Toward a Community-Led, Public Health Approach to Multilevel Violence Prevention for Black and Brown Transgender and Gender-Diverse Communities

There is currently a war on Black and Brown transgender and nonbinary (TNB) people in America. TNB people include those whose gender differs from the sex assigned to them at birth, those who do not identify with gender binary constructs of “man” or “woman,” and those who are expansive or fluid in their gender. The year 2021 was the deadliest on record for TNB communities, with at least 57 documented murders of TNB individuals; 66% of the victims were Black women, 86% were people of color, and 69% were killed with a gun.¹ These numbers are likely an underestimate, as TNB victims are often misgendered in official reports¹ and most murders of TNB people remain unsolved. Beyond lethal violence, data indicate that nearly one in 10 TNB individuals have been physically assaulted in the past year and 47% experience sexual violence in their lifetimes.²

Victimization of TNB people must be understood within the larger context of discrimination at the intersection of interlocking systems of oppression (e.g., racism, sexism, heterosexism, and cisgenderism). Discrimination against individuals and structural sources of oppression are mutually reinforcing or co-constitutive and jointly contribute to interpersonal violence against TNB people. For Black and Brown TNB people, community violence linked to cisgenderism and gender oppression is intertwined with White supremacy.² TNB people of color are uniquely targeted and criminalized by police, government, and media, as evident by widespread dissemination of misinformation in news, political scapegoating, biased law enforcement, and legislation designed to exclude Black and Brown TNB people from public life (e.g., “walking while trans” bills).³

Because of discrimination, TNB people of color experience disproportionately higher rates of unemployment, housing insecurity, and incarceration compared with White TNB people. In the National Transgender Discrimination Survey (NTDS),² Black TNB people had nearly twice the unemployment rate of all TNB respondents (26% vs 14%) and over three times the unemployment rate of the broader US population (7%). Black transgender respondents also reported a much lower rate of homeownership (14%) compared with transgender respondents of all races (32%) and the general US population (67%). An alarming 41% of Black respondents reported experiencing homelessness compared with 19% of all transgender respondents. Thirty-five percent of Black respondents had been arrested or held in a cell because of bias compared with 7% of all transgender respondents. These disparities are directly linked to the pervasive violence to which Black and Brown TNB people are exposed in the public sector (e.g., employment, housing, health care, prisons).²

In addition to its direct influence on morbidity and mortality, community violence and discrimination have significant health impacts, elevating risk for depression, anxiety, suicidality, substance use disorder, and HIV.^4,5 Further, community violence perpetrated in the public sector disproportionately erodes trust in the very organizations upon which TNB communities of color depend to access life-saving and quality of life–supporting services. For example, 34% of Black NTDS respondents, compared with 23% of respondents of all races, reported delaying necessary health care because of anticipated violence or mistreatment by providers.² These impacts further reinforce health inequities and cycles of poverty.²

PRIORITIES FOR MULTILEVEL INTERVENTION

Given the mutually reinforcing contributions of individual and structural discrimination to violence-linked health inequities for Black and Brown TNB people, a multilevel approach to violence prevention for these communities is essential. Here, we outline a set of strategic priority areas for interrupting this epidemic of violence, its intersecting drivers, and its downstream consequences.

Empowerment Self-Defense

Black and Brown TNB individuals deserve tools and strategies for resisting the onslaught of victimization that pervades daily life. Empowerment self-defense (ESD) approaches are group-based interventions that empower participants with physical, verbal, and psychological tools to understand their bodies as sources of strength while explicitly holding perpetrators responsible for violence.⁶ Despite the demonstrated efficacy of ESD programs to prevent violence in presumably cisgender samples,⁶ research and the dissemination of ESD for TNB populations are scarce.

Trans women and transfeminine people of color face specific experiences of oppression at the intersections of racism, cisgenderism, and sexism (termed “transmisogynoir”)⁷ associated with a constellation of victimization types (e.g., hate crimes, police violence, workplace violence, violence in sex work, community gun violence) distinct from that predominately examined in ESD research (i.e., cisgender women’s risk of campus sexual assault). Although emerging evidence suggests that community-based support in the development of self-defense strategies is protective for Black trans women survivors of violence,⁸ public health initiatives promoting cultural attunement and effectiveness of ESD for structurally vulnerable Black and Brown TNB women are needed.

In a series of pilot studies, our team has documented high perceived credibility of and demand for ESD programming among Black and Brown trans women. In a pilot trial in which the majority of participants were Black and Brown trans women, we found high rates of acceptability, feasibility, and preliminary efficacy⁹ of an ESD violence prevention approach tailored for and embedded in the Brooklyn Ghost Project,¹⁰ a Black and Brown TNB-led grassroots community-based organization (CBO) in New York City founded by the second author. In the program implementation process, we created formal peer-support employment opportunities in ESD training for TNB people.^9,11 This aspect of implementation provided an opportunity to disrupt cycles of poverty comprising the socio-ecological context of interpersonal victimization.

Further, numerous community-led (rather than research-driven) self-defense initiatives currently exist in CBOs that serve TNB people of color, including THORN,¹¹ a Chicago-based project arming Black and Brown TNB people with self-defense tools (e.g., stun guns, pepper spray), and Trans Wellness Center,¹² a Los Angeles, California–based coalition of CBOs providing comprehensive services for TNB individuals, including a free self-defense class led by a trans woman of color who is a former national judo champion. Public health efforts to support and strengthen self-defense initiatives must amplify and credit the work of community leaders and commit to avoid co-opting, exploiting, or threatening TNB community control. THORN distributes self-defense resources only in situations in which recipients are not asked to do anything in return (e.g., issue payment, participate in research or health programming) for accessing these resources.¹² This policy of nonextractive investment in the safety of Black and Brown TNB people is a sound model for the field. Additionally, we refer readers to several excellent self-auditing guidelines^13,14 for critically evaluating community partner engagement to promote nonexploitative dynamics (i.e., relationships that ensure lasting benefits to community members).

Equitable Community– Government Partnerships

Public service organizations mandated with enforcement of antidiscrimination policy often fail to recognize or utilize the much-needed expertise of TNB-led organizations. Not only is this exclusion a missed opportunity for enhancing civil rights, it also perpetuates alienation of TNB individuals from the public sector and further desensitizes broader society to the community’s suffering. Community–government partnerships that equitably invest in TNB community expertise to support the implementation and enforcement of policy-level violence prevention efforts are a promising intervention avenue.

In 2019, New York State passed the Gender Expression Nondiscrimination Act, prohibiting discrimination against TNB persons in public accommodations. Despite the promise of this policy, Black and Brown TNB New Yorkers have been largely excluded from its implementation and enforcement. Leveraging constituent expertise of TNB-led CBOs in New York City to evaluate the impact of this legislation and to deliver trainings to fill implementation and enforcement gaps presents a clear opportunity for change. Compensating and empowering structurally vulnerable community members to enforce antidiscrimination policies is one way to counter the dehumanization experienced by TNB individuals in institutional settings and increase the community’s visibility as experts, rather than victims.

Funding Grassroots Community-Based Organizations

The continued survival and thriving of Black and Brown TNB communities in the face of ongoing violent oppression reflects community resilience and leadership. Black and Brown trans-led grassroots CBOs have always been and continue to be the primary line of defense against the harms of community violence.⁸ Unfortunately, these organizations are grossly underfunded. The inadequate funding of Black and Brown trans-led organizations and operations ensures that services and programs delivered for the community are designed, created, facilitated, and organized with minimal community input.

In the last decade, federal and foundation funding for TNB issues has increased tremendously. However, TNB communities are rarely the primary recipients of these funds, which instead accrue to White cisgender-led organizations that become gatekeepers of these funds to funnel down to Black and Brown trans-led grassroots CBOs forming what they call “partnerships.” However, all too often these “partnerships” are strategically designed and implemented to proclaim ownership and extract the expertise and labor of Black and Brown TNB communities. Reorganization of funding priorities and policies to incentivize the funding of Black and Brown TNB-led CBOs is urgently needed. We urge public health professionals and funding agencies to trust the expertise and vision of Black and Brown TNB leaders, who embody transformation and survival, by investing in bold violence-prevention solutions that resist and reimagine the structural conditions of violence that prevent Black TNBs from thriving.¹⁵ This includes, but is not limited to, strategies targeting economic empowerment, housing justice, and decriminalization and decarceration.¹⁵

CONCLUSION

Community violence against TNB people is a public health crisis in the United States warranting a multilevel public health intervention approach. We amplify the work of Black TNB community leaders to highlight high-priority components of a multilevel public health approach to violence prevention for these communities that emphasizes empowering TNB community and interrupting structural contributions to victimization.