Transgender women sex workers' experiences accessing sexual health care in Iran: a qualitative study

Background This study aimed to examine the experiences of transgender women who work in the sex industry regarding their access to health care facilities for sexual health. Transgender women sex workers are recognised worldwide as a high-risk group for HIV and sexually transmitted infections (STIs).Methods In Iran, between January and May 2022, we employed a snowball sampling technique to recruit a diverse group of 22 transgender women sex workers aged 19-42 years. Semi-structured interviews were conducted with these participants to provide insights into their experiences with accessing sexual health care.Results The data was analysed using thematic analysis, revealing four overarching themes: experiences of violence, contextual barriers to health, socioeconomic challenges and HIV/STI risk practices, and 11 sub-themes. The results demonstrate that many participants experienced difficulties in accessing sexual health services due to violence, discrimination, financial difficulties and lack of awareness about STIs.Conclusion Sex workers face extraordinarily challenging occupational risks, including sexual and physical abuse, mental health issues, and HIV and STIs. Targeted public intervention programs and research for this group are urgently needed. Outreach programs engaging with underserved transgender women sex workers have the potential to enhance access to healthcare services, and contribute to the reduction of HIV transmission rates. Transgender women who work in the sex industry face difficulties accessing health care facilities. This population is recognised worldwide as a high-risk group for sexually transmitted infections and HIV In this paper, we describe challenges for accessing healthcare amongst transgender women sex workers in Iran.