Transgender Intimate Partner Violence and Help-Seeking Patterns

Community-Based Participatory Research with Sexual and Gender Minority Trauma Survivors: Challenges, Solutions, and Recommendations for Future Research

Research on sexual and gender minority (SGM) and domestic violence/sexual assault (DV/SA) is needed given that SGM people are at elevated risk of experiencing DV/SA and accessing inclusive and affirming services from DV/SA community agencies poses challenges for SGM survivors. Community-based participatory research (CBPR) is emerging as a valuable methodological tool in this area, yet few CBPR studies focus on DV/SA among SGM people. In the current paper, we present a case study of a CBPR study conducted in collaboration with SGM survivors of DV/SA, as well as community stakeholders (i.e., DV/SA agency staff and providers). More specifically, we make six recommendations to address CBPR study challenges specifically focused on SGM DV/SA, including (a) integrating positionality throughout every step of the research process, (b) establishing rapport with community partners early in the process, (c) engaging external experts in conducting research related to SGM DV/SA to enhance community-research partnerships, (d) ensuring diverse identities are represented within the study team, (e) developing clear, co-defined feedback and communication guidelines with a Survivor Advisory Board (SAB), and (f) implementing an SAB engagement/retention plan. We also provide concrete examples from our CBPR case study to illustrate each recommendation. These recommendations may enhance the impact of conducting CBPR that seeks to promote recovery from DV/SA among SGM via practices for sustainable community partnerships and linkage-to-care efforts for SGM survivors.

Factors Associated with Transgender and Gender Diverse People's Experience of Sexual Coercion, and Help-Seeking and Wellbeing Among Victims/Survivors: Results of the First Australian Trans and Gender Diverse Sexual Health Survey

Purpose: Our study examined factors associated with transgender and gender diverse ("trans") people's experience of sexual coercion, as well as the factors associated with help-seeking and wellbeing among victims/survivors. Methods: We analyzed cross-sectional data from the first Australian Trans and Gender Diverse Sexual Health Survey, conducted in 2018. Logistic regressions were undertaken to identify factors associated with sexual coercion, help-seeking, and wellbeing. Results: Of the sample of 1448 participants, 53.4% had been sexually coerced, which was associated with older age, Aboriginal or Torres Strait Islander descent, nonbinary gender, being presumed female gender at birth, currently living publicly some or all the time as their affirmed gender, having regular sex, and use of drugs to enhance or alter sexual experiences. Protective factors included having a higher income and access to gender affirming care. Help-seeking was reported among 49.5% of victims/survivors and was associated with having more trans friends. Wellbeing among victims/survivors was associated with being older, residing in regional/remote areas, having higher levels of education and annual income, being presumed female gender at birth, having stronger satisfaction with one's sex life, and good health care access. Wellbeing was not associated with help-seeking. Conclusion: Sexual coercion was prevalent among participants, but help-seeking behavior was low. Protective factors identified underscore the importance of socioeconomic supports, access to health and gender affirming care, and peers. Accessible peer-led and culturally safe preventive and trauma-focused supports should also be considered for trans people who experience sexual coercion.

The Association Between Sexual Violence and Suicidal Ideation Among Transgender Women and the Role of Gender-Affirming Healthcare Providers in Seven Urban Areas in the United States, 2019 to 2020

Transgender women are disproportionately affected by sexual violence and corresponding mental health sequelae; however, many do not access healthcare due to experiences with transphobia. This analysis evaluated the association between sexual violence and suicidal ideation and the moderating effect of having a healthcare provider (HCP) with whom transgender women were comfortable discussing gender-related issues ("gender-affirming HCP"). We analyzed cross-sectional data from the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance among Transgender Women (NHBS-Trans). Transgender women were recruited using respondent-driven sampling from seven urban areas from 2019 to 2020 and participated in an HIV biobehavioral survey. This analysis was restricted to transgender women who visited a HCP in the past 12 months ("healthcare-seeking transgender women" [HSTW]) (N = 1,489). Log-linked Poisson regression models provided adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) to estimate the association between sexual violence and suicidal ideation in the past 12 months. The interaction between sexual violence and having a gender-affirming HCP was statistically significant (p-value = .034). Among 1,489 HSTW, 225 (15.1%) experienced sexual violence and 261 (17.5%) reported suicidal ideation; 1,203 (80.8%) reported having a gender-affirming HCP. Sexual violence was associated with suicidal ideation (aPR = 2.65, 95% CI [2.08, 3.38]); the association was notably higher among those who did not have a gender-affirming HCP (aPR = 3.61, [2.17, 6.02]) than among those who did (aPR = 1.87, [1.48, 2.37]). Eliminating transphobia and promoting trauma- and violence-informed approaches in healthcare are necessary for sexual violence and suicide prevention among HSTW.

Disclosure and Help-Seeking Experiences of Sexual and Gender Minority Victims of Intimate Partner Violence: A Mixed-Methods Study

Sexual and gender minorities assigned female at birth (SGM-AFAB) experience high rates of intimate partner violence (IPV), with negative effects on health and well-being. Disclosure of and help-seeking for IPV can support the well-being of IPV survivors, yet are understudied among SGM-AFAB people. To better understand the IPV disclosure and help-seeking experiences in this population, we conducted semi-structured interviews with 41 SGM-AFAB young adults who experienced physical, sexual, or severe psychological IPV. Qualitative analyses explored to whom SGM-AFAB disclosed IPV, barriers to disclosure/help-seeking, the types of responses received, and perceived helpfulness of responses. Exploratory mixed methods analyses assessed frequency of code endorsement, demographic differences, and associations among codes. Three-quarters of participants disclosed IPV, though rates were lower for sexual and physical than psychological IPV and very few sought help from formal sources. The most common barriers to disclosure were not viewing the IPV as abuse and anticipation of negative responses, often due to stigma; other participants described inability to access formal help and concerns about SGM incompetence in those services. Most actual responses received were considered helpful, including emotional support, labeling the IPV as unhealthy, nonjudgmental listening, actions to stop the IPV, and practical support. Minimizing IPV or criticizing the victim was common unhelpful response; advice to end the relationship was considered helpful and unhelpful. Whereas 92% of friend responses were described as helpful, around half of family (56%) and therapist (62%) responses were helpful. Findings suggest that efforts to increase access to culturally affirmative services and educate SGM youth to recognize IPV in their relationships may help promote help-seeking and well-being among SGM-AFAB IPV survivors.

Multilevel experiences of carceral violence in Los Angeles, California: first-hand accounts from a racially diverse sample of transgender women

Transgender women face a disproportionate burden of carceral violence, or violence related to policing and the criminal legal system, with transgender women of colour experiencing even greater disparities. Several frameworks conceptualise the mechanisms through which violence impacts transgender women. However, none of them directly explore the role of carceral violence, particularly as it is experienced by transgender women themselves. Sixteen in-depth interviews were conducted with a racially/ethnically diverse sample of transgender women in Los Angeles between May and July 2020. Participants were between 23 - 67 years old. Participants identified as Black (n = 4), Latina (n = 4), white (n = 2), Asian (n = 2), and Native American (n = 2). Interviews assessed experiences of multilevel violence, including from police and law enforcement. Deductive and inductive coding methods were used to identify and explore common themes concerning carceral violence. Experiences of law enforcement-perpetrated interpersonal violence were common and included physical, sexual and verbal abuse. Participants also highlighted structural violence, including misgendering, the non-acceptance of transgender identities, and police intentionally failing to uphold laws that could protect transgender women. These results demonstrate the pervasive, multilevel nature of carceral violence perpetrated against transgender women and suggest avenues for future framework development, trans-specific expansions of carceral theory, and system-wide institutional change.

Social Support and the Association Between Certain Forms of Violence and Harassment and Suicidal Ideation Among Transgender Women - National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019-2020

Violence and harassment toward transgender women are associated with suicidal thoughts and behaviors, and social support might moderate such association. This analysis explored the association between certain forms of violence and harassment and suicidal ideation and moderation by social support. Better understanding of these associations could guide mental health services and structural interventions appropriate to lived experiences of transgender women. This cross-sectional analysis used data from CDC's National HIV Behavioral Surveillance Among Transgender Women. During 2019-2020, transgender women were recruited via respondent-driven sampling from seven urban areas in the United States for an HIV biobehavioral survey. The association between experiencing certain forms of violence and harassment (i.e., gender-based verbal and physical abuse or harassment, physical intimate partner abuse or harassment, and sexual violence) and suicidal ideation was measured using adjusted prevalence ratios and 95% CIs generated from log-linked Poisson regression models controlling for respondent-driven sampling design and confounders. To examine moderation, the extents of social support from family, friends, and significant others were assessed for interaction with certain forms of violence and harassment; if p interaction was <0.05, stratified adjusted prevalence ratios were presented. Among 1,608 transgender women, 59.7% experienced certain forms of violence and harassment and 17.7% reported suicidal ideation during the past 12 months; 75.2% reported high social support from significant others, 69.4% from friends, and 46.8% from family. Experiencing certain forms of violence and harassment and having low-moderate social support from any source was associated with higher prevalence of suicidal ideation. Social support from family moderated the association between experiencing certain forms of violence and harassment and suicidal ideation (p interaction = 0.01); however, even in the presence of high family social support, experiencing certain forms of violence and harassment was associated with higher prevalence of suicidal ideation. Social support did not completely moderate the positive association between experiencing violence and harassment and suicidal ideation. Further understanding of the social support dynamics of transgender women might improve the quality and use of social support. Policymakers and health care workers should work closely with transgender women communities to reduce the prevalence of violence, harassment, and suicide by implementing integrated, holistic, and transinclusive approaches.

Help-Seeking for Severe Intimate Partner Violence Among Sexual and Gender Minority Adolescents and Young Adults Assigned Female at birth: A Latent Class Analysis

Sexual and gender minority adolescents and young adults assigned female at birth (SGM-AFAB) report high rates of intimate partner violence (IPV) victimization. Despite adverse health outcomes of IPV, many survivors, particularly SGM-AFAB, do not seek help. This study (1) examined the proportion of SGM-AFAB who reported severe IPV victimization who sought help; (2) elucidated patterns of help-seeking facilitators and barriers; and (3) identified associations between sociodemographic characteristics, IPV victimization types, and minority stressors and latent classes of help-seeking facilitators and barriers. Participants included 193 SGM-AFAB (Mage = 20.6, SD = 3.4; 65.8% non-monosexual; 73.1% cisgender; 72.5% racial/ethnic minority; 16.6% annual household income $20,000 or less). Most participants who experienced severe IPV did not seek help (62.2%). Having a person or provider who was aware of the participant's abusive relationship was the most common reason for seeking help (50; 68.5%). Minimizing IPV was the most common reason for not seeking help (103; 87.3%). Fewer than 5% of SGM-AFAB who experienced severe IPV and who did not seek help reported SGM-specific help-seeking barriers, including not wanting to contribute to negative perceptions of the LGBTQ community, not disclosing their SGM status, and perceiving a lack of tailored services. Help-seeking facilitators and barriers varied by sociodemographic characteristics. Three classes of help-seeking facilitators and two classes of help-seeking barriers emerged. SGM-AFAB subgroups based on sexual and gender identity, recent coercive control, and identity as IPV victims differed in latent classes. This study's findings confirm SGM-AFAB IPV survivors' low likelihood of seeking help. Our results also underscore the importance of continuing to bolster SGM-AFAB survivors' access to trauma-informed, culturally sensitive, and affirming support. Further, multilevel prevention and intervention efforts are needed to reduce minimization of abuse and anticipatory judgment and blame among SGM-AFAB who hold multiple marginalized identities, experience coercive control, and identify as IPV victims.

Disclosure Experiences for Transgender and Nonbinary Survivors of Intimate Partner Violence

While transgender individuals experience high rates of intimate partner violence (IPV), current gendered and heteronormative depictions of IPV in society may create unique barriers for transgender survivors who attempt to disclose their abuse, thus leaving survivors without access to support resources. This study sought to understand the barriers to disclosure transgender survivors face and how they overcome these barriers. Through in-depth interviews with transgender IPV survivors (n = 9), the researcher found that experiences of IPV were often inseparable from survivors' experiences of their gender identity. Both external and internalized transphobia served as barriers which framed how participants viewed their abuse and who they disclosed their abuse to. Conversely, transgender-affirming support helped participants overcome these barriers. These barriers and aids also took different forms and meanings based upon other intersecting identities, such as gender and ability status. Implications for researchers and service providers, as well as directions for future research are reviewed.

The Relationship Between Formal Help-Seeking and Sexual Orientation Among Victims of Domestic Violence

Domestic violence, broadly defined, includes violence among children, parents, siblings, intimate partners, and other relatives. Help-seeking behaviors for domestic violence, especially among sexual minority (gay, lesbian, bisexual, and others who are not heterosexual) victims, is not well understood. Using the National Crime Victimization Survey, the current study fills a gap in the literature regarding the relationship between sexual orientation and four types of formal help-seeking among victims of violence perpetrated by a relative or an intimate partner: reporting to the police, seeking psychological care, contacting a victim services agency, and seeking medical assistance. This study additionally examined whether individual and incident level variables are related to formal domestic violence help-seeking among sexual minority victims. Results indicate that sexual orientation was significantly related to seeking psychological care and help from a victim services agency, and the relationship between individual and incident level characteristics varies by type of help-seeking among victims of domestic violence. These results suggest that sexual minority victims' decisions to access services is likely influenced by the availability of services and victims' perceptions of how they would be treated within the various systems. Future research should continue to examine the help-seeking process among sexual minority victims of domestic violence in order to develop appropriate policy responses and provide services needed by this population.

Intimate Partner Violence and Openness to Online Counseling Among College Students

Intimate partner violence (IPV) is prevalent and has devastating consequences for college students. Online counseling (OC) may be a way to decrease barriers to help. This study seeks to determine openness to OC compared to face-to-face counseling (F2F) by examining: (1) How openness to OC varies depending on college students' personal and IPV characteristics and (2) How these characteristics vary compared to college non-IPV survivors. Two linear regressions were conducted using a sample from a cross sectional survey. First with the entire sample of college students (N = 1,518) to examine characteristics of those more open to OC and second with only those that identified as experiencing IPV (n = 1,211). The results demonstrated that IPV survivors are less open to OC than to F2F counseling (b = -.23, p < .01). For the model with all college students, those who were significantly more open to OC were female (b = -.39, p < .001), identified as LGBT (b = .23, p < .05), or Asian/Pacific Islander (API) (b = .26, p < .05), and had a physical health issue (b = -.19, p < .05). For the model that only analyzed IPV survivors, the same characteristics were shown to be significantly related to openness to OC. More research is needed to explore why IPV survivors are less open to OC compared to F2F counseling. Exploring why characteristics of female, LGBT, and physical health issues lead to openness to OC could help understand what barriers need to be addressed for wider use.

Centering Transgender Survivors' Experiences of Intimate Partner Violence Victimization: A Critique of Dominant Approaches to Research and Service Provision

Transgender (trans) survivors are infrequently included in the intimate partner violence (IPV) literature, and they are rarely the central subjects of IPV research. Similarly, trans survivors are rarely at the center of IPV service provision. In this article we articulate the importance of centering trans survivors in IPV research and practice through developing a nuanced understanding of the unique manifestations of abuse for trans individuals. Using intersectionality (Collins, 2019; Crenshaw, 1989, 1991) as our theoretical framework, we discuss the manifestations of dominance in trans IPV research and service provision. Specifically, we explain how cissexism, binarism, trans misogyny, and dysphoria reify White supremacist cisheteropatriarchy in intimate relationships, research, and service provision. We argue the importance of researchers and service providers alike to recognize and detect identity abuse tactics as well and how they contribute to the unique barriers trans survivors encounter to access resources and their help-seeking behaviors. With a more nuanced understanding of the ways that White supremacist cisheteropatriarchy affect trans individuals' experiences of IPV, researchers and service providers will be better able to understand and respond to abuse tactics used against trans people.