Xia Yu has not visited her family in years, afraid that they would be ashamed of her identity. Yang Zhou stopped taking the subway to avoid the stares of strangers. Xiao Tong was once beaten by police. “They asked really perverted questions, like how do you have sex,” she said. “I turned around and asked, do you want to try? Then he kicked me, really, he kicked me.”

Transgender sex workers like Xia, Yang and Xiao – all pseudonyms – are among the most marginalised and vulnerable populations in China today, the nonprofit organisation Asia Catalyst says in a detailed research report released on Friday.

The 79-page report, titled My Life is Too Dark to See the Light: A Survey of the Living Conditions of Transgender Female Sex Workers in Beijing and Shanghai, says China’s transgender sex workers suffer from intense social ostracism and economic marginalisation, leaving them vulnerable to HIV infection and abuse by law enforcement officials.

Asia Catalyst, in cooperation with two local NGOs – Beijing Zuoyou Information Centre and Shanghai CSW and MSM Centre – interviewed 70 transgender sex workers between December 2013 and September 2014 for the report. All of the interviewees – 35 in Beijing and 35 in Shanghai – were born male but “presented as women while doing sex work”.

Although the Chinese government does not actively punish transgender people for their identity, the country’s lack of non-discrimination laws and basic medical resources for transitioning leaves many transgender people feeling permanently trapped on society’s bottom rung.

The majority of Chinese people refuse to regard transgender identification as socially acceptable – Confucian standards of morality discourage breaking with convention, and traditional Chinese society holds men in higher esteem than women. The social stigma has forced many transgender people to live hidden lives far from family – 97% of Asia Catalyst’s interviewees had left their home towns.

China’s community of transgender sex workers is diverse, including gay men, transgender people (who were born as one sex but identify as another), and transsexual people (who have undergone sex reassignment surgery).

The report says a “considerable percentage” of transgender women in the Asia-Pacific region are engaged in sex work. “Some people do sex work because they need to earn money – they tell us they earn more after they dress as women,” Shen Tingting, Asia Catalyst’s advocacy programme director, told reporters on Friday. “But everyone has different motivations.” Many are unable to find other jobs.

While sex work in China is technically illegal, prostitution is ubiquitous and often thinly veiled, and the ban pits sex workers against police. More than 60% of Asia Catalyst’s interviewees had been arrested, and many said they had been beaten or threatened with physical violence. This dynamic also exposes sex workers to abuse by clients.

“Under normal circumstances, it’s not convenient to report things to the police, because we have an embarrassing identity that’s not approved,” said one interviewee, Xiao Huli. “Although the law is supposed to apply equally to everyone, there are still limitations. This profession isn’t out in the open, so if you go to the police, nothing good will come of it. It makes more sense to just suffer in silence.”

Globally, transgender sex workers are 49 times more likely to be infected with HIV than the general population, and nine times more vulnerable to the virus than female sex workers, said the report.

For many transgender people in China, sex reassignment surgery is prohibitively expensive, and resources for understanding their sexual orientations are scarce. “Isolated and often humiliated when seeking public services, particularly in healthcare settings, has also led many to self-medicate and engage in dangerous transitioning practices, including on self-administered hormone use,” the report says.