**Background:** Transgender people experience heightened social vulnerability due to gender-based prejudice, yet data on food insecurity in this population are scarce. The COVID-19 pandemic exacerbated food insecurity in Brazil, where over half the general population experienced some degree of food insecurity by late 2020. This study aimed to estimate the frequency of food insecurity in a Brazilian transgender sample and investigate its associations with dietary changes and perceived prejudice during the pandemic.
**Methods:** An online cross-sectional study was conducted between October and December 2020. Participants were recruited via social media (Instagram, Twitter, Facebook, WhatsApp), national LGBT networks, and specialized outpatient clinics. Eligible individuals were ≥18 years, living in Brazil, and self-identified as transgender. The final sample comprised 109 participants after excluding duplicates. Food insecurity was measured using the reduced 8-item Brazilian Food Insecurity Scale (EBIA), with cutoff points: food security (0), mild (1–3), moderate (4–5), and severe (6–8). Dietary changes were assessed via three variables (ability to purchase food, food diversity, access to healthy food) comparing periods before and after pandemic onset. Perceived prejudice was measured using the Perceived Prejudice Scale, categorized into quartiles (low, medium, high, extreme). Bivariate analysis used Pearson’s chi-square test; Poisson regression with robust variance estimated prevalence ratios (PR) adjusted for income, education, and employment. Model predictive power was evaluated using ROC curve (area = 88.46%, CI 82–95).
**Key Results:** Of 109 participants, 53.2% were trans men, 29.4% trans women, 6.4% travestis, 7.3% non-binary, and 3.7% other identities. Participants were distributed across all Brazilian regions (51.4% Northeast, 20.2% South, 14.7% Southeast, 8.3% North, 5.5% Midwest); 58.7% self-declared as Black (Black or Brown). Overall, 68.8% (95% CI 59.37–76.9) experienced some degree of food insecurity, and 20.2% (95% CI 13.59–28.91) experienced severe food insecurity. The pandemic affected food purchasing power in 15.6%, food diversity in 15.7%, and access to healthy foods in 11% of participants. In bivariate analysis, income (p<0.01), education (p<0.01), employment (p<0.01), changes in ability to purchase food (p<0.01), changes in food diversity (p<0.01), and changes in access to healthy food (p<0.01) were significantly associated with food insecurity; perceived prejudice was not (p=0.08). In the adjusted Poisson regression model, the strongest predictors were income (2nd tertile vs 3rd: PR 1.71, 95% CI 1.15–2.55, p<0.01; 1st tertile vs 3rd: PR 1.78, 95% CI 1.21–2.63, p<0.01) and unemployment (PR 1.82, 95% CI 1.10–3.02, p=0.02). Dietary change variables showed elevated but non-significant adjusted PRs: difficulty purchasing food (PR 1.15, 95% CI 0.95–1.139, p=0.16), reduced food diversity (PR 1.20, 95% CI 0.94–1.52, p=0.14), and reduced access to healthy food (PR 1.25, 95% CI 0.97–1.62, p=0.09). Perceived prejudice categories were not significantly associated (moderate vs low: PR 1.34, 95% CI 0.87–2.06, p=0.19; strong: PR 1.29, 95% CI 0.93–1.79, p=0.13; extreme: PR 1.16, 95% CI 0.84–1.61, p=0.37). The model had a Deviance goodness-of-fit of 41.53 (chi2 > 0.05) and Akaike’s information criterion of 213.53.
**Clinical Implications:** This study provides the first estimate of food insecurity frequency in a Brazilian transgender sample during the COVID-19 pandemic. The 68.8% prevalence is substantially higher than contemporaneous national estimates for cisgender women (64.1%) and men (47.5%), and severe food insecurity (20.2%) was double the national estimate (9%). Income and employment were the dominant drivers, suggesting that structural economic factors—rather than individual-level perceived prejudice—primarily determine food insecurity in this population. The lack of association with perceived prejudice may reflect that systemic discrimination operates through economic pathways (e.g., employment discrimination, wage gaps) rather than direct individual perception. These findings underscore the need for income support, employment protection, and food assistance programs specifically tailored to transgender individuals. The authors recommend larger, population-based studies to confirm these findings and to explore how structural prejudice mediates food insecurity through economic determinants.