Learning to Endure: A Qualitative Examination of the Protective Factors of Homeless Gender Minority Youth and Emerging Adults Engaged in Survival Sex

Background and Purpose

Gender minority youth and emerging adults (GM YEA) face a number of adversities, including harassment, abuse, and hostile home and school environments (Austin & Craig, 2015). These adversities are associated with deleterious consequences, including mental health problems, substance abuse, suicide, and homelessness. In fact, homelessness has been considered a serious public health problem among transgender youth (Kattari & Begun, 2017; Detloff et al., 2017). However, there is evidence that GM YEA still demonstrate resilience under extraordinary conditions. Therefore, this study examined how GM YEA who are homeless and engaging in survival sex describe and understand the protective factors present in their lives, despite the abundant risks presented by their circumstances.

Methods

In-depth qualitative interviews were conducted with 57 racially/ethnically diverse GM YEA living in a large U.S. city, as part of larger study that examined the experiences of sexual and gender minority homeless youth engaged in survival sex. Participants were 17-26 years old (M=19.88, SD=1.55), and identified as transgender woman (53%), transgender man (16%), and other (32%; gender-queer, gender-fluid, androgynous, or non-binary). The majority of youth identified as Black (40%), multiracial (35%), Latinx (16%), White (5%), and as another race (3%). Researchers conducted a secondary analysis of qualitative data using thematic analysis to identify patterns and also to elucidate the lived experiences of participants beyond surface level descriptions. Multiple coders, peer debriefings, negative case analysis, and audit trails were used to ensure rigor.

Results

We identified three themes to capture youth’s understanding of their protective factors: relying on oneself and others to avoid harm, accessing gender-affirming health and mental health care, and proactively maintaining sexual health. Participants described mitigating risk of harm while attempting to meet their basic needs (e.g., making money, securing housing) by relying on themselves and others. Additionally, amidst the challenges of being homeless and engaging in survival sex, participants still had to care for their physical and mental health. They described the importance of having gender-affirming health and mental health services, which supported their ability to live authentically and manage stress. Participants also expressed keen awareness of the sexual health risks of engaging in survival sex. To deal with this, they described making calculated, often proactive decisions about using protection and being cautious about the clients they had sex with.

Conclusions and Implications

Despite the pervasive risks present for homeless GM YEA engaging in survival sex, participants described having multiple protective factors that contribute to their resilience. The protective factors described by GM YEA fall outside traditional understandings of protective factors and reflect the ways in which hyper-marginalized youth must navigate their own survival and well-being. This study aligns with literature suggesting resilience is not mutually exclusive from risk, evidenced by GM YEA’s understanding of their own protective factors (Shelton, 2016). By focusing on GM YEA, primarily YEA of color, this research privileges the experiences of individuals historically underrepresented in research and encourages future research to incorporate these perspectives into policies and programs designed to serve this population of YEA.