Supporting Transgender Women Engaged in Sex Work

It is essential to implement a psychosocial intervention model tailored to the realities of transgender women engaged in the sex trade

hands with LGBTQIA+

The article shows that transgender women engaged in sex work face particular situations, often linked to the stigma of their lifestyle, which makes them more likely to hide their substance use, particularly in conventional care settings – Photo by Alexander Grey on Unsplash

In a new article, available in full here (Spanish version only), the authors highlight the need to study the interactions that can occur when transgender sex workers use a combination of pharmacological treatments and psychoactive substances. The article also highlights the importance and value of implementing a psychosocial intervention model adapted to the realities of these people, based on an intersectional analysis.


Mercè Meroño Salvador. Mercè holds a degree in Psychology and a Master’s degree in Public Health. She is the coordinator of programmes for sex workers based on a rights and harm reduction perspective. She is the president of the Fundació Àmbit Prevenció, Barcelona (Catalonia).

Download full text (in Spanish)


The Fundació Àmbit Prevenció has been working since 1993 with people at risk of social exclusion to provide a tailored response to their health needs through a comprehensive, interdisciplinary approach, promoting empowerment and emancipation. This work is carried out from an intersectional, cross-feminist perspective, based in particular on the fight against macho violence and inequality, with the aim of building greater social justice.


Throughout its history, the Foundation’s projects have been based on risk and harm reduction for sex workers, people who use psychoactive substances and HIV-positive people. These projects are mainly based on support services and outreach programmes, always based on establishing and maintaining links and proximity to the environment in which these people live, which is essential in order to properly understand their needs and respond to their requests.

Offering high-quality professional support

In this context, the need to identify new challenges for professional intervention is highlighted. Indeed, the paucity of data and knowledge from similar experiences confirms the shortcomings observed, particularly in the area covered by this article: trans women working in the sex industry who are also taking HRT, psychoactive substances (prescribed or not/legal or illegal), erectile stimulants and antiretrovirals.

The difficulty of studying and managing such interactions becomes apparent in outreach work. We need to understand not only the methods, routes and frequency of use, but also the social aspects associated with the individual, such as habits, behaviour and emotions, and the contexts in which they occur.

Trans sex workers: precariousness and stigma

Through the Foundation’s outreach work, the authors have observed an increase in the number of transgender sex workers undergoing pharmacological treatment, using psychoactive substances and living in precarious conditions, exacerbated by the impact of COVID-19 and the economic crisis. They also tend to diversify the substances they use – including methamphetamine, cocaine, poppers and GHB – and to self-medicate with hormone replacement therapy. These factors make risk and harm reduction interventions more complex and require a much-needed rethink of psychosocial models.

The article shows that these women face particular situations, often linked to the stigma of their lifestyle, which makes them more likely to hide their substance use, particularly in conventional care settings.

Given this reality, the method of contact plays a key role in establishing a relationship that is strong enough to meet their needs.

Follow-up based on a gender perspective

Early identification services are essential, as they allow effective referral to specialist services, while at the same time establishing outreach work based on an intersectional and gendered approach to health and harm reduction.

The article emphasizes the urgent need to move towards a shared decision-making model in which all parties have access to information about substances of use and abuse, prescribed treatments and the various physical and mental pathologies. Research should take all these aspects into account so that it can feed into an evidence-based care and support strategy tailored to the specific needs of the people concerned.

Finally, the article stresses the importance of moving away from reductionist approaches that focus exclusively on pharmacology. An intersectional and individualized analysis is essential to reduce inequalities and improve care and access to health in order to reduce risk and harm.