Narratives of agency and exclusion among cisgender male and transgender female sex workers in Cape Town, South Africa: dominant gender constructs and implications for the HIV epidemic Zoe Samudzi, MSc Department of Social Psychology, London School of Economics Center of Excellence for Transgender Health, University of California San Francisco Background This qualitative study (Samudzi & Mannell, 2015) explores discrimination, exclusion, vulnerability, and empowerment and how they influence the health outcomes of cisgender men and transgender women utilizing services at the Sex Workers Education and Advocacy Taskforce (SWEAT) in Cape Town, South Africa. Cisgender men Normative constructions of South African masculinities revolve around heterosexual virility Cisgender heterosexual men expressed feeling “emasculated” in having sex with other men Men working in an industry gendered as feminine results in stigmatized characterization of a “feminized (i.e. failed or subordinated) masculinity Difficulty in attaining masculinity related to economic success in a climate of poverty, inequality, and high unemployment Implications Barriers to condom use relate heavily to hegemonic masculinity. Female sex workers, transgender and cisgender alike, may be less likely to attempt condom negotiation because of a fear of violence that may accompany it. Male clients may also offer to pay more for unprotected sex, and unprotected receptive sex may be a gender affirming opportunity for transgender women who may not receive affirmation elsewhere. HIV prevention programs centered purely on sexual education or condom use as “female empowerment” neglect greater dynamics of sexual negotiation where men are more likely to initiate and dominate sexual activities. In order to support HIV prevention strategies, governments should not only decriminalize sex work but also support identity-affirming advocacy spaces to best address greater dynamics underpinning risky sexual interactions. Findings The transgender women and cisgender men alike reported discrimination and exclusion within a number of different spaces, most frequently by police and state entities. The transgender women described opportunities for gender affirmation, coping, social networking, empowerment, and increased self-efficacy. Many cisgender men similarly derived empowerment from sex work advocacy and accessing health-enhancing resources, but a number expressed shame in not feeling like “real” men. Transgender women Not considered “real” women (i.e. possess an “illegitimate femininity”) because gender does not align with the sex they were assigned at birth They bear gender markers that actively challenge norms: transgender identities decouple sex as gender Excluded from women’s spaces, including sexual health & HIV prevention spaces Vulnerable to corrective physical assault and rape because of social-structural transmisogyny