A Cross-Sectional Examination of Family Rejection and Poor Mental Health and Drug Use Among Transgender Women Sex Workers with HIV in the Dominican Republic

Purpose: We examined the frequency of family rejection among transgender women sex workers with HIV in the Dominican Republic and assessed the relationship between family rejection and mental health and drug use. Methods: In this exploratory study, we analyzed cross-sectional survey data collected in 2019 as part of a mixed-methods study with transgender women sex workers with HIV ( N = 100). Family rejection due to being transgender was assessed with a single-item measure of frequency of rejection with three response categories: never, sometimes, and many times. We conducted multivariate logistic regressions to examine the association between frequency of family rejection and depressive and anxiety symptoms, and recent drug use. Results: Among participants, 31% reported never being rejected by family, 36% rejected sometimes, and 33% rejected many times. Individuals who reported being rejected many times by family were significantly more likely to report depressive symptoms (adjusted odds ratio [aOR]: 3.12, 95% confidence interval [CI]: 1.10–8.81) and drug use (aOR: 3.45, 95% CI: 1.17–10.17) compared with those who reported never being rejected by family. Having experienced rejection many times was not associated with anxiety symptoms. There were no significant differences between those who reported never being rejected by family and those who reported being sometimes rejected. Conclusion: Family rejection was associated with depression and drug use among transgender women sex workers with HIV. These findings suggest that interventions focused on reducing family rejection of transgender family members could be critical for improving mental health and substance use outcomes among transgender women sex workers with HIV.