Stigma affects health in many ways, and this is exemplified in sex workers, who are seen as suitable targets for violence.1 Studies on transgender sex workers show they are routinely subjected to violence, public humiliation, and, not infrequently, murder.2 Male transvestite sex workers are difficult to access3 and vulnerable in terms of public health and criminal justice policy; both of these facts have implications for the control of sexually transmitted diseases.4

The transvestite population is also vulnerable to HIV from silicon implanting and drug misuse,5 and to multidrug resistant tuberculosis.6 Few data are available on police violence towards female or transvestite sex workers, but non-governmental organisations in developing countries have reported police harassment or “social cleansing” of transvestite sex workers.7 Rigorous research is therefore needed to understand the precise context of this multiple vulnerability.

The linked qualitative study by Rhodes and colleagues (doi: 10.1136/bmj.a811) analysed 31 …