Family rejection, acceptance, support and health among transgender women sex workers living with HIV in Santo Domingo, Dominican Republic.

Background: Rejection from parents can lead transgender (trans) youth and young adults to experience poor health outcomes, while parental and sibling acceptance and support can be protective against poor health outcomes. The role of family in adult trans women's lives has been minimally investigated.

Aim: This study aimed to explore experiences of familial rejection, acceptance, and support in the lives of trans women sex workers living with HIV in the Dominican Republic.

Method: In-depth interviews were conducted with 21 trans women ages 23 to 49 in Santo Domingo in 2019. We conducted a qualitative analysis of the interviews. We developed narrative summaries and a case-based matrix to analyze data within and across participants and confirm patterns and themes in the data.

Results: Familial rejection and acceptance were processes with most participants receiving acceptance from at least one family member over time as well as receiving emotional and instrumental support. Poor health outcomes influenced by rejection and lack of support included suicide attempts, depression, and substance use. Conversely, acceptance and support bolstered well-being and provided housing stability and assistance with HIV treatment.

Conclusion: Family rejection and acceptance play an important role throughout the life course. Working with families to become accepting of their trans family members could improve trans women's health outcomes.