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Peer-reviewedCC BY-NC 4.0BMJ Open

Past-year violence experienced by transgender women living with HIV with or without recent involvement in transactional sex: the French national cross-sectional ANRS-Trans&HIV study

  • Marion Fiorentino1
  • Margot Annequin1
  • Aissatou Faye1
  • Marion Mora1
  • Raymond Van-Huizen1
  • Michel Bourrelly1
  • Gwenaëlle Maradan2
  • Cyril Berenger2
  • Florence Michard3
  • Yazdan Yazdanpanah3
  • Anaenza Freire Maresca4,5
  • Elisabeth Rouveix4
6 more authors
  • Liam Balhan6,7
  • Marie Costa6,7
  • David Michels6,7
  • Laszlo Blanquart8
  • Giovanna Rincon8
  • Bruno Spire1,7
8 affiliations
  1. 1IRD, Aix Marseille Univ, Inserm, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
  2. 2ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
  3. 3Service de Maladies Infectieuses, Hôpital Bichat - Claude-Bernard, Paris, Île-de-France, France
  4. 4Service de médecine interne, UFR Paris Île-de-France Ouest, Boulogne-billancourt, France
  5. 5Service de Maladies Infectieuses et Tropicales, Hôpital Avicenne, Bobigny, France
  6. 6AIDES, Pantin, France
  7. 7Community-Based Research Laboratory, Coalition PLUS, Pantin, France
  8. 8ACCEPTESS-T, Paris, France
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Abstract

Introduction: Stigma and violence experienced by transgender women and women engaged in transactional sex may negatively impact health and access to HIV care. We investigated typologies of past-year violence experienced by transgender women living with HIV (TWLH), with or without involvement in transactional sex (TWLH-TS and TWLH-nTS, respectively) in France.

Methods: We used data from the 2020–2022 French national cross-sectional ANRS-TRANS&HIV survey, which included TWLH recruited in 36 HIV care centres. We performed latent class analyses using variables representing combinations of past-year violence type and perpetrator separately for TWLH-TS and TWLH-nTS. Correlates of the resulting past-year violence typologies among TWLH-TS were assessed using multinomial logistic regression.

Results: Among TWLH-TS (66% of the 501 participants), three typologies emerged: low reported violence (42% of the 501 participants), multiple-perpetrator violence (8%) and client and street violence (17%). Among TWLH-nTS (34% of the 501 participants), two typologies emerged: low reported violence (30% of the 501 participants) and multiple-perpetrator violence (3%). In TWLH-TS, correlates of client and street violence were inadequate housing, ART interruption, stimulant use and daily cannabis use, while those of multiple-perpetrator violence were depression and a lack of emotional support. Client and street violence and multiple-perpetrator violence were correlated with meeting clients in outdoor locations.

Conclusion: TWLH in France face intersecting forms of systemic violence and structural vulnerability. One in ten experienced multi-form, multiple-perpetrator violence, regardless of transactional sex involvement, with potential consequences for mental health. Client and street violence affected one in four TWLH-TS, and was associated with precarious housing and working conditions, as well as substance use and ART adherence difficulties. Ensuring equitable access to HIV care and mental health services for transgender women is essential and inseparable from protecting their fundamental human rights and improving their socioeconomic conditions.

Trial Registration: NCT04849767 .

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Cite

BibTeXRIS
BibTeX
@article{fiorentino2026pastyear,
  title = {{Past-year violence experienced by transgender women living with HIV with or without recent involvement in transactional sex: the French national cross-sectional ANRS-Trans&HIV study}},
  author = {Marion Fiorentino and Margot Annequin and Aissatou Faye and Marion Mora and Raymond Van-Huizen and Michel Bourrelly and Gwenaëlle Maradan and Cyril Berenger and Florence Michard and Yazdan Yazdanpanah and Anaenza Freire Maresca and Elisabeth Rouveix and Liam Balhan and Marie Costa and David Michels and Laszlo Blanquart and Giovanna Rincon and Bruno Spire},
  journal = {BMJ Open},
  year = {2026},
  month = oct,
  doi = {10.1136/bmjopen-2025-111751},
  url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2025-111751},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Past-year violence experienced by transgender women living with HIV with or without recent involvement in transactional sex: the French national cross-sectional ANRS-Trans&HIV study
AU  - Marion Fiorentino
AU  - Margot Annequin
AU  - Aissatou Faye
AU  - Marion Mora
AU  - Raymond Van-Huizen
AU  - Michel Bourrelly
AU  - Gwenaëlle Maradan
AU  - Cyril Berenger
AU  - Florence Michard
AU  - Yazdan Yazdanpanah
AU  - Anaenza Freire Maresca
AU  - Elisabeth Rouveix
AU  - Liam Balhan
AU  - Marie Costa
AU  - David Michels
AU  - Laszlo Blanquart
AU  - Giovanna Rincon
AU  - Bruno Spire
PY  - 2026
DA  - 2026/10/01
JO  - BMJ Open
DO  - 10.1136/bmjopen-2025-111751
UR  - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2025-111751
AB  - Introduction: Stigma and violence experienced by transgender women and women engaged in transactional sex may negatively impact health and access to HIV care. We investigated typologies of past-year violence experienced by transgender women living with HIV (TWLH), with or without involvement in transactional sex (TWLH-TS and TWLH-nTS, respectively) in France.  Methods: We used data from the 2020–2022 French national cross-sectional ANRS-TRANS&HIV survey, which included TWLH recruited in 36 HIV care centres. We performed latent class analyses using variables representing combinations of past-year violence type and perpetrator separately for TWLH-TS and TWLH-nTS. Correlates of the resulting past-year violence typologies among TWLH-TS were assessed using multinomial logistic regression.  Results: Among TWLH-TS (66% of the 501 participants), three typologies emerged: low reported violence (42% of the 501 participants), multiple-perpetrator violence (8%) and client and street violence (17%). Among TWLH-nTS (34% of the 501 participants), two typologies emerged: low reported violence (30% of the 501 participants) and multiple-perpetrator violence (3%). In TWLH-TS, correlates of client and street violence were inadequate housing, ART interruption, stimulant use and daily cannabis use, while those of multiple-perpetrator violence were depression and a lack of emotional support. Client and street violence and multiple-perpetrator violence were correlated with meeting clients in outdoor locations.  Conclusion: TWLH in France face intersecting forms of systemic violence and structural vulnerability. One in ten experienced multi-form, multiple-perpetrator violence, regardless of transactional sex involvement, with potential consequences for mental health. Client and street violence affected one in four TWLH-TS, and was associated with precarious housing and working conditions, as well as substance use and ART adherence difficulties. Ensuring equitable access to HIV care and mental health services for transgender women is essential and inseparable from protecting their fundamental human rights and improving their socioeconomic conditions.  Trial Registration: NCT04849767 .
SN  - 2044-6055
SN  - 2044-6055
ER  -