Sexual abuse and substance use before or during sex among transgender women in Brazil.

Transgender women and travestis (TWT) experience high rates of sexual violence and substance use, but few studies explore drug use specifically before or during sex. As such, this study investigated the association between lifetime sexual abuse and drug use before or during sex among TWT in Brazil. TransOdara was a cross-sectional study conducted in five Brazilian cities using respondent-driven sampling from 2019 to 2021. A total of 1,317 TWT completed a questionnaire aided by trained interviewers. Poisson regression was used to estimate associations between abuse history and substance use (marijuana, cocaine or crack) before or during sex, adjusting for confounders. Over half (53.9%) of the participants reported sexual abuse or attempted abuse, and 36.7% reported substance use before or during sex. Abuse history was associated with a higher prevalence of substance use (adjusted PR = 1.17; 95%CI: 1.01-1.35). History of sex work was also associated (PR = 2.02), whereas high school completion proved a protective factor (PR = 0.82). Sexual abuse is significantly associated with substance use in sexual contexts among TWT. Public health strategies must address trauma, substance use, and social vulnerabilities in this population, bringing together the efforts of public health and human rights.