Supplementary File 1: COREQ checklist.

<div><p>Introduction</p><p>Transgender women are considered as one of the most vulnerable populations for commercial sex work and sexually transmitted infections. This mixed-method study aimed to explore the factors associated with commercial sex work among transgender women of Nepal along with their experience and the stigma associated with it.</p><p>Methods</p><p>A concurrent mixed-methods approach was employed in this cross-sectional study conducted from July to December 2022 in the Kathmandu Valley of Nepal. A total of 152 transgender women participated in the quantitative survey, and 17 of them were selected for in-depth interviews (IDIs). The chi-square test was employed at a 5% level of significance to identify factors associated with commercial sex work. Qualitative data from the IDIs were thematically analyzed, with key themes emerging around reasons for engaging in sex work and the stigma associated with it including the Silence, Shame, and Dignity & Treatment domains under sex work stigma.</p><p>Results</p><p>Out of 152 transgender women, 104 (64%; 95% CI: 60.5–75.0%) were found to be currently working as a commercial sex worker. Factors such as education, household wealth, homelessness, history of sexual and verbal abuse, including rape and physical attacks, and socialization with others were found to have a statistically significant relation with commercial sex work at p<0.05. Despite engagement in commercial sex work, a higher proportion experienced sex work stigma under the Sex Work Stigma Scale.</p><p>Conclusion</p><p>The findings, derived from both quantitative and qualitative studies, emphasize the urgency of targeted interventions to alleviate the challenges faced by this marginalized population. The observed higher proportion of commercial sex work and sex work stigma underscores the pervasive social challenges of transgender women. A comprehensive and coordinated effort is essential, bringing together governmental, private sector, and public awareness initiatives to effectively manage stigma and address the underlying causes of commercial sex work.</p></div>