"They feel empowered to discriminate against las chicas": Latina transgender women's experiences navigating the healthcare system

Integrating Gender-Affirming Care in a Medical Spanish Endocrine System Curriculum

Introduction

With a growing Hispanic population in the United States, medical education is adapting to provide the necessary language skills and cultural competence for effective health care. However, the incorporation of gender-affirming care in the context of medical education for Hispanic populations requires further emphasis.

Methods

This curriculum presented a 3-week medical Spanish endocrine system module designed for first-year medical students. The module aimed to enhance students' ability to communicate effectively with Spanish-speaking patients about endocrine health while integrating principles of gender-affirming care. It included classroom sessions, standardized patient practice, and clinical practice with peer tutors. Pre- and postmodule surveys and assessments were conducted to evaluate the module's effectiveness.

Results

Out of 76 participants, 72 completed the postmodule evaluation. Survey results indicated significant increases in confidence levels across various aspects of patient interaction in Spanish, with statistically significant gains observed in all assessed areas. Knowledge test outcomes revealed enhanced proficiency in Spanish terminology related to the endocrine system, with scores increasing from an average of 22.3 premodule to 25.7 postmodule (p = .002), as measured by the paired t test. Additionally, students performed well in the diabetic consultation objective structured clinical examination station, with a high mean score of 86%, surpassing the satisfactory threshold.

Discussion

This curriculum highlights the success of a comprehensive educational approach in expanding medical students' language proficiency and ability to provide gender-affirming care to address health care disparities and improve patient outcomes among diverse populations.

Breaking barriers: How transwomen meet their healthcare needs

BACKGROUND

 Transgender women - individuals assigned male at birth but who identify as female - are disproportionately affected by, among others, human immunodeficiency virus (HIV), other sexually transmitted diseases (STIs) and mental health issues. Studies show that transgender women often encounter discrimination and stigma when seeking healthcare from health facilities.

AIM

 This study assessed the healthcare needs of transgender women, their experiences of the mainstream healthcare system and alternative strategies for navigating the healthcare system.

SETTING

 The study was carried out in the City of Ekurhuleni Metropolitan Council in South Africa's Gauteng province.

METHODS

 A case study design was followed. Participants were purposively selected and included 10 transgender women aged 26-50. Individual semi-structured interviews were conducted over 2 months.

RESULTS

 Participants expressed a need for hormone replacement therapy, HIV treatment and prevention and treatment for STIs. Experiences of participants within the healthcare system were predominantly negative, with instances of discrimination, stigma and privacy violations being commonplace. Alternative strategies to meet their healthcare needs included the use of self-medication, consulting traditional healers and utilising non-governmental organisations.

CONCLUSION

 There is an urgent need for equitable and inclusive health management of transgender women in South Africa.Contribution: This study provided a first look in a South African context into how and to what extent transwomen employ alternative healthcare strategies such as self-medication and utilising non-governmental organisations when faced with mainstream healthcare access barriers. The use of traditional doctors was identified as a novel, alternative strategy used by transwomen to access healthcare and treatment.

Highs, Lows, and Hormones: A Qualitative Metasynthesis of Transgender Individuals' Experiences Undergoing Gender-Affirming Hormone Therapy

Gender Affirming Hormone Therapy (GAHT) is a key therapeutic approach which aims to help trans and gender diverse (or simply "trans") individuals' transition from their sex-presumed-at-birth to their experienced gender identity. Previous reviews have focused on synthesizing quantitative experiences; however, a qualitative lens is important to understand the personal journey of GAHT. This review provides a qualitative meta-synthesis of the experiences of trans people around the world who have undergone GAHT to elicit contextualized understanding of the changes experienced. Systematic searches of eight databases identified an initial 2670 papers, refined to a final 28 papers. Overall, findings suggested that the GAHT journey is unique and elicited a myriad of changes which, whilst challenging at times, were life-changing and brought about positive psychological, physical, and social changes. Other themes explored GAHT not being treated as a fix-all for associated mental health issues, the rules that govern appraisal of physical changes, how privilege and social identity evolve, and the power of affirmation. This work offers important recommendations to improve the care offered to trans people undergoing GAHT. Namely, person-centered support is essential, and peer-navigation may be a useful future direction to explore.

The Health Needs of Sexual and Gender Minority Migrant Women in the United States: A Scoping Review

Purpose: This scoping review characterizes the peer-reviewed evidence on the health of first-generation sexual and gender minority (SGM) migrant women to the United States and identifies research gaps and future priorities. Methods: On February 1, 2022, the following databases were searched: PubMed (MEDLINE), Embase, CINAHL Plus with Full Text, APA PsycINFO, and PAIS Index. Primary research studies based in the United States, in English, on first-generation SGM migrants (i.e., immigrants, refugees, asylum seekers) were included. Gray literature and review articles were excluded. Health outcome data were not extracted from nonbinary populations nor transgender men. Themes were generated using qualitative content analysis. Results: Thirty-three studies were reviewed, most were qualitative, and 11 focused on transgender women migrants (especially from Latin America), while only one was exclusively on sexual minority women (SMW) migrants. Premigration experiences of violence and discrimination were linked to high prevalence rates of post-traumatic stress disorder, depression, and anxiety. Postmigration stressors included lack of educational and employment opportunities, reduced access to social services, and experiences of stigma and discrimination, which were also associated with the development of depressive symptoms. Transgender women migrants reported not seeking formal medical care, given a lack of gender-affirming services and insurance resulting in reliance on unsafe informal care networks for hormone therapy and feminization procedures. Conclusion: Future interventions should focus on fostering social support networks of SGM migrant women to help improve their mental health outcomes. Research priorities should include studies on SMW migrants and more quantitative research that could identify additional health needs (i.e., sexual health) of SGM migrant women.

SARS-CoV-2 Infection and Testing Experiences in a Nationwide Sample of Transgender and Gender-Diverse Adults, June-December 2021

OBJECTIVES

COVID-19 surveillance data are rarely collected or disaggregated by gender identity in the United States. We quantified COVID-19 testing experiences and SARS-CoV-2 infection history among transgender and gender-diverse (TGD) people to inform testing strategies and public health responses.

METHODS

From June 14 through December 16, 2021, TGD adults enrolled in a US nationwide online survey with optional SARS-CoV-2 antibody testing. We used multinomial regression analyses to identify correlates of suspected and confirmed SARS-CoV-2 infection (vs no known infection). We identified correlates of inability to access COVID-19 testing when needed using generalized linear models for binomial variables.

RESULTS

Participants (N = 2092) reported trans masculine (30.5%), trans feminine (27.3%), and nonbinary (42.2%) gender identities. Ten percent of respondents had a confirmed history of SARS-CoV-2 infection, and 29.8% had a history of suspected SARS-CoV-2 infection. Nonbinary gender (adjusted prevalence ratio [aPR] = 1.68; 95% CI, 1.12-2.53), experiencing homelessness (aPR = 1.65; 95% CI, 1.05-2.60), and food insecurity (aPR = 1.45; 95% CI, 1.03-2.04) were associated with confirmed SARS-CoV-2 infection. Food insecurity (aPR = 1.38; 95% CI, 1.10-1.72), chronic physical health condition (aPR = 1.44; 95% CI, 1.15-1.80), chronic mental health condition (aPR = 3.65; 95% CI, 2.40-5.56), and increased anticipated discrimination scores (aPR = 1.03; 95% CI, 1.01-1.05) were associated with suspected SARS-CoV-2 infection. Thirty-four percent (n = 694 of 2024) of participants reported an inability to access COVID-19 testing when needed, which was associated with Latinx or Hispanic ethnicity, inconsistent telephone access, homelessness, disability, and transportation limitations. The majority (79.4%) reported a complete COVID-19 vaccine course at the time of participation.

CONCLUSIONS

Inclusion of TGD people in public health surveillance and tailored public health strategies to address TGD communities' social and structural vulnerabilities may reduce barriers to COVID-19 testing.

To Go or Not to Go: Factors That Influence Health Care Use Among Trans Adults in a Non-Representative U.S. Sample

Trans people tend to utilize health care at rates lower than cisgender people, which commonly results in short-term and long-term unfavorable health outcomes. Theoretically informed by Andersen's behavioral model of health services use and Lerner and Robles' adapted behavioral model of health services use for transgender people, the current study examined how individual characteristics of trans people along with the external environment and health care service environment they must navigate impact their health care utilization. Binary logistic regression was used to analyze data from the 2015 United States Trans Survey (N = 27,715), the largest trans sample to date. Perception of health care provider (HCP) knowledge, health insurance status, and health care costs each produced the strongest effect on visiting a doctor or HCP in the past year. The results showed that having a provider that had some level of knowledge about trans people was potentially most critical to increase utilization. Discussion points include increasing trans-focused curriculum in health professional schools, utilizing trans standardized patients in health professional schools, and holding insurance companies accountable to provide trans affirming care.

“In the Voices of People Like Me”: LGBTQ Coping During Trump’s Administration

The present study explored strategies that LGBTQ people used to cope during the U.S. presidential administration of Donald Trump. Coping strategies can buffer the impact of identity-related stigma and decreased psychological well-being, however, little is known about the ongoing coping strategies used by LGBTQ people during Trump’s presidential administration. This research addresses this gap in the literature. Participants included 335 LGBTQ individuals who were negatively impacted by the discriminatory policies of the Trump administration. Participants completed an online survey where they discussed the coping strategies they used during the Trump administration. Thematic analysis revealed five coping-related themes, including: (a) Coping Through Connecting With People, (b) Coping Through Self-Care and Self-Preservation Activities, (c) Coping Through Relational Disengagement, (d) Coping Through Activism, and (e) Coping Through Outness Decisions. Our discussion explores how counseling psychologists can work with LGBTQ clients to maximize coping strategies for managing distress during anti-LGBTQ presidential administrations.

Latinx trans immigrants' survival of torture in U.S. detention: A qualitative investigation of the psychological impact of abuse and mistreatment

BACKGROUND

A trans person is murdered every 3 days in the world, with the majority of these murders occurring in Latin America. This violence is a motivating factor for Latinx trans immigrants to immigrate to the United States. Regardless of whether individuals may be able to remain in the U.S., trans immigrants and asylum seekers are often held in detention facilities until immigration courts decide their cases. Although there are several standards of care and guidelines produced for trans and nonbinary (TNB) people who are held in detention, various reports have indicated that Immigration and Customs Enforcement (ICE) has not or inappropriately implemented these guidelines, thereby incurring and increasing risk of harm upon TNB immigrants.

AIMS

This qualitative study used thematic analysis to provide an understanding of the psychological impact that the systemic power of US detention proceedings had on the lives of Latinx, trans immigrants.

METHOD

The semi-structured interview protocol and implementation of this study was developed in collaboration with two national Latinx, LGBTQ immigrant advocacy organizations. The sample included 30 trans participants, between the ages of 18 and 52 (M = 23) who immigrated from El Salvador (40%), Guatemala (23%), México (17%), Honduras (17%), and Peru (3%).

RESULTS

Participants reported being subject to debilitating and torturous conditions in "La Hielera", torture and abusive treatment by detention authorities, being denied access to basic human needs and medical care, and held in solitary confinement as punishment. This dehumanization, abuse, and transphobia in detention incurred psychological sequelae on participants including trauma, anxiety and depression, suicidal ideation, and a preference to self-deport.

DISCUSSION

Implications include calls to abolish immigration detention, recommendations for mental health providers, and an overall restructuring of policies and services for humane asylum seeking processes for trans, Latinx immigrants.

"A center for trans women where they help you": Resource needs of the immigrant Latinx transgender community

Background

Immigrant Latinx transgender people often migrate to the United States because of a desire for increased safety and more opportunities. However, after migrating to the United States, immigrant Latinx transgender people often struggle to access basic needs, including health care, jobs, and stable finances. These struggles are exacerbated for undocumented immigrant Latinx transgender people. There is a gap in the literature regarding needed resources for immigrant Latinx transgender community members living in the United States.

Aims

Utilizing a critical intersectionality framework, the aim of the present study was to investigate the resource needs of immigrant Latinx transgender community members living in the United States.

Methods

A community sample of 18 immigrant Latinx transgender people living in a large metropolitan city in Florida participated in individual semi-structured interviews to explore their community resource needs.

Results

Thematic analysis revealed five themes related to resources that participants needed including: 1) Transgender healthcare/resources, 2) Public education, 3) Financial aid resources, 4) Homelessness resources, and 5) Addictions care. Two resource need-related themes were identified that pertain specifically to undocumented immigrant Latinx transgender people, including: 1) Documentation papers for access, and 2) Legal aid.

Conclusions

Findings suggest that immigrant Latinx transgender community members in this study provided guidance about broad resources needed to enhance their wellness and safety, and promote liberation of community members. Participants' resource needs suggest the importance of policy and structural level changes from institutions with power that consider and enhance the wellness of immigrant Latinx transgender people. Findings also suggest the need for more tailored interventions and case work to better support immigrant Latinx transgender people.