Mindfulness, Mental Health, and Violence Exposure Among Transgender Female Sex Workers Living with HIV in the Dominican Republic

Purpose: Mental illness is a significant public health issue among transgender female sex workers (FSW). A variety of factors inform the prevalence of mental illness among transgender FSW, including violence exposure and stigma. Mindfulness, the process of paying attention to the immediate experience with awareness and attentiveness in a nonjudgmental way, has been shown to improve mental health among stigmatized populations, including cisgender FSW living with HIV. The analysis examines the relationship between mindfulness and mental health among transgender FSW living with HIV in the Dominican Republic (DR) and investigates if mindfulness impacts the relationship between violence exposure and mental health. Methods: One hundred transgender FSW living with HIV participated in a cross-sectional survey in Santo Domingo, DR, in 2019. We conducted multivariate linear regressions to assess the relationship between mindfulness and anxiety and depression, respectively, adjusting for covariates. We also conducted multivariate linear regression for the impact of violence exposure (a three-class latent variable) on each outcome, moderating for mindfulness and adjusting for covariates. Results: Mindfulness was associated with lower depression and anxiety scores and moderated the relationship between violence exposure and depression, but only for those in the mid-level violence exposure class. Conclusion: This formative work creates a strong foundation for future implementation and evaluation of mindfulness-based interventions with this population to address their mental health needs. Future research should examine the relationships between mindfulness, social support, social cohesion, and social change.