Resilience among Cisgender and Transgender Women in Street-Based Sex Work in Baltimore, Maryland

Introduction: Resilience represents adaptability and empowerment and can buffer against the consequences of trau-matic events. Cisgender and transgender women in street-based sex work are at high risk for trauma, yet data on their resilience are sparse. A clearer understanding of resilience and its correlates is useful for informing sex worker-centered interventions. Methods: Using the Connor-Davidson 10-item Resilience Scale (range, 0-40), we describe resilience among 165 cis-gender and 42 transgender street-based women sex workers in Baltimore, Maryland. Longitudinal cohort data were used to examine correlates of resilience in each population. Analyses are conducted using multiple linear regression. Results: The mean resilience score was 24.2 (95% confidence interval, 23.6-24.8) among cisgender women sex workers and 32.2 among transgender women sex workers (95% confidence interval, 30.8-32.7). Among cisgender participants, positive correlates of resilience were being Black, Hispanic, or other race (ss = 2.7; p = .004), having housing (ss = 1.9; p = .034), social cohesion score (ss = 0.18; p = .047), and daily drug injection (ss = 3.7; p < .001); negative correlates of resilience were sexual violence (ss = -4.8; p = .006) and exposure to egregious police acts (ss = -0.6; p = .015). Among transgender participants, higher education level (ss = 8.8; p < .001), food security (ss = 3.5; p = .005), and housing stability (ss = 2.0; p < .001) were associated with increased resilience, and daily noninjection drug use (excluding marijuana; ss = -3.3; p < .001) and physical violence (ss = -2.9; p < .001) were associated with reduced resilience. Conclusions: This study is the first to characterize factors that may influence resilience among cisgender and transgender women sex workers. Results highlight tangible intervention targets for promoting mental health and safety among a uniquely vulnerable population of women. (c) 2020 Jacobs Institute of Women's Health. Published by Elsevier Inc.