondent-driven sampling study. Sex Transm Dis [Internet]. 2017 [cited 2020 June 18];44(11):663-70. Available from: https://doi.org/10.1097/OLQ.0000000000000662 https://doi.org/10.1097/OLQ.000000000000... ^,4545. Degtyar A, George P, Mallma P, Díaz D, Cárcamo C, García P, et al. Sexual risk, behavior, and HIV testing and status among male and transgender women sex workers and their clients in Lima, Peru. Int J Sex Health [Internet]. 2018 [cited 2020 June 23];30(1):81-91. Available from: https://doi.org/10.1080/19317611.2018.1429514 https://doi.org/10.1080/19317611.2018.14... ^-4747. Sherman SG, Park JN, Galai N, Allen ST, Huettner SS, Silberzahn BE. Drivers of HIV infection among cisgender and transgender female sex worker populations in Baltimore City: Results from the SAPPHIRE Study. J Acquir Immune Defic Syndr [internet]. 2019 [cited 2020 June 22];80(5):513-21. Available from: https://doi.org/10.1097/QAI.0000000000001959 https://doi.org/10.1097/QAI.000000000000... ^,5353. Poteat T, White RH, Footer KHA, Park NJ, Galai N, Huettner S. Characterising HIV and STIs among transgender female sex workers: A longitudinal analysis. Sex Transm Infect [Internet]. 2021 [cited 2020 June 23];97:226-31. Available from: https://doi.org/10.1136/sextrans-2019-054414 https://doi.org/10.1136/sextrans-2019-05... .
O uso (e abuso) de substâncias ilícitas e o álcool.	Foi identificado o consumo de drogas como cocaína, além das drogas de uso injetável e de inalação durante o trabalho sexual. Há relatos de uso de álcool excessivo, da prática profissional sob a influência de álcool e uso de forma combinada de álcool e droga durante e/ou antes da prática sexual, descrevendo que “o trabalho fisicamente fica mais fácil”1010. Logie CH, Wang Y, Lacombe-Duncan A, Jones N, Ahmed U, Levermore K, et al. Factors associated with sex work involvement among transgender women in Jamaica: a cross-section study. J Int AIDS Soc [Internet]. 2017 [cited 2020 June 15];20(1):21422. Available from: https://doi.org/10.7448/IAS.20.01/21422 https://doi.org/10.7448/IAS.20.01/21422... ^,2424. Russi JC, Serra M, Vinõles J, Pérez MT, Ruchansky D, Alonso G, et al. Sexual transmission of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus type 1 infections among male transvestite commercial sex workers in Montevideo, Uruguay. Am J Trop Med Hyg [Internet]. 2003 [cited 2020 June 18];68(6):716-20. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12887033 https://www.ncbi.nlm.nih.gov/pubmed/1288... ^,3535. Nemoto T, Iwamoto M, Perngparn U, Areesantichai C, Kamitani E, Sakata M. HIV-related risk behaviors among kathoey (male-to-female transgender) sex workers in Bangkok, Thailand. AIDS Care [Internet]. 2012 [cited 2020 June 18];24(2):210-9. Available from: https://doi.org/10.1080/09540121.2011.597709 https://doi.org/10.1080/09540121.2011.59... ^,4242. Budhwani H, Hearld KR, Hasbun J, Charow R, Rosario S, et al. Transgender women’s drug use in the Dominican Republic. Transgender Health [Internet]. 2017 [cited 2020 June 23];2(1):188-94. Available from: https://doi.org/10.1089/trgh.2017.0032 https://doi.org/10.1089/trgh.2017.0032... ^-4343. Wickersham JA, Gibson BA, Bazazi AR, Pillai V, Pedersen CJ, Meyer JP, et al. Prevalence of human immunodeficiency virus and sexually transmitted infections among cisgender and transgender women sex workers in greater Kuala Lumpur, Malaysia: Results from a respondent-driven sampling study. Sex Transm Dis [Internet]. 2017 [cited 2020 June 18];44(11):663-70. Available from: https://doi.org/10.1097/OLQ.0000000000000662 https://doi.org/10.1097/OLQ.000000000000... ^,4747. Sherman SG, Park JN, Galai N, Allen ST, Huettner SS, Silberzahn BE. Drivers of HIV infection among cisgender and transgender female sex worker populations in Baltimore City: Results from the SAPPHIRE Study. J Acquir Immune Defic Syndr [internet]. 2019 [cited 2020 June 22];80(5):513-21. Available from: https://doi.org/10.1097/QAI.0000000000001959 https://doi.org/10.1097/QAI.000000000000... ^,5050. Wang Q, Chang R, Wang Y, Jiang X, Chang S, Shen Q, et al. Correlates of alcohol and illicit drug use before commercial sex among transgender women with a history of sex work in China. Sexual Health [Internet]. 2019 [cited 2020 June 22];17(1):45-52. Available from: https://doi.org/10.1071/sh18194 https://doi.org/10.1071/sh18194... ^-5252. Miller WM, Miller WC, Barrington C, Weir SS, Chen SY, Emch ME, et al. Sex work, discrimination, drug use and violence: a pattern for HIV risk among transgender sex workers compared to MSM sex workers and other MSM in Guatemala. Glob Public Health [Internet]. 2020 [cited 2020 June 22];15(2):262-74. Available from: https://doi.org/10.1080/17441692.2019.1671984 https://doi.org/10.1080/17441692.2019.16... .
A dimensão social e estrutural das vulnerabilidades: das redes de apoio fragilizadas às violências reproduzidas contra os corpos dissidentes.	Destacam-se adversidades econômicas e interpessoais, histórico de expulsão de casa, redes de apoio fragilizadas e dificuldades no emprego devido ao gênero, além da exclusão que restringe o acesso a espaços sociais. A inserção no trabalho sexual é considerada uma “norma” para jovens mulheres transgênero devido ao preconceito e dificuldades no mercado de trabalho formal, sendo possível identificar que a população com menos de 36 anos de idade era mais envolvida com trabalho sexual. O envolvimento no trabalho sexual é, muitas vezes, devido às necessidades de sobrevivência. Emergiram-se o contexto de violência, de assédio contra as trabalhadoras sexuais transgênero e como este preconceito é moldado pelo contexto sócio estrutural, além dos cenários de encarceramento e criminalização. Em geral, a vulnerabilidade é influenciada pelo contexto social e estigma, bem como o acesso às redes de apoio escassas e falta de apoio em termos de programas sociais e de saúde1010. Logie CH, Wang Y, Lacombe-Duncan A, Jones N, Ahmed U, Levermore K, et al. Factors associated with sex work involvement among transgender women in Jamaica: a cross-section study. J Int AIDS Soc [Internet]. 2017 [cited 2020 June 15];20(1):21422. Available from: https://doi.org/10.7448/IAS.20.01/21422 https://doi.org/10.7448/IAS.20.01/21422... ^,2424. Russi JC, Serra M, Vinõles J, Pérez MT, Ruchansky D, Alonso G, et al. Sexual transmission of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus type 1 infections among male transvestite commercial sex workers in Montevideo, Uruguay. Am J Trop Med Hyg [Internet]. 2003 [cited 2020 June 18];68(6):716-20. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12887033 https://www.ncbi.nlm.nih.gov/pubmed/1288... ^-2525. Sausa LA, Keatley JA, Operario D. Perceived risks and benefits of sex work among transgender women of color in San Francisco. Arch Sex Behav [Internet]. 2007 [cited 2020 June 20];36(6):768-77. Available from: https://doi.org/10.1007/s10508-007-9210-3 https://doi.org/10.1007/s10508-007-9210-... ^,2727. Wilson EC, Garafalo R, Harris RD, Herrick A, Martinez M, Martinez J, et al. Transgender female youth and sex work: HIV risk and a comparison of life factors related to engagement in sex work. AIDS Behav [Internet]. 2009 [cited 2020 June 18];13(5):902-13. Available from: https://doi.org/10.1007/s10461-008-9508-8 https://doi.org/10.1007/s10461-008-9508-... ^-2828. Infante C, Sosa-Rubi SG, Cuadra SM. Sex work in Mexico: Vulnerability of male, transvestite, transgender and transsexual sex workers. Cult Health Sex [internet]. 2009 [cited 2020 June 23];11(2):125-37. Available from: https://doi.org/10.1080/13691050802431314 https://doi.org/10.1080/1369105080243131... ^,3131. Cortez FCP, Boer DP, Baltieri DA. A psychosocial study of male-to-female transgendered and male hustler sex workers in São Paulo, Brazil. Arch Sex Behav [Internet]. 2011 [cited 2020 June 20];40(6):1223-31. Available from: https://doi.org/10.1007/s10508-011-9776-7 https://doi.org/10.1007/s10508-011-9776-... ^,3535. Nemoto T, Iwamoto M, Perngparn U, Areesantichai C, Kamitani E, Sakata M. HIV-related risk behaviors among kathoey (male-to-female transgender) sex workers in Bangkok, Thailand. AIDS Care [Internet]. 2012 [cited 2020 June 18];24(2):210-9. Available from: https://doi.org/10.1080/09540121.2011.597709 https://doi.org/10.1080/09540121.2011.59... ^,3737. Nuttbrock LA, Hwahng SJ. Ethnicity, sex work, and incident HIV/STI among transgender women in New York City: a three year prospective study. AIDS Behav [Internet]. 2017 [cited em 19 Jun 2020];21(12):3328-35. Available from: https://doi.org/10.1007/s10461-016-1509-4 https://doi.org/10.1007/s10461-016-1509-... ^-4242. Budhwani H, Hearld KR, Hasbun J, Charow R, Rosario S, et al. Transgender women’s drug use in the Dominican Republic. Transgender Health [Internet]. 2017 [cited 2020 June 23];2(1):188-94. Available from: https://doi.org/10.1089/trgh.2017.0032 https://doi.org/10.1089/trgh.2017.0032... ^,4444. Matthen P, Lyons T, Taylor M, Jennex J, Anderson S, Jollimore J, et al. “I walked into the industry for survival and came out of a closet”: how gender and sexual identities shape sex work experiences among men, two spirit, and trans people in Vancouver. Men Masc [Internet]. 2018 [cited 2020 June 23];21(4):479-500. Available from: https://doi.org/10.1177/1097184X16664951 https://doi.org/10.1177/1097184X16664951... ^,4747. Sherman SG, Park JN, Galai N, Allen ST, Huettner SS, Silberzahn BE. Drivers of HIV infection among cisgender and transgender female sex worker populations in Baltimore City: Results from the SAPPHIRE Study. J Acquir Immune Defic Syndr [internet]. 2019 [cited 2020 June 22];80(5):513-21. Available from: https://doi.org/10.1097/QAI.0000000000001959 https://doi.org/10.1097/QAI.000000000000... ^-4949. Guler E. A divided sisterhood: support networks of trans sex workers in urban Turkey. AAPSS [internet]. 2020 [cited 2020 June 22];689(1):149-67. Available from: https://doi.org/10.1177/0002716220919745 https://doi.org/10.1177/0002716220919745... ^,5252. Miller WM, Miller WC, Barrington C, Weir SS, Chen SY, Emch ME, et al. Sex work, discrimination, drug use and violence: a pattern for HIV risk among transgender sex workers compared to MSM sex workers and other MSM in Guatemala. Glob Public Health [Internet]. 2020 [cited 2020 June 22];15(2):262-74. Available from: https://doi.org/10.1080/17441692.2019.1671984 https://doi.org/10.1080/17441692.2019.16... .
As doenças psicossociais, discriminação e desafios das pessoas trans profissionais do sexo.	O sexo pago foi associado com depressão, ideação suicida e níveis mais altos de danos. Há a descrição de sentimentos negativos em relação a lidar com estereótipos e estigmas. Há vários desafios que envolvem desde experiências de transfobia de clientes até sentimentos de repulsa reproduzidos pela família, clientes e sociedade, que vão culminar em contextos de sofrimentos psíquicos1010. Logie CH, Wang Y, Lacombe-Duncan A, Jones N, Ahmed U, Levermore K, et al. Factors associated with sex work involvement among transgender women in Jamaica: a cross-section study. J Int AIDS Soc [Internet]. 2017 [cited 2020 June 15];20(1):21422. Available from: https://doi.org/10.7448/IAS.20.01/21422 https://doi.org/10.7448/IAS.20.01/21422... ^,3131. Cortez FCP, Boer DP, Baltieri DA. A psychosocial study of male-to-female transgendered and male hustler sex workers in São Paulo, Brazil. Arch Sex Behav [Internet]. 2011 [cited 2020 June 20];40(6):1223-31. Available from: https://doi.org/10.1007/s10508-011-9776-7 https://doi.org/10.1007/s10508-011-9776-... ^,3535. Nemoto T, Iwamoto M, Perngparn U, Areesantichai C, Kamitani E, Sakata M. HIV-related risk behaviors among kathoey (male-to-female transgender) sex workers in Bangkok, Thailand. AIDS Care [Internet]. 2012 [cited 2020 June 18];24(2):210-9. Available from: https://doi.org/10.1080/09540121.2011.597709 https://doi.org/10.1080/09540121.2011.59... ^,5454. Capous-Desyllas M, Loy V. Navigating intersecting identities, self-representation, and relationships: a qualitative study with trans sex workers living and working in Los Angeles. Sociological Inquiry [Internet]. 2020 [cited 2020 June 23];90(2):339-70. Available from: https://doi.org/10.1111/soin.12350 https://doi.org/10.1111/soin.12350... .

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Alef Diogo da Silva Santana alefeerp@usp.br