A community based-research approach to understanding the needs of transgender sex-workers in the Dominican Republic
Background: A local AIDS service organization in the Dominican Republic has recently developed a social and educational space for transgender sex workers conducting HIV/AIDS prevention work in the area. In its development stage, a volunteer/consultant was contracted to conduct a needs assessment. Stigmatization forces individuals to be far removed from health care, employment and educational services. It also contributes to lack of social support therefore a better understanding of the harsh realities transgender face is recommended for program development.
Methods: Research methodology included a series of field observations, focus groups and in-depth interviews. Conversations were recorded, transcribed and analyzed. All data collected was confidential and meetings were private. Focus groups explored HIV knowledge and experience, societal dilemmas as it pertained to being transgender, gender identity and health access. Additional field observations included onsite visits to street work, homes, strategic planning meetings, dinners and parties. The findings were reported to community members and staff.
Results: Approximately 30-40 individuals contributed to the needs assessment and had at least visited the host organization once. Though about 95% of individuals understood HIV transmission, few had access or felt restricted to seeking health services. Their testimonies spoke clearly to having experienced stigma and discrimination. Stories included being excluded from family, schools and medical facilities. The group prioritized police harassment as their primary problem. Gender identity varied between individuals.
Conclusions: Developing rapport and a non-judgmental approach increased understanding and access to personal information. The wealth of information collected was useful for appropriate intervention planning. Transgender sex workers are experts of their lives. Social support and an active role in their health may lead to stronger community ties, increase access to useful and relevant health information and improved behavioral outcomes. A peer-based intervention is most recommended.
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