Mapping Multilevel Contributions to the Sexual Victimization of Trans Women and Trans Feminine People: A Qualitative Intersectional Stigma Analysis

Abstract

We aimed to characterize and conceptually organize multilevel factors associated with the sexual victimization experiences of trans women and trans feminine people to advance violence prevention interventions for health-equity. Between October 2020 and July 2021, we conducted in-depth interviews with 17 expert informants in New York City, which we transcribed, coded, and analyzed. Qualitative insights were derived through an intensive, team-based iterative coding strategy resulting in the development of an exhaustive set of consensus codes which were organized and interpreted in a multi-level structure. Findings revealed a complex constellation of intersecting macro- and micro-structural mechanisms reinforcing sexual violence. Unique characteristics of this violence were characterized hierarchically in terms of: 1) violence forms (e.g., murder, fetishization), 2) perpetrators (e. g., safety-staff; group assault), 3) contexts (e.g., public accommodations), 4) functions (e.g., gender policing), 5) ideological reinforcers (e.g., transphobia, racism), and 6) structural reinforcers (e.g., legislation; linking access to material means of survival to poverty/illness). Results indicate that acute incidents of sexual victimization are “the tip of the iceberg” of the violence impacting trans communities. The community experts we interviewed (e.g., trans women, violence prevention practitioners, social workers) understand chronic functional, ideological, and structural oppression as inextricable from sexual violence. Multi-level determinants of violence therefore constitute essential targets of sexual violence prevention intervention for this population.

Violence against trans and nonbinary (TNB) communities is a “national epidemic” (Valentine et al., 2017). In 2021, the Human Rights Campaign documented 57 documented murders of trans individuals, its deadliest year on record (Human Rights Campaign, 2021). Although nationally representative epidemiological surveys of TNB people are currently lacking, a 2020 meta-analytic review found that trans people were 2.5 times more likely to experience sexual intimate partner violence compared to cisgender individuals (Peitzmeier et al., 2020). In another analysis of a large sample of primary care patients (N = 7572), trans patients reported six times higher odds of sexual victimization compared to cisgender women (Valentine et al., 2017). In addition to its direct health impacts, sexual victimization is potentially traumatic and associated with a host of secondary health impacts (Hendricks & Testa, 2012; Hughto et al., 2015; Reisner et al., 2014) including disparities in lifetime prevalence of posttraumatic stress disorder (Goldstein et al., 2016), substance use disorders (Hughto et al., 2021), HIV (Reisner et al., 2016), and chronic stress-related disease (McQuillan et al., 2021). Moreover, the recent onslaught of anti-trans policies in the U.S (Anti-transgender Legislation Tracker, 2024) is likely to exacerbate violence-related health disparities for TNB communities (Scheer et al., 2022). Thus, multi-level public health strategies to better understand and target contextual factors maintaining sexual victimization of these communities are urgently needed.

These strategies must account for the epidemiology of risk for sexual victimization exposure and its attendant health consequences, which is not evenly distributed, but instead coalesces around experiences of intersecting marginalization (Dinno, 2014; Graham, 2014; Hames et al., 2015; Lefevor et al., 2019; Sing & McKleroy, 2011; Wirtz et al., 2020). For example, trans women, including women and nonbinary people who identify with a transfeminine experience of gender, are at highest risk for all forms of interpersonal violence exposure compared to other sexual and gender minority individuals (Wirtz et al., 2020; Graham, 2014) and Black and Brown trans women are far more likely to experience lethal victimization than their white trans sisters (Lefevor et al., 2019l Dinno, 2014). Effective TNB sexual violence prevention approach must account for this larger context of identity-based discrimination and the interplay between intersecting forms of oppression (e.g., racism, sexism, HIV-stigma) comprising the social conditions of sexual violence (Graham, 2014; Singh & McKleroy, 2011).

Intersectional stigma frameworks (Bowleg, 2008; Crenshaw, 1990) center the lived experience of historically marginalized individuals by describing the intersecting micro-level social identities (e.g., race, gender) and macro-level factors (racism, misogyny, cis-genderism) that structure patterns of oppression. Rooted in Black feminist scholarship (Collins 2009; hooks, 1984) and epistemological frameworks highlighting the influence of unjust systems of social power on knowledge production practices (e.g., standpoint theory; Harding, 1986), intersectional stigma theory recognizes the expertise of individuals in communities that are socially and structurally oppressed, who are better equipped than outsiders to acquire awareness of the characteristics and mechanisms of their oppression as a function of the need to survive these conditions. As such, intersectional stigma frameworks are indispensable to the development of critical multi-level sexual violence prevention for TNB communities.

Unfortunately, research designed to inform sexual violence prevention for TNB people is scarce, particularly formative investigations that seek to query and elucidate multi-level and contextual determinants of this violence. To begin to address this critical gap, we leverage in-depth community interviews collected as part of a larger study designed to develop a sexual violence prevention intervention for trans women and trans feminine people in NYC. The current study aimed to outline the macro and micro-structural factors associated with the sexual victimization of trans women and trans feminine people and describe associated priorities to advance multi-level violence prevention interventions for this population.

Methods

From October 2020 to July 2021, we conducted in-depth interviews (N = 17) with expert informants comprised of two groups: 1) trans women in NYC; and 2) community stakeholders in violence-prevention/TNB social support services. Interviews were focused on understanding the experiences of violence impacting trans women and trans feminine people including its content, context, and contributions of intersectional stigma (i.e., sexism, racism, classism) to this violence. Participants were also asked about their recommendations for approaches to intervene in this violence. We centered trans women in the focus of our interview discussions given our intersectional stigma approach and evidence for disproportionate victimization exposure experienced by this population (Wirtz et al., 2020; Graham, 2014). We queried participants about experiences of violence impacting trans women broadly rather than limiting our focus to sexual violence specifically given evidence that stigma-related processes may result in the underreporting of sexual violence (e.g., Delker et al., 2020). This approach also aligns with best-practice guidance for phenomenological research (Englander, 2019) to assess the broader “ground” surrounding a construct to better understand the “figure” of the phenomenon in context.

Participants were recruited through outreach to existing community-researcher partnerships between the first-author and members of a Community Advisor Board (CAB) consulting to the first-author on this and related projects. CAB members, comprising TNB community leaders and stakeholders at organizations known for serving trans women, were provided virtual and physical flyers advertising the current study and invited to share broadly. Additional participants were identified through snowball sampling. Community stakeholders included individuals with expertise in trans-specific violence prevention (N = 3), legal support (N = 1), mental health care (N = 1), and housing access (N = 2). Among all expert informants in our sample (i.e., both those with expertise conferred by lived experience and those with professional expertise) twelve (70.6%) individuals in the interview sample were trans women, one was a trans man (5.9%), and four were nonbinary people (23.5%). Five (29.4%) interviewees were Hispanic/Latinx. Six (35.3%) interviewees were Black, eight (47.1%) were White, one (5.9%) was American Indian, and two (11.8%) were Asian. Interviewees’ ages ranged between 18 and 56 (M = 34.5, SD = 10.54).

Study procedures were approved by the local ethics board associated with Hunter College. All participants provided informed consent for participation. The authors used a set of open-ended questions developed at the outset of the study (Table 1) based on existing quantitative and qualitative studies (Graham et al., 2014; James et al., 2015; Singh & McKleroy, 2011; Testa et al., 2015) and consultation with CAB members. Best practice suggestions for increasing interview quality (Hill, 2012; Kvale, 1996) guided generation of short interview questions that could glean correspondingly long and rich answers. Interviews lasted between 56 and 122 minutes (M = 78 minutes, SD = 18 minutes) and were conducted by all members of the authorship team. Interviewees were compensated $40 for their time. At the conclusion of each interview, the interviewer completed field notes indicating any significant interview characteristics (Hill, 2012), including repetition of previously identified themes, the emergence of novel themes, participants’ nonverbal communication, reflections on the interview experience, reflection of potential interviewer bias, and any other notable descriptions.

Table 1.

Description of Content, Context, and Contributors to Violence Identified by Trans Women and Key Stakeholders: Interview Questions by Domain

Victimization Experiences

1. “In your experience or observation, what forms of violence would you say most impact trans women?”

2. “Where do you see this violence coming from most frequently or most powerfully?”

Contributors of Intersectional Stigma to Violence and Victimization

3. “What role does transphobia and gender-related discrimination play in the violence you see impacting trans women?”

4. “What role does racism or a disregard for trans people of color play in the violence you see impacting trans women?”

5. “What role does classism or a lack of financial resources play in the violence you see impacting trans women?”

Approaches to Violence Prevention

6. “What specific strategies or approaches are needed to interrupt the violence impacting trans women.”

Note. Additional follow-up probes were asked as appropriate in the context of the interview.

Researchers’ Backgrounds, Experiences, and Biases

The research team was comprised of one clinical psychologist, two graduate students, and one bachelor’s level research assistant. All study team members are White, sexual and/or gender minorities. Although three of the study team members identify as trans, trans women were not represented on the research team. We adopted a phenomenological approach (Englander, 2019) to derive themes from participant interviews to better understand the contexts and experiences of sexual violence impacting trans women. Due to the inductive nature of this approach, researcher perspectives and potential biases are likely to influence the meaning-making processes of data analysis. To minimize the influence of research team biases, research team members engaged in active, weekly discussions throughout the coding process, which involved articulating themes inherent to participant descriptions paralleled by process-oriented, consensus-seeking dialogue on coding discrepancies, and iterative discussions that named our positionalities, assumptions, and biases. All members of the research team highly value the health, longevity, and well-being of trans women and trans feminine people. Members of the research team strive towards anti-racism and vehemently oppose sexism and patriarchy.

Data Analysis

Interviews were audio-recorded and transcribed verbatim to facilitate rapid-content analysis (Beebe, 2001). The urgency of developing interventions to mitigate the public health crisis of violence against trans women and trans feminine people cannot be overstated. A rapid coding approach allowed us to quickly distill the expertise of interviewees into actionable findings. Rapid-content analysis is an intensive, team-based approach for qualitative data analysis that quickly generates preliminary findings to inform intervention development (Beebe, 2001). The first author provided training to the data analysis team, randomly selecting a subset of three transcripts to be summarized concurrently by the four raters to ensure consistency in data reduction strategies (Sobo et al., 2003). Each rater completed initial summaries independently, then met collectively to compare; disagreements were resolved through consensus. Once consistent coding was established, each coder was assigned additional transcripts to summarize and reduce into a matrix. Once all transcripts were analyzed and summarized, the coding team met to examine all data summaries in matrix form and to identify codes across all transcripts (Beebe, 2001). Finally, the team completed a phase of axial coding (Averill, 2002) informed by feminist standpoint and intersectional stigma theories. In this stage, codes were reviewed and organized into hierarchical themes to increase our ability to interpret codes within in a multi-level structure.

Results

Results of content analyses derived from participant responses to questions about victimization experiences and contributors to this violence were organized around six core theoretically derived themes which can be summarized as follows: (a) the sexual victimization reported by participants co-occurred with many other forms of violence (e.g., physical assault, community violence) distinctive in its severity (e.g., murder) and expression (e.g., fetishization of trans bodies, misgendering); (b) although many participants described victimization at the hands of known perpetrators (e.g., intimate partner), reports of sexualized violence perpetrated by strangers and/or public officials were not uncommon; (c) the ecological context of the violence (i.e., where it took place) described by participants included, not only threats in private, but also public attacks either facilitated by or undeterred by bystanders; (d) the reported functions of violence clearly reflected attempts to “police gender” (i.e., to control or punish through violence expressions of gender identity that deviate for cisgender/heterosexual norms); (e) participants offered clear social analyses of the ideological reinforcers of violence (i.e., belief systems associated with and undergirding violent systems of oppression [e.g., transphobia; racism; patriarchy]) and (f) of the institutionalized structural reinforcers of violence (i.e., the broader sociopolitical/historical/legal context foundational to violence).

Themes were conceptualized as overlapping levels or standpoints from which our community expert respondents discerned the victimization of trans women and trans feminine people. Each theme was related to a unique cluster of intersecting codes and subcodes explicated based on similarities emerging across cases. However, codes are not mutually exclusive and are hypothesized to be correlated. Table 2 summarizes these results. Themes are listed first followed by codes classified within that theme (right-hand column) and definitions/summaries of these codes within the sample (left).

Table 2.

Content, Context and Contributors to Violence Identified by Trans Women and Key Stakeholders: Codes, Subcodes, and Definitions Organized by Theme

Theme/Codes/Subcode	Definition/Summary
Forms of Violence
Sexual	Violence perpetrated via sexualized behavior enacted with intent to gain power/control over victim. Includes rape, harassment, sexual coercion (e.g., by weaponizing victim’s need for gender validation), blackmailing, fetishizing, luring/tricking
Physical	Violence perpetrated via physical behavior enacted with intent to cause bodily harm. Includes physical assault, assault with a weapon (e.g., spit, bleach, knife, gun)
Verbal/Emotional	Violence perpetrated via speech act enacted with intent to cause emotional harm. Includes verbal threats/intimidation, misgendering, transphobic slurs, and media/cyberviolence (i.e., the generation, endorsement, and/or dissemination of hate-speech via technology)
Economic	Violence perpetrated by causing economic harm to the victim, thereby stripping them of safety-supporting benefits of financial security. Includes workplace discrimination, mugging/robbing, restricted access to education/labor market/affordable housing
Perpetrators of Violence
Community members	Violence perpetrated by individuals upon whose goodwill the victim depends for daily functioning/survival including family, friends, neighbors, and roommates.
Intimate partners/dates	Violence perpetrated by victim’s sexual and/or romantic partner
Strangers	Violence perpetrated by unknown assailants including passersby and assaults perpetrated by groups.
Authorities	Violence perpetrated by those with social power over victim and/or those charged to protect and serve including landlords, employers, police, security guards, counselors, medical staff, and pimps.
Contexts of Violence
Public	Violence that occurs in plain sight of bystanders (e.g., streets, trains, buses) and/or in public service settings (e.g., schools, hospitals, prisons, shelters). Bystanders seldom intervene
Private	Violence occurring in personal space (e.g., home/car)
Function of Violence
Gender Policing
From outside the community	Violence perpetrated as a reaction to those whose expression does not conform to binary sex/gender norms; violence as expression of cis men’s inability to accept desire for a trans woman for fear of social reprisal. Meant to bring social behavior into alignment with binary sex/gender norms
From inside the community	Internalized transphobia expressed as lateral hostility towards non-binary expressions of gender diversity
Via barred access to resources	Individuals outside gender binary are punished via experiences of discrimination (i.e., in healthcare, employment, housing, policing) which increases exposure to contexts (e.g., homelessness, survival sex work) with elevated risk for violence
Structural Reinforcers of Violence
Legislative
Lack of legal protections	Permissibility/lack of reprisal for violence in housing, employment, public accommodations
Anti-trans legislation	Enactment of laws that criminalize trans identity, expression, and/or survival resources (e.g., gender affirming care, sex work) potentiate risk for violence including walking while trans bill, bathroom bills, and bills banning trans youth in sports
Broken social safety net
Resources linked to illness/poverty	Social policy that makes access to social support resources contingent upon HIV+ status and/or income below poverty line increase risk for exposure to economic and HIV-stigma related violence
Poor access to gender affirming care	Pervasive barriers to gender-affirming therapy, hormone replacement therapy, gender affirming surgeries, bathrooms etc. increase risk for being “clocked” (i.e., inadvertently publicly perceived as trans) and subjected to associated violence
Political scapegoating	Backlash against trans visibility in reactionary political movements and the sidelining of trans rights within the broader LGBT/social justice movements for political gain instantiate antipathy towards trans people
Ideological Reinforcers of Violence
Colonization mindset	Adoption of violence justifying ideologies prescribing that those who are worthy of violence according to our culture will be targeted (i.e., predators go for “easy targets”)
Transphobic beliefs	Violence justifying beliefs about trans people. Examples include: trans people are inherently threatening because they aren’t who they say they are; trans women are actually men…and men can’t be raped; trans women are pedophiles/are a threat to your children; trans women are a threat to women’s political advancement- trans exclusionary reactionary feminism (i.e.,TERFism)
Patriarchy/male- entitlement/misogyny	Ideology prescribing that men have the right to control women and anyone they ascribe femininity
Racism/white privilege	Ideology prescribing inferiority of non-white people. Manifestations include: police/authorities assume trans women of color are criminals/unemployable; police/authorities likely to perceive black victim as perpetrator; queer-white saviorism/performative activism
HIV stigma	Ideology that constructs people living with HIV as a social threat such that perceived/assumed HIV status increases risk of violence (e.g., retribution for “giving” HIV to client/partner)
Xenophobia	Ideology that constructs immigrants as a social threat; associated with barred access to safety supporting resources (e.g., gender affirming medical care

Forms, Perpetrators, and Contexts of Violence

When queried about violence most impacting the community, sexual violence was described as an important area of concern. Participants also described forms and contexts of violence that were not exclusively classified as sexual. Across all forms and contexts of violence perpetrated against trans women and trans feminine people, participant responses reflected a clear pattern of objectification, dehumanization, and identity-based degradation that were inextricable from and/or co-occurred with the fundamental harms of sexual violence. For example, community experts commonly discussed physical assault as a form of violence co-occurring with sexual victimization. The nature of the violence described by participants was particularly notable for its targeted qualities and its severity. Specifically, hate-based attacks and murder of trans women, particularly Black trans women, emerged as a salient subcode within this theme. For example, Participant #1 noted, “Throughout my life, I’ve seen a lot of trans women get murdered. I think it is more Black trans women.”

This quote reflects both the severity and pervasiveness of anti-TNB violence; it also reflects its intersections with racism, an observation echoed across numerous participants and themes (see Functions and Reinforcers of Violence below). Participants also described exposure to forms of sexualized violence unique to TNB populations (i.e., misgendering, fetishization of TNB bodies or identities) associated with risk for exposure to physical violence, including murder. For example, Participant #2 described the violence of sexual fetishization and its associated risks as follows:

A lot of men think of transgender females as fetishes, not just as human beings. Where it’s like they just like having something to themselves that they have in secret that nobody else knows about, and I think when a transgender girl-she has that thought in her head that ‘Oh, this is my boyfriend and I’m his girlfriend’ and then, a lot of times they don’t know that the man is actually only thinking of them as a fetish, so [the woman] crosses a certain line like say they post a picture of them, maybe they tell somebody about them, they meet their family, they show up at their house, and then it leads to an even bigger problem where the man gets upset and then he takes his anger out on the transgender girl. And so you find a lot of situations where a lot of trans girls die because of a man, who they’re supposedly not dating.

In the above example, the participant understands lethal physical violence as emerging in concert with the sexual violence of fetishization of trans women’s bodies. In this context, the basic assertion of humanity within a sexual relationship (i.e., publicly acknowledging the existence of the intimate relationship) is understood as a life-threatening act.

Beyond, intimate relationships, numerous participants reported on targeted hate-crimes perpetrated against trans women in public settings. For example, another community member respondent (Participant #3) described the violence she experienced as simply a function of being herself, a Black trans woman, in public. She said, “You can walk into the store and they just attack you. Or you could be on a subway and they attack you. On the bus, they attack you.” Participant #3 further described the public expression of this targeted violence as follows:

A lot of robberies, a lot of girls getting beat up, a lot of girls getting cut. A lot of girls getting bleach thrown on them. That’s a new thing now. They’re throwing bleach on them, you know. And it’s so sad like wow. Or the guy will actually make them think he likes them and try to rob them…You know, a White trans woman can walk down the block and they won’t bother her but a Black trans woman walks down the block and all hell breaks loose.

This quote reflects the interconnected nature of the sexual (i.e., luring/tricking: “the guy will actually make them think he likes them”) and physical victimization of trans women in public-setting along with the intersectional stigma implicated in its targeted nature (against Black trans women).

These and other participant responses also highlight a unique context of the violence facing trans women; that is, much of the violence described by our participants was perpetrated by strangers in public settings. Although violence perpetrated by intimate partners and family members was certainly reported (see example above), many descriptions of violence reported by participants were coded as public and perpetrated in plain-sight of bystanders. Our analysis also suggested that rather than intervening, bystanders often joined in on the attack, forcing TNB individuals to respond to group-based assaults alone. The public and collective nature of this violence is illustrated by the following quote from a sexual violence prevention facilitator and TNB community member (Participant #4):

That level of violence is just not only happening a lot but almost permissible like it’s granted. It’s not checked….when it comes to physical violence, you know, being held up with a knife or literally being punched and things like that on the street, I just know that that’s happening a lot. Or you know we’ve gotten groups [attending sexual violence prevention training] that are saying… our residents at the trans housing are getting harassed in the neighborhood and one [trans] woman was followed to the train station and one of them got punched.

Not only does this quote reflect the social permissibility of violence experienced by the groups of TNB individuals who this respondent encountered while delivering sexual violence prevention programming, but it also highlights the presence of violence in the context of ostensibly “safe” or regulated public accommodations. Indeed, this context (i.e., public service settings) emerged as salient subcode in our data analysis. Violence occurring in spaces explicitly created to support the safety of TNB people was reported by multiple respondents. For example, Participant #3 described vicarious exposure to the victimization of a trans woman in a residence designed for sexual and gender minority New Yorkers experiencing housing instability: “The security guard was spitting on her. And she had to fight the security guard because she was transgender. And he kept calling her ‘him’.” This quote reflects the use of misgendering as a unique form of violence to which TNB people are exposed and connects this form of verbal abuse to a physical and sexualized attack in an ostensibly protected public-setting. Other participants reported similar instances of co-occurring sexual violence and harassment by medical providers in city hospitals and security guards in detention centers.

Functions and Reinforcers of Violence: “Gender Policing,” Ideology, and Institutions

Across participant responses, codes reflecting participants perceptions of the functions of violence against the community emerged. Participant responses seemed to indicate a belief that this violence functions to police, via punishment and revocation of safety-supporting resources (e.g., family, housing, healthcare), forms of gender expression that deviate from dominant binary social norms. Participant #1, a Black trans woman, stated:

I know that nine times out of ten when black trans women were murdered and killed, they don’t look for a killer. And when they do find the killer, the first thing the man says ‘she tricked me’…The violence comes [from] people not accepting who they are. It’s the men that are not accepting their bisexuality. That’s what it is. And then the society says if you go with a trans woman, you are still gay.

This participant speaks not only to the lethality of violence impacting the community and its disproportionate impact on Black trans women, but she also names the contributions of structural racism in police practice and connects this physical violence (i.e., murder) to a sexualized attack on trans women’s identities and bodies. Specifically, this response reflects an analysis of the ideological motivators of the perpetrator, who conflates sexual orientation with gender expression (i.e., cis men’s attraction to and intimate contact with trans women is stigmatized as indicator of gay sexuality). This quote also reveals functional consequences of violence against trans women—to eradicate/control socially sanctioned forms of gender expression and to uphold heterosexist and patriarchal gender norms.

The situation described above appears to highlight the use of violence against trans women by male aggressors as an attempt to protect such perpetrators from accusations and social sanctions associated with not living up to masculine norms (i.e., norms prescribing exclusive heterosexual identity and attraction to cisgender women), rather than a direct effort to punish trans gender women for violating those norms. However, other respondents spoke directly to violence against trans women and trans feminine people as functioning to directly police or punish trans women and trans feminine people for their embodiment of gender expressions and identities that challenge cissexist norms. For example, one community member (Participant #5) stated:

Clearly, it’s a direct link [between ideology and violence]. I think that part of that direct link is being femme is equated in the world with being weak. And predators are going to go for what they consider an easy target. If you’re femme presenting, especially if somebody is caught on to the idea that you’re trans female, it is the blossoming of everything that our culture has taught us that is transgressive, that is taboo, that is wrong, that is worthy of violence, you know like, ‘I’m going to beat the gay out of you, I’m going to beat the trans out of you, I’m going to beat the feminine that I hate out of you. Because I can.’ It’s completely reinforced by these notions of moving through the spectrum of gender because of the colonial puritanical approach to a binary system. And that binary system, that colonization mindset, that I’m still undoing too.

This participant clearly observes the violence against trans women and trans feminine people as driven by an intersecting set of attitudes that include misogyny (“beat the feminine that I hate out of you”), heterosexism (“beat the gay out of you”), and transphobia (“beat the trans out of you”). The notion, reflected in this participant’s language, that these socially reviled characteristics (i.e., “everything that our culture has taught us is transgressive…”) can be isolated, punished, and excised through violence reflects a gender-policing function of violence against trans women and trans feminine people. The above quote also defines a colonization mindset as a belief structure adopted by perpetrators that leverages violence justifying ideologies (i.e., misogyny, transphobia, racism, heterosexism, etc.) to identify and target TNB, particularly multiply marginalized trans women and trans feminine people, because they are socially devalued and unlikely to be defended by others (i.e., “an easy target”).

The above participant also provides an analysis of the association between this interpersonal socialization process and an internalized one associated with the victimization of trans women and trans feminine people. Indeed, this participant acknowledges that they themselves are “still undoing” this “colonization mindset.” As such, it is not surprising, given evidence of the internalization of the socio-cultural and ideological structures of oppression that maintain disproportionate risk for victimization of trans women and trans feminine people, that some participants reported that gender-policing violence may also be perpetrated laterally, between trans and/or nonbinary people. For example, Participant #4 states:

Within the trans community, I do think that the younger generation…are acknowledging and to some extent more embracing the non-binary gender queer space…I’m sure there’s like girls that are gender policing still. I do see it because you know these young people are also coming there. They’re homeless, because maybe they got kicked out from other parts of the country, and they end up in New York, because they know New York has services. So, these young folks are coming from different parts of the country where they were socialized with these very binary way of thinking so they’re bringing their own internalized transphobia. So, I’m not saying it doesn’t exist but I do think that in the community, in the trans community, folks who might be in the middle of the gender spectrum, might experience like lateral hostility within the members.

Beyond the interpersonal and intrapersonal manifestations of gender-policing and its ideological reinforcers, numerous participants named legislative and policy-related structures of oppression maintaining the victimization of trans women and trans feminine people. For example, the “Walking While Trans Bill,” a term used to describe anti-loitering and solicitation legislation in NYC, was cited by several participants as a primary tool by which police targeted trans women, particularly Black trans women, whose very presence in public space was often assumed to be synonymous with sex-work. These laws and related legislation (“bathroom bills”; legislation banning gender-affirming care and trans-youth participation in sport), were understood by participants as a form of violence itself, scapegoating and criminalizing the public existence of trans people by conflating trans identity and expression with sexual predation. Participant #6 describes the “Walking While Trans Bill” in the following terms:

The walking while trans” law [was a] loitering law that was very old…And it’s under the guise of the completion of sex trafficking and sex work. Which is just like honestly like a dog whistle from the right and like people who want to not let people have control over their bodies…obviously we don’t want sex trafficking but what happens is that because of the act of policing, not just the police, is so hyper focused on sex trafficking to the point that [someone who is perceived to be a] sex worker who’s autonomously working, they’re still giving them over to the police, which is what we don’t want because [police have enacted] so much violence towards all people, including trans women and femmes.

Here, this community member highlights how the targeting of trans women and trans feminine people in public spaces, by strangers/public servants, is both sexualized (trans women are assumed to be sex workers) and normalized through legislation and social practice (i.e., police training). The above quote also makes clear how the sexualized targeting of trans women produces direct risk for exposure to other forms of violence associated with contact with the criminal justice system (e.g., police custody, incarceration).

Other participants spoke to socioeconomic structures, including systems of public health funding (or lack thereof [i.e., broken social safety net]), undergirding and maintaining violence associated with the policies, ideologies, and practices described above. For example, Participant #7 quoted below, describes associations between economic violence (i.e., conditions of discrimination barring access to safety supporting resources [e.g., employment, housing]) and poor access to gender-affirming care as a route through which trans women and trans feminine people are exposed to physical and sexual violence associated with being visibly trans.

I think that plays a large role when it comes to passing as well. A lack of access to clothes, that fit your expression, that plays a huge role into [the violence trans women and trans feminine people experience]. Also playing a huge role into hygiene and grooming, when folks can’t access the proper hairdresser, or anyone that will, um, help with their facial hair. There’s so much, there’s so many things that classism play a role to, and not having access to resources that help with that. And that goes way past getting dressed, and doing your hair, then goes to medications as well and medical and mental supports.

For this participant, socio-economic conditions structure victimization risk by blocking many trans people from accessing the kind of gender affirming resources that allow for the safety that comes with the right to choose how one expresses their gender identity. The quote above clarifies that “passing” (i.e., to avoid being publicly outed at trans) requires access to gender affirming care. Further, in the context of the examples of targeted hate-crimes against trans women in public described above, thwarted access to this form of bodily autonomy (i.e., gender-affirming resources) constitutes a grave danger.

Others highlight the ways in which social structures of the “broken social-safety net” reinforce violence risk by linking access to services for TNB people to chronic illness (i.e., HIV) and poverty. For example, Participant #3, a trans woman with extensive experience in the provision of social services to the community, provided a structural analysis of the maintenance of cycles of poverty in TNB communities by a healthcare system that both discriminates against TNB people and links safety-supporting resources (i.e., healthcare, housing) to poverty and sexual health (i.e., HIV status).

It’s all about the dollar. It’s not about feeling safe or being compassionate or empathy about the situation. It’s all about the dollar. Agencies, they have all these groups for[TNB people]. It’s all about that Medicaid card. They don’t really give a hell about you. And I think that is sad, you know. I know that’s how they get funded. I get it, but don’t make me feel like that and if you’re not HIV positive, you don’t really get housing or you don’t really get services here in New York City. So that causes a lot of havoc where a lot of girls are forced to work the stroll at night to put their life on the line. Or the girls have to rob the date or somebody or do crimes that lead to drugs and addiction and prostitution, which leads to violence.

This quote reflects a cycle of sexual victimization risk maintained by a social service structure that predicates access to social safety support on sexual risk. This participant discerns a clear set of economic and structural incentives that maintain and drive this cycle. For this and other participants, a socio-economic structure that links access to healthcare and other safety-supporting resources to poverty (i.e., “that Medicaid card”) and/or illness (“if you’re not HIV positive, you don’t really get services”) increases trans women’s exposure to contexts (e.g., homelessness, survival sex work) with elevated risk for violence. Together, these examples highlight a complex and interconnected network of victimization experiences, contexts, functions, ideologies, and institutional structures, that together comprise the totality of the phenomenon of sexual victimization risk impacting this community.

Recommendations for Violence Prevention

When queried about interventions with the potential to interrupt the violence impacting trans women and trans feminine people, participants identified approaches that cut across the social ecology (i.e., spanning individual-, interpersonal-, social-, structural-level strategies). A list of these approaches organized and summarized by theme is provided in Table 3. Similar to the themes that emerged to characterize the nature and context of violence impacting this community, each theme pertaining to violence intervention recommendations reflects a set of conceptually related ideas that are hypothesized to overlap. For example, a single intervention recommendation (e.g., self-defense training) often entailed characteristics of intervention approaches organized within other themes (e.g., empowerment, community support).

Table 3.

Violence Prevention Approaches Identified by Trans Women and Key Stakeholders: Definitions Organized by Theme

Theme	Definition/Summary
Self-Defense	Intervention that supports safety by training individuals with verbal, physical, and awareness skills to resist violence. Also includes the provision of self-defense tools (e.g., taser, pepper spray, knife).
Structural Solutions	Interventions that interrupt legal, ideological, and political structures that reinforce violence. Includes public education/voter registration campaigns, legal discrimination protections, and the creation of physical structures (e.g., gender neutral bathrooms) that disrupt cisgender segregation of space.
Community Support	Interventions that leverage community strength and resilience for protection. Includes support groups, exchange of information between community members and across generations, mutual aid, close knit chosen families, mobilizing collection action (i.e., organizing), and sharing stories of survival
Social Safety Net	Interventions that promote safety by facilitating access to economic/material resources (e.g., housing, employment, education, gender affirming care, insurance, cellphone, fiscal literacy)
Empowerment	Interventions that increase individual capacity for self-protection by underscoring the inherent worth and humanity of trans women. Includes approaches that focus on cultivating self-love, pride, and affirmation.

Indeed, violence prevention approach themes were multi-level and broadly mapped on to participants’ understanding of the factors driving and maintaining the violence impacting trans women and trans feminine people. Specifically, given accounts of violence occurring in public-spaces, in the absence of bystander intervention, and perpetrated with a weapon, participants spoke to the importance of arming community members with self-defense skills and tools and of leveraging community-support to organize and exchange safety-supporting resources. To the extent that violence was understood as an expression of legal, ideological, and political structures designed to maintain the oppression of trans women and trans feminine people, participants spoke to the importance of structural solutions, including the enactment of discrimination protection legislation and the use of public outreach/education to challenge the misrepresentation of trans women and trans feminine people as a threat to be policed. Moreover, strategies to promote self-love, pride, and affirmation (i.e., empowerment) was framed as an essential antidote to the internalization of violence-justifying ideologies that pervade public discourse about trans women and trans feminine people. Finally, given the role of broken or inadequate social structures in driving the violence impacting this community, participants described efforts to buttress the social safety net, (e.g., providing access to housing, employment, healthcare, and education) to interrupt structural contributors to the victimization of trans women and trans feminine people.

Discussion

We conducted in-depth interviews with experts on violence impacting trans women and trans feminine people to map multi-level forms, reinforcers, and mechanisms associated with the sexual victimization of trans women and trans feminine people in New York City. Results indicate that this violence is pervasive, targeted, severe in terms of potential lethality, and often occurs in public in the absence of bystander intervention. Further, axial coding revealed that sexual violence was conceptualized by participants as, “the tip of the iceberg, (Hotchkiss, 2021)” that was often inextricable from other forms of violence. Our analysis suggests that the sexual violence to which trans women and trans feminine people are exposed is fundamentally linked in its form, context, and structure to violence that cuts across physical, emotional, and economic domains. All accounts of victimization described by our participants were characterized by a pattern of objectification, dehumanization, and identity-based degradation fundamental to the violence of sexual abuse. According to Herman (1992) sexual violence is uniquely harmful, not only because it constitutes an attack on the body, but also because it represents a breakdown of the trust, goodwill, and interdependence necessary for survival in a social world. These harms were apparent across the accounts of our expert respondents. The current study extends Herman’s conceptualization of sexual violence to the experiences of trans women and trans feminine people and challenges the assumption that the sexual violence to which this population is exposed can or should be wholly isolated from other forms violence.

Further, chronic functional, ideological, and structural determinants of violence were described by experts in this study as forms of violence in-and-of themselves. Participants overwhelmingly named experiences within these “deeper” structures of violence (e.g., anti-trans legislation, racial disparities in enforcement of laws by police, transphobic and fetishizing assumptions about TNB people, inaccessibility of safety-supporting resources including housing, healthcare, employment), as foundational to and part-and-parcel of sexual violence. These findings align with existing theoretical scholarship by Snorton and Haritaworn (2013) who describe systematic violence against trans people of color as an intentional, structural, sociopolitical devaluation of trans people of color that extracts value from their deaths. Findings from the current analysis provide empirical support for this theoretical work by systematically describing the structural violence and stigma that inform risk to trans women’s lives across all other levels (e.g., community, interpersonal, individual). These findings echo calls for violence prevention research and programming that moves beyond individual issues, to develop interventions targeting multi-level structural mechanisms of sexual violence-linked health disparity (Hatzenbuehler, 2016; Nation et al., 2021).

Findings presented here should be interpreted in the context of the study’s limitations. Most notably, non-representation of trans women and trans people of color in the research team limits the clarity of our perspectives. Participants of color may not have felt comfortable disclosing their experiences to White researchers. In keeping with intersectional stigma theory, we cannot separate the threads of our privilege from the fabric of systems of oppression. As such, the relatively privileged social positions of the research team limit our ability to fully understand the contributions of structural racism and intersectional oppression to the sexual victimization of diverse TNB communities. Further the current sample was entirely based in New York City and recruited through the research team’s community advisory network with a focus on the experiences of trans women. As such findings may not reflect the nature of sexual violence impacting trans people in fundamentally different contexts (e.g., trans women in rural settings; trans women who do not engage with or are isolated from community-based organizations; trans men and/or trans masculine nonbinary people). Additional research is needed to better understand and address violence operating in these contexts.

Implications

Nonetheless, our findings have significant implications to inform multi-level sexual violence prevention research and interventions targeting TNB communities. Given findings on the role of structural and institutional stigma in driving the victimization of trans women and trans feminine people, efforts to increase individual resistance against interpersonal violence will not be sufficient. Structural and community level stigma interventions for resisting violence against trans women and trans feminine people are needed. The community experts we interviewed identify a clear set of high-priority targets for a multi-level stigma intervention approach including policy-, structural-, and community-level strategies (see Table 3). However, more research is needed to understand which policies and practices have been successful in protecting trans women and trans feminine people from victimization and continued dependency on institutions that have repeatedly denied them care or explicitly tried to harm them.

Researchers should also take seriously the ways in which identity-based factors inform differences in exposure environmental threats and the severity of chronic exposure to violence, particularly regarding the targeting of Black and Brown TNB people. More research is needed that centers the experiences of Black trans women. Moreover, multilevel stigma interventions should focus particular attention on affirming the humanity of Black trans women. Direct investment in the leadership, work, and vision of Black trans women is essential. This investment may take the form of direct funding of Black trans women-led grassroots organizations, as well as funding the systematic priorities of these organizations which include but are not limited to economic empowerment programs, housing justice, prison-abolition efforts, decriminalization of survival work, and the broader movement for Black lives (Berke & Collins, 2023).

      While we work to dismantle the structures that reinforce violence at a structural, community, and interpersonal level, our findings indicate that trans women regularly face extreme and ongoing violence. Tools for resistance that meet the imminent threats to life and safety faced by trans women and trans feminine people are urgently needed. Given the pervasive and extreme nature of the violence reported by our participants, our findings suggest that training programs in self-defense for trans women and trans feminine people are warranted. Indeed, a number of scholars have called for more research in the development and implementation of empowerment self-defense programming for this population (Frazer & Howe, 2015; Sherman et al., 2021). These recommendations are supported by our participants and by findings which suggest that bystanders and public officials are not reliable agents of violence prevention for TNB people, particularly Black trans women, and that safety is often denied to trans people within traditional public health systems such as hospitals and shelters.

Given the entrenchment of structural violence that the current data describes, institutions that are themselves alienated from TNB communities, especially trans women and trans feminine people of color, are unlikely to foster trust and confidence in the effectiveness of violence prevention interventions barring sufficient community involvement. However, the results of this analysis suggest that research and intervention programs are themselves potential points of intervention, whereby the acceptance and inclusion of community experts, an insistence on substantive representation throughout the process, and the validation of lived experiences of trans survival tactics can help fill the gap in knowledge created by intersectional oppressive histories (racist, transphobic, patriarchal) of structural disenfranchisement.

Biographies

Danielle S. Berke, PhD, is an Associate Professor of Psychology at Hunter College of the City University of New York where she directs the Gender Based Violence Laboratory. She also holds appointments in the Health Psychology and Clinical Science and Basic and Applied Social Psychology doctoral programs of the CUNY Graduate Center.

Maiya Hotchkiss is a doctoral student in M.S.W./Ph.D. program at the Suzanne Dworak-Peck School of Social Work at the University of Southern California. Their professional and research interests include health and safety disparities, particularly among transgender and nonbinary individuals, interpersonal and structural violence, violence prevention and treatment, community-facilitated evidence-based interventions and community-based participatory research.

Ash M. Smith, M.S. is a doctoral student in the Health Psychology and Clinic Science doctoral program at the CUNY Graduate Center. His current program of research leverages qualitative and quantitative methods to characterize experience of gender dysphoria and the role of shame in relationships between minority stress and suicidality.

Craig Gilbert, M.S. completed a master’s thesis from the General Psychology program at Hunter College in the Spring of 2022 which focused on on-verbal pride expression and behavioral and emotional resilience among sexual and gender minority populations. Broadly, they are interested in leveraging psychological science and clinical intervention to support access to embodiment experiences for transgender and nonbinary people that transcend medicalized constructs and support psychological flourishing.