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Maoto M, Davis B. Breaking barriers: How transwomen meet their healthcare needs. Afr J Prim Health Care Fam Med 2024; 16:e1-e6. [PMID: 38949443 DOI: 10.4102/phcfm.v16i1.4598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 07/02/2024] Open
Abstract
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.
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Affiliation(s)
- Millicent Maoto
- Africa Centre for HIV/Aids Management, Faculty of Economics and Management Sciences, Stellenbosch University, Stellenbosch.
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Kelly PJ, Myers-Matthews P, Collins AB, Wolfe HL, Miller-Jacobs C, Davis M, Adrian H, Briody V, Fernández Y, Operario D, Hughto JM. A qualitative study of reasons to use substances and substance use treatment experiences among transgender and gender diverse adults in Rhode Island. SSM. QUALITATIVE RESEARCH IN HEALTH 2024; 5:100399. [PMID: 38854803 PMCID: PMC11157666 DOI: 10.1016/j.ssmqr.2024.100399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Affiliation(s)
- Patrick J.A. Kelly
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
- Center for Promotion and Health Equity, Brown University School of Public Health, Box G-121-8, Providence, RI, 02912, USA
| | | | - Alexandra B. Collins
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Hill L. Wolfe
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Cameron Miller-Jacobs
- Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Madison Davis
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Haley Adrian
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
| | - Victoria Briody
- Warren Alpert School of Medicine, Brown University, 222 Richmond Street, Providence, RI, 02903, USA
| | - Yohansa Fernández
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
- Warren Alpert School of Medicine, Brown University, 222 Richmond Street, Providence, RI, 02903, USA
| | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30329, USA
| | - Jaclyn M.W. Hughto
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
- Center for Promotion and Health Equity, Brown University School of Public Health, Box G-121-8, Providence, RI, 02912, USA
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
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Birch L, Bindert A, Macias S, Luo E, Nwanah P, Green N, Stamps J, Crooks N, Singer RM, Johnson R, Singer RB. When Stigma, Disclosure, and Access to Care Collide: An Ethical Reflection of mpox Vaccination Outreach. Public Health Rep 2024; 139:379-384. [PMID: 37846098 PMCID: PMC11037228 DOI: 10.1177/00333549231201617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
Experiences of stigma in health care encounters among LGBTQ+ populations (lesbian, gay, bisexual, transgender, and queer and questioning) have long been a barrier to care. Marginalization and historically grounded fears of stigmatization have contributed to a reluctance to disclose sexual behavior and/or gender identity to health care providers. We reflect on how student nurses grappled with the ethics of patient disclosure while providing mobile outreach in Chicago for mpox (formerly monkeypox) from fall 2022 to spring 2023. Student nurses addressed how requiring disclosure of sexual behavior or sexual orientation may serve as a barrier to accessing preventive care, such as mpox vaccination. Accounts of stigma and criminalization experienced by LGBTQ+ people provide insight on challenges historically associated with disclosure in health care.
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Affiliation(s)
- Lane Birch
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Adam Bindert
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Susy Macias
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Ellis Luo
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Patrick Nwanah
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Noel Green
- Department of Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Jahari Stamps
- Southside Health Advocacy Resource Partnership, Chicago, IL, USA
| | - Natasha Crooks
- Department of Human Development Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Rebecca M. Singer
- Department of Population Health Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Robin Johnson
- Department of Human Development Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Randi Beth Singer
- Department of Human Development Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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Clark KD, Lunn MR, Bosse JD, Sevelius JM, Dawson-Rose C, Weiss SJ, Lubensky ME, Obedin-Maliver J, Flentje A. Societal stigma and mistreatment in healthcare among gender minority people: a cross-sectional study. Int J Equity Health 2023; 22:162. [PMID: 37620832 PMCID: PMC10463432 DOI: 10.1186/s12939-023-01975-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Gender minority (GM; individuals whose gender is not aligned with that traditionally associated with the sex that was assigned to them at birth) people have widely reported mistreatment in healthcare settings. Mistreatment is enacted by individuals within society who hold stigmatizing beliefs. However, the relationship between healthcare mistreatment and societal stigma (i.e., the degree to which society disapproves of GM people) is unclear and not measured consistently. METHODS We analyzed data from 2,031 GM participants in The Population Research in Identity and Disparities for Equality (PRIDE) Study's 2019 Annual Questionnaire to determine whether societal stigma was associated with participants' past-year reports of mistreatment (defined as denial of healthcare services and/or lower quality care) in medical or mental healthcare settings. We created a proxy measure of societal stigma by incorporating variables validated in existing literature. Participants reported whether they had experienced mistreatment in medical and mental health settings independently. RESULTS Healthcare denial and/or lower quality care during the past year was reported by 18.8% of our sample for medical settings and 12.5% for mental health settings. We found no associations between the societal stigma variables and past-year reports of healthcare denial and/or lower quality care in medical or mental healthcare settings. CONCLUSIONS Although a high proportion of GM people reported past-year healthcare mistreatment in both medical and mental health settings, mistreatment had no relationship with societal stigma. Factors other than societal stigma may be more important predictors of healthcare mistreatment, such as healthcare workers' knowledge of and attitudes toward GM people. However, other measures of societal stigma, or different types of mistreatment, may show stronger associations. Identifying key factors that contribute to mistreatment can serve as targets for intervention in communities and healthcare settings.
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Affiliation(s)
- Kristen D Clark
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden.
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA
| | - Jordon D Bosse
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave, Boston, MA, USA
| | - Jae M Sevelius
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA, USA
- Center of Excellence for Transgender Health, Department of Medicine, University of California, 513 Parnassus Avenue, San Francisco, San Francisco, CA, USA
| | - Carol Dawson-Rose
- Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way, San Francisco, CA, USA
| | - Sandra J Weiss
- Department of Community Health Systems, UCSF Depression Center, University of California, San Francisco, 2 Koret Way, San Francisco, CA, USA
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA
- Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way, San Francisco, CA, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA
- Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way, San Francisco, CA, USA
- Alliance Health Project, Department of Psychiatry, School of Medicine, University of California, San Francisco, 1930 Market Street, San Francisco, CA, USA
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Frazier TL, Lopez PM, Islam N, Wilson A, Earle K, Duliepre N, Zhong L, Bendik S, Drackett E, Manyindo N, Seidl L, Thorpe LE. Addressing Financial Barriers to Health Care Among People Who are Low-Income and Insured in New York City, 2014–2017. J Community Health 2022; 48:353-366. [PMID: 36462106 PMCID: PMC10060328 DOI: 10.1007/s10900-022-01173-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 12/04/2022]
Abstract
AbstractWhile health care-associated financial burdens among uninsured individuals are well described, few studies have systematically characterized the array of financial and logistical complications faced by insured individuals with low household incomes. In this mixed methods paper, we conducted 6 focus groups with a total of 55 residents and analyzed programmatic administrative records to characterize the specific financial and logistic barriers faced by residents living in public housing in East and Central Harlem, New York City (NYC). Participants included individuals who enrolled in a municipal community health worker (CHW) program designed to close equity gaps in health and social outcomes. Dedicated health advocates (HAs) were explicitly paired with CHWs to provide health insurance and health care navigational assistance. We describe the needs of 150 residents with reported financial barriers to care, as well as the navigational and advocacy strategies taken by HAs to address them. Finally, we outline state-level policy recommendations to help ameliorate the problems experienced by participants. The model of paired CHW–HAs may be helpful in addressing financial barriers for insured populations with low household income and reducing health disparities in other communities.
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Affiliation(s)
- Taylor L Frazier
- Health Initiatives Department, Community Service Society of New York, New York, NY, USA
| | - Priscilla M Lopez
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Amber Wilson
- Health Initiatives Department, Community Service Society of New York, New York, NY, USA
| | - Katherine Earle
- Health Initiatives Department, Community Service Society of New York, New York, NY, USA
| | - Nerisusan Duliepre
- Health Initiatives Department, Community Service Society of New York, New York, NY, USA
| | - Lynna Zhong
- New York University-City University of New York Prevention Research Center, New York University Langone Health, New York, NY, USA
| | - Stefanie Bendik
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Elizabeth Drackett
- Bureau of Harlem Neighborhood Health, Center for Health Equity and Community Wellness, NYC Department of Health and Mental Hygiene, New York, NY, USA
| | - Noel Manyindo
- Bureau of Harlem Neighborhood Health, Center for Health Equity and Community Wellness, NYC Department of Health and Mental Hygiene, New York, NY, USA
| | - Lois Seidl
- Bureau of Harlem Neighborhood Health, Center for Health Equity and Community Wellness, NYC Department of Health and Mental Hygiene, New York, NY, USA
| | - Lorna E Thorpe
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA.
- New York University-City University of New York Prevention Research Center, New York University Langone Health, New York, NY, USA.
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Hughes LD, Gamarel KE, King WM, Goldenberg T, Jaccard J, Geronimus AT. State-Level Policy Stigma and Non-Prescribed Hormones Use among Trans Populations in the United States: A Mediational Analysis of Insurance and Anticipated Stigma. Ann Behav Med 2022; 56:592-604. [PMID: 34390573 PMCID: PMC9242548 DOI: 10.1093/abm/kaab063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Medical gender affirmation (i.e., hormone use) is one-way transgender (trans) people affirm their gender and has been associated with health benefits. However, trans people face stigmatization when accessing gender-affirming healthcare, which leads some to use non-prescribed hormones (NPHs) that increase their risk for poor health. PURPOSE We examined whether healthcare policy stigma, as measured by state-level trans-specific policies, was associated with NPHs use and tested mediational paths that might explain these associations. Because stigmatizing healthcare policies prevent trans people from participation in healthcare systems and allow for discrimination by healthcare providers, we hypothesized that healthcare policy stigma would be associated with NPHs use by operating through three main pathways: skipping care due to anticipated stigma in healthcare settings, skipping care due to cost, and being uninsured. METHODS We conducted analyses using data from the 2015 U.S. Transgender Survey. The analytic sample included trans adults using hormones (N = 11,994). We fit a multinomial structural equation model to examine associations. RESULTS Among trans adults using hormones, we found that healthcare policy stigma was positively associated with NPHs use and operated through insurance coverage and anticipating stigma in healthcare settings. The effect sizes on key predictor variables varied significantly between those who use supplemental NPHs and those who only use NPHs suggesting the need to treat NPHs use as distinct from those who use supplemental NPHs. CONCLUSIONS Our work highlights the importance of healthcare policy stigma in understanding health inequities among trans people in the USA, specifically NPHs use.
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Affiliation(s)
- Landon D Hughes
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Kristi E Gamarel
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Wesley M King
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Tamar Goldenberg
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James Jaccard
- Silver School of Social Work, New York University, New York, NY, USA
| | - Arline T Geronimus
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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Hughes LD, King WM, Gamarel KE, Geronimus AT, Panagiotou OA, Hughto JM. Differences in All-Cause Mortality Among Transgender and Non-Transgender People Enrolled in Private Insurance. Demography 2022; 59:1023-1043. [PMID: 35548863 PMCID: PMC9195044 DOI: 10.1215/00703370-9942002] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Few studies have analyzed mortality rates among transgender (trans) populations in the United States and compared them to the rates of non-trans populations. Using private insurance data from 2011 to 2019, we estimated age-specific all-cause mortality rates among a subset of trans people enrolled in private insurance and compared them to a 10% randomly selected non-trans cohort. Overall, we found that trans people were nearly twice as likely to die over the period as their non-trans counterparts. When stratifying by gender, we found key disparities within trans populations, with people on the trans feminine to nonbinary spectrum being at the greatest risk of mortality compared to non-trans males and females. While we found that people on the trans masculine to nonbinary spectrum were at a similar risk of overall mortality compared to non-trans females, their overall mortality rate was statistically smaller than that of non-trans males. These findings provide evidence that some trans and non-trans populations experience substantially different mortality conditions across the life course and necessitate further study.
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Affiliation(s)
- Landon D. Hughes
- School of Public Health and Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Wesley M. King
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Arline T. Geronimus
- School of Public Health and Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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Clark KD, Luong S, Lunn MR, Flowers E, Bahalkeh E, Lubensky ME, Capriotti MR, Obedin-Maliver J, Flentje A. Healthcare Mistreatment, State-Level Policy Protections, and Healthcare Avoidance Among Gender Minority People. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:1717-1730. [PMID: 36458212 PMCID: PMC9701649 DOI: 10.1007/s13178-022-00748-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 05/07/2023]
Abstract
INTRODUCTION This study examined whether past experiences of mistreatment in healthcare were associated with greater healthcare avoidance due to anticipated mistreatment among gender minority (GM) people. We evaluated whether state-level healthcare policy protections moderated this relationship. METHODS Data from the 2018 Annual Questionnaire of The PRIDE Study, a national longitudinal study on sexual and gender minority people's health, were used in these analyses. Logistic regression modeling tested relationships between lifetime healthcare mistreatment due to gender identity or expression and past-year healthcare avoidance due to anticipated mistreatment among GM participants. Interactions between lifetime healthcare mistreatment and state-level healthcare policy protections and their relationship with past-year healthcare avoidance were tested. RESULTS Participants reporting any lifetime healthcare mistreatment had greater odds of past-year healthcare avoidance due to anticipated mistreatment among gender expansive people (n = 1290, OR = 4.71 [CI]: 3.57-6.20), transfeminine people (n = 263, OR = 10.32 [CI]: 4.72-22.59), and transmasculine people (n = 471, OR = 3.90 [CI]: 2.50-6.13). Presence of state-level healthcare policy protections did not moderate this relationship in any study groups. CONCLUSIONS For GM people, reporting lifetime healthcare mistreatment was associated with healthcare avoidance due to anticipated mistreatment. State-level healthcare policy protections were not a moderating factor in this relationship. Efforts to evaluate the implementation and enforcement of state-level policies are needed. Continued efforts to understand instances of and to diminish healthcare mistreatment of GM people are recommended. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s13178-022-00748-1.
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Affiliation(s)
- Kristen D. Clark
- Department of Nursing, University of New Hampshire, Durham, NH USA
| | - Sean Luong
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA USA
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA USA
| | - Elena Flowers
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, CA USA
| | - Esmaeil Bahalkeh
- Department of Health Management & Policy, University of New Hampshire, Durham, NH USA
| | - Micah E. Lubensky
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA
| | | | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA USA
| | - Annesa Flentje
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA
- Department of Psychiatry, School of Medicine, Alliance Health Project, University of California San Francisco, San Francisco, CA USA
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Gamarel K, King WM, Mouzoon R, Xie H, Stanislaus V, Iwamoto M, Baxter K, Suico S, Nemoto T, Operario D. A "tax" on gender affirmation and safety: costs and benefits of intranational migration for transgender young adults in the San Francisco Bay area. CULTURE, HEALTH & SEXUALITY 2021; 23:1763-1778. [PMID: 32924839 PMCID: PMC7956137 DOI: 10.1080/13691058.2020.1809711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/10/2020] [Indexed: 06/02/2023]
Abstract
Many transgender (trans) young adults migrate to urban enclaves with known infrastructures to fulfil gender affirmation needs such as obtaining trans-inclusive healthcare and support. This study sought to explore experiences of intranational migration (i.e. migration within a single country) for gender affirmation among trans young adults who relocated to San Francisco. A convenience sample of 61 trans young adults aged 18 to 29 (32% nonbinary, 28% trans women, and 40% trans men; 84% identified as a person of colour) participated in a one-time qualitative interview as part of a larger study. Thematic analysis was used to develop and refine the codes and themes. Three overarching themes became apparent regarding intranational migration and gender affirmation needs: (1) access to basic gender affirmation needs; (2) safety; and (3) the price of gender affirmation. Migration for gender affirmation and safety placed informants at risk for structural vulnerabilities including homelessness, unemployment and racism. Despite these structural vulnerabilities, participants were willing to "pay" the price in order to gain gender affirmation and safety. Findings underscore the importance of moving beyond individual-level risk factors to understand how unmet gender affirmation needs may place trans young adults in structurally vulnerable positions that can affect health and wellness.
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Affiliation(s)
- Kristi Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Wesley M. King
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Raha Mouzoon
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Hui Xie
- Public Health Institute, Oakland, CA, USA
| | | | | | | | | | | | - Don Operario
- Department of Behavior and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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10
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Kearns S, Kroll T, O‘Shea D, Neff K. Experiences of transgender and non-binary youth accessing gender-affirming care: A systematic review and meta-ethnography. PLoS One 2021; 16:e0257194. [PMID: 34506559 PMCID: PMC8432766 DOI: 10.1371/journal.pone.0257194] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 08/25/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Transgender and non-binary individuals frequently engage with healthcare services to obtain gender-affirming care. Little data exist on the experiences of young people accessing gender care. This systematic review and meta-ethnography aimed to identify and synthesise data on youths’ experiences accessing gender-affirming healthcare. Method A systematic review and meta-ethnography focusing on qualitative research on the experiences of transgender and non-binary youth accessing gender care was completed between April-December 2020. The following databases were used: PsychINFO, MEDLINE, EMBASE, and CINAHL. The protocol was registered on PROSPERO, international prospective register of Systematic Reviews (CRD42020139908). Results Ten studies were included in the final review. The sample included participants with diverse gender identities and included the perspective of parents/caregivers. Five dimensions (third-order constructs) were identified and contextualized into the following themes: 1.) Disclosure of gender identity. 2.) The pursuit of care. 3.) The cost of care. 4.) Complex family/caregiver dynamics. 5.) Patient-provider relationships. Each dimension details a complicated set of factors that can impact healthcare navigation and are explained through a new conceptual model titled “The Rainbow Brick Road”. Conclusion This synthesis expands understanding into the experience of transgender and non-binary youth accessing gender-affirming healthcare. Ryvicker’s behavioural-ecological model of healthcare navigation is discussed in relation to the findings and compared to the authors’ conceptual model. This detailed analysis reveals unique insights on healthcare navigation challenges and the traits, resources, and infrastructure needed to overcome these. Importantly, this paper reveals the critical need for more research with non-binary youth and research which includes the population in the design.
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Affiliation(s)
- Seán Kearns
- School of Medicine, University College Dublin, Dublin, Ireland
- National Gender Service, St Columcille’s Hospital, Dublin, Ireland
- * E-mail: ,
| | - Thilo Kroll
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Donal O‘Shea
- School of Medicine, University College Dublin, Dublin, Ireland
- National Gender Service, St Columcille’s Hospital, Dublin, Ireland
- Department of Endocrinology and Diabetes Mellitus, St Vincent’s University Hospital, Dublin, Ireland
| | - Karl Neff
- School of Medicine, University College Dublin, Dublin, Ireland
- National Gender Service, St Columcille’s Hospital, Dublin, Ireland
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Singer RB, Johnson AK, Crooks N, Bruce D, Wesp L, Karczmar A, Mkandawire-Valhmu L, Sherman S. "Feeling Safe, Feeling Seen, Feeling Free": Combating stigma and creating culturally safe care for sex workers in Chicago. PLoS One 2021; 16:e0253749. [PMID: 34185795 PMCID: PMC8241054 DOI: 10.1371/journal.pone.0253749] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/12/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Previous studies have established that sex workers experience discrimination and stigma within healthcare settings, limiting their access and receipt of culturally safe care. These barriers impact sex workers' ability and desire to routinely engage with the healthcare system. Community empowerment interventions that are culturally safe offer an effective strategy to improve access to services and health outcomes for sex workers. OBJECTIVES This project was designed to inform the development of community empowerment interventions for sex workers by understanding their self-management, health promotion, and harm reduction needs. METHODS In-depth interviews (N = 21) were conducted with sex workers in Chicago. Transcripts of individual interviews were analyzed in Dedoose using rapid content analysis. RESULTS Participants had a mean age of 32.7 years; 45% identified as White, 20% as Black, 15% as Latinx, and 20% as multiple races; 80% identified as Queer. A total of 52% of participants identified as cisgender women, 33% as transgender or gender fluid, 10% as cisgender men, and 5% declined to answer. Themes of self-management practices, stigmatizing and culturally unsafe experiences with healthcare providers, and the prohibitive cost of healthcare emerged as consistent barriers to routinely accessing healthcare. Despite identifying patient-centered care as a desired healthcare model, many participants did not report receiving care that was respectful or culturally responsive. Themes also included developing strategies to identify sex worker-safe care providers, creating false self-narratives and health histories in order to safely access care, and creating self-care routines that serve as alternatives to primary care. CONCLUSION Our findings demonstrate how patient-centered care for sex-workers in Chicago might include holistic wellness exercises, accessible pay scales for services, and destigmatizing healthcare praxis. Focus on culturally safe healthcare provision presents needs beyond individualized, or even community-level, interventions. Ongoing provider training and inbuilt, systemic responsivity to patient needs and contexts is crucial to patient-centered care.
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Affiliation(s)
- Randi Beth Singer
- Department of Human Development Nursing Science, College of Nursing University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Amy K. Johnson
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Natasha Crooks
- Department of Human Development Nursing Science, College of Nursing University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Douglas Bruce
- Department of Health Sciences, College of Science and Health, DePaul University, Chicago, Illinois, United States of America
| | - Linda Wesp
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States of America
| | - Alexa Karczmar
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
| | - Lucy Mkandawire-Valhmu
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States of America
| | - Susan Sherman
- Department of Health, Behavior and Society, John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Anderson JG, Bartmess M, Jabson Tree JM, Flatt JD. Predictors of Mind-Body Therapy Use Among Sexual Minority Older Adults. J Altern Complement Med 2021; 27:352-359. [PMID: 33601924 PMCID: PMC8182477 DOI: 10.1089/acm.2020.0430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Introduction: Sexual minority (SM; lesbian, gay, bisexual) older adults age 50+ experience a higher prevalence of chronic disease and disability, as well as a poorer physical and mental health status, compared with their heterosexual peers. Many adults use complementary and integrative therapies, particularly mind-body therapies, as health-enhancing approaches and to support well-being. However, no study to date has examined the use of mind-body therapies among SM older adults. Materials and Methods: Data were from the 2017 National Health Interview Survey. Descriptive and summary statistics were calculated to describe use of mind-body therapies by SM older adults (aged 50+). The authors also tested associations between use of mind-body therapies and health and well-being among SM older adults and compared associations with their non-SM counterparts. Results: SM older adults reported higher usage (36%) of mind-body therapies compared with heterosexual adults (22%), with lesbian women reporting the highest use (39.4%). Having a SM identity was associated with mind-body therapy use; SM older adults were 57% more likely to use a mind-body therapy. Conclusion: Mind-body therapies may be a useful tool for SM older adults to enhance their health and well-being. Future qualitative research is needed to investigate more deeply the reasons SM older adults use mind-body therapies. To advance the health and well-being of SM older adults, the authors also need intervention studies that explore the effectiveness of mind-body interventions and the possible need for tailoring these to the unique needs of this population.
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Affiliation(s)
- Joel G. Anderson
- College of Nursing, and University of Tennessee-Knoxville, Knoxville, TN, USA
| | - Marissa Bartmess
- College of Nursing, and University of Tennessee-Knoxville, Knoxville, TN, USA
| | | | - Jason D. Flatt
- School of Public Health, University of Nevada-Las Vegas, Las Vegas, NV, USA
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Legislation, Market Size, and Access to Gender-affirming Genital Surgery in the United States. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3422. [PMID: 33680670 PMCID: PMC7929723 DOI: 10.1097/gox.0000000000003422] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023]
Abstract
The value of gender-affirming genital surgery (GAGS) has been established for certain transgender or gender non-conforming patients. This study aimed to determine the availability of GAGS by state and region in the United States, and to query possible associations of access to care with healthcare legislation and local market size.
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Kennedy CE, Yeh PT, Byrne J, van der Merwe LLA, Ferguson L, Poteat T, Narasimhan M. Self-administration of gender-affirming hormones: a systematic review of effectiveness, cost, and values and preferences of end-users and health workers. Sex Reprod Health Matters 2021; 29:2045066. [PMID: 35312467 PMCID: PMC8942532 DOI: 10.1080/26410397.2022.2045066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Self-administration of quality gender-affirming hormones is one approach to expanding access to hormone therapy for individuals seeking secondary sex characteristics more aligned with their gender identity or expression and can be empowering when provided within safe, supportive health systems. To inform World Health Organization guidelines on self-care interventions, we systematically reviewed the evidence for self-administration compared to health worker-administration of gender-affirming hormones. We conducted a comprehensive search for peer-reviewed articles and conference abstracts that addressed effectiveness, values and preferences, and cost considerations. Data were extracted in duplicate using standardised forms. Of 3792 unique references, five values and preferences articles were included; no studies met the criteria for the effectiveness or cost reviews. All values and preferences studies focused on self-administration of unprescribed hormones, not prescribed hormones within a supportive health system. Four studies from the U.S. (N = 2), Brazil (N = 1), and the U.K. (N = 1) found that individuals seeking gender-affirming hormone therapy may self-manage due to challenges finding knowledgeable and non-stigmatising health workers, lack of access to appropriate services, exclusion, and discomfort with health workers, cost, and desire for a faster transition. One study from Thailand found health worker perspectives were shaped by restrictive legislation, few transgender-specific services or guidelines, inappropriate communication with health workers, and medical knowledge gaps. There is limited literature on self-administration of gender-affirming hormone therapy. Principles of gender equality and human rights in the delivery of quality gender-affirming hormones are critical to expand access to this important intervention and reduce discrimination based on gender identity.
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Affiliation(s)
- Caitlin E. Kennedy
- Associate Professor, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ping Teresa Yeh
- Research Associate, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jack Byrne
- Co-investigator, Counting Ourselves, Trans Health Research Lab, the Aotearoa New Zealand Trans and Non-binary Health Survey, University of Waikato, Hamilton, New Zealand
| | - L. Leigh Ann van der Merwe
- Founder/Director & Research Lead, Social, Health and Empowerment Feminist Collective of Transgender Women of Africa, East London, South Africa
| | - Laura Ferguson
- Assistant Professor, Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tonia Poteat
- Associate Professor, Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Manjulaa Narasimhan
- Scientist, Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction – HRP, Geneva, Switzerland
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15
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Rouhani S, Decker MR, Tomko C, Silberzahn B, Allen ST, Park JN, Footer KHA, Sherman SG. Resilience among Cisgender and Transgender Women in Street-Based Sex Work in Baltimore, Maryland. Womens Health Issues 2020; 31:148-156. [PMID: 33298401 DOI: 10.1016/j.whi.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Resilience represents adaptability and empowerment and can buffer against the consequences of traumatic events. Cisgender and transgender women in street-based sex work are at high risk for trauma, yet data on their resilience are sparse. A clearer understanding of resilience and its correlates is useful for informing sex worker-centered interventions. METHODS Using the Connor-Davidson 10-item Resilience Scale (range, 0-40), we describe resilience among 165 cisgender and 42 transgender street-based women sex workers in Baltimore, Maryland. Longitudinal cohort data were used to examine correlates of resilience in each population. Analyses are conducted using multiple linear regression. RESULTS The mean resilience score was 24.2 (95% confidence interval, 23.6-24.8) among cisgender women sex workers and 32.2 among transgender women sex workers (95% confidence interval, 30.8-32.7). Among cisgender participants, positive correlates of resilience were being Black, Hispanic, or other race (ß = 2.7; p = .004), having housing (ß = 1.9; p = .034), social cohesion score (ß = 0.18; p = .047), and daily drug injection (ß = 3.7; p < .001); negative correlates of resilience were sexual violence (ß = -4.8; p = .006) and exposure to egregious police acts (ß = -0.6; p = .015). Among transgender participants, higher education level (ß = 8.8; p < .001), food security (ß = 3.5; p = .005), and housing stability (ß = 2.0; p < .001) were associated with increased resilience, and daily noninjection drug use (excluding marijuana; ß = -3.3; p < .001) and physical violence (ß = -2.9; p < .001) were associated with reduced resilience. CONCLUSIONS This study is the first to characterize factors that may influence resilience among cisgender and transgender women sex workers. Results highlight tangible intervention targets for promoting mental health and safety among a uniquely vulnerable population of women.
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Affiliation(s)
- Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins School of Public Health, Baltimore, Maryland; Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, Maryland.
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Catherine Tomko
- Department of Health, Behavior and Society, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Bradley Silberzahn
- Department of Sociology, The University of Texas at Austin, Austin, Texas
| | - Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Katherine H A Footer
- Department of Health, Behavior and Society, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins School of Public Health, Baltimore, Maryland
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16
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Tabaac AR, Jolly D, Boskey ER, Ganor O. Barriers to Gender-affirming Surgery Consultations in a Sample of Transmasculine Patients in Boston, Mass. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3008. [PMID: 32983769 PMCID: PMC7489736 DOI: 10.1097/gox.0000000000003008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 11/25/2022]
Abstract
Gender diverse people are increasingly pursuing gender-affirming surgery, but little is known about their experiences on accessing care. As part of the baseline assessment for an ongoing longitudinal study, we examined the types of barriers and self-reported out-of-pocket costs associated with gender-affirming surgery most commonly endorsed by transmasculine chest (top) and genital (bottom) surgery patients at their initial surgical consultation. METHODS A brief survey was administered to a clinical sample of transmasculine patients (n = 160; age ≥15 years) seeking a gender-affirming surgery at the Center for Gender Surgery in Boston, Mass. from April 2018 to February 2020. RESULTS The barriers most commonly endorsed by top surgery patients were insurance coverage and age. For bottom surgery patients, the most commonly endorsed barriers were getting mental health letters and readiness for surgery. Bottom surgery patients were also more likely to report barriers of readiness for surgery and cost of/access to hair removal, than top surgery patients (Ps < 0.05). Bottom surgery patients were more likely to report out-of-pocket costs related to hair removal, surgical consultation, and surgery (Ps < 0.05), whereas top surgery patients were more likely to report hormone treatment costs (P = 0.01). Average out-of-pocket costs were high (mean = 2148.31) and significantly higher for bottom surgery patients (b = 4140.30; β = 0.64; 95% confidence interval, 3064.6-5216.0). CONCLUSIONS Transmasculine patients experience a variety of barriers when seeking gender-affirming surgery. Presurgical requirements, insurance access, and high out-of-pocket costs may hinder access to care for many transmasculine people seeking bottom surgery.
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Affiliation(s)
- Ariella R. Tabaac
- From the Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Mass
- Department of Pediatrics, Harvard Medical School, Boston, Mass
- Center for Gender Surgery, Boston Children’s Hospital, Boston, Mass
| | - Divya Jolly
- Center for Gender Surgery, Boston Children’s Hospital, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Mass
| | - Elizabeth R. Boskey
- Center for Gender Surgery, Boston Children’s Hospital, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Mass
- Department of Surgery, Harvard Medical School, Boston, Mass
| | - Oren Ganor
- Center for Gender Surgery, Boston Children’s Hospital, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Mass
- Department of Surgery, Harvard Medical School, Boston, Mass
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17
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Glick JL, Lopez A, Pollock M, Theall KP. Housing insecurity and intersecting social determinants of health among transgender people in the USA: A targeted ethnography. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 21:337-349. [PMID: 34993513 PMCID: PMC8726680 DOI: 10.1080/26895269.2020.1780661] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Background: Housing is an important social determinant of health (SDOH). Transgender people face a unique blend of discrimination and compromised social services, putting them at risk for housing insecurity and associated public health concerns. Aims: This targeted ethnography explores housing insecurity as a SDOH among transgender people in the U.S. Methods: In-depth interviews were conducted with transgender people (n = 41) throughout the U.S.A., identified through purposive sampling. A semi-structured guide was used to elicit personal stories and peer accounts of insecure housing experiences and coping strategies. Interviews were audio recorded and transcribed. Data was coded, sorted, and analyzed for key themes. Results: Responses revealed pervasive housing insecurity and inter-related challenges. Respondents discussed how intersecting identities create unique constellations of vulnerability, which "intersect like a star." Financial insecurity and interpersonal rejection were lead housing insecurity causes, often resulting in psychological strain, which was sometimes addressed with substances and sexual risk-taking. These factors were cyclically accompanied by financial and employment insecurity and a cascade of unmet social needs. Social support facilitated coping. Discussion: Findings support increasing transgender housing security intervention resources that address intersecting and cyclical discrimination, trauma, housing, employment, and health issues.
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Affiliation(s)
- Jennifer L. Glick
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alex Lopez
- Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Miranda Pollock
- School of Medicine, Section of Community and Population Medicine, Louisiana State University Health Sciences Center – New Orleans, New Orleans, Louisiana, USA
| | - Katherine P. Theall
- Global Community Health and Behavioral Sciences and LSUHSC Comprehensive Alcohol and HIV Research Center (CARC), Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Glick JL, Lopez A, Pollock M, Theall KP. "Housing Insecurity Seems to Almost Go Hand in Hand with Being Trans": Housing Stress among Transgender and Gender Non-conforming Individuals in New Orleans. J Urban Health 2019; 96:751-759. [PMID: 31529193 PMCID: PMC6814659 DOI: 10.1007/s11524-019-00384-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Housing is an important social determinant of physical and mental health. Transgender and gender non-conforming individuals (T/GNCI) face a unique constellation of discrimination and compromised social services, putting them at risk for housing insecurity, homelessness, and its associated public health concerns. This study explores housing insecurity among T/GNCI in New Orleans, LA, where the infrastructural landscape is marked by an underinvestment in housing stock and disaster capitalism. In-depth interviews were conducted with T/GNCI (n = 17) living in New Orleans, identified through purposive sampling. Semi-structured guides were used to elicit personal stories and peer accounts of insecure housing experiences and coping strategies. Interviews were audio recorded and transcribed. Data was coded, sorted, and analyzed for key themes using NVIVO 11. Respondents discussed an array of circumstances that contribute to housing insecurity, including intersectional stigma and discrimination coupled with gentrification and a changing housing landscape in the city. Housing was intricately intertwined with employment and other structural issues; vulnerability in one realm was closely tied to insecurity in the others. Social support and queer family structures emerged as a key source of resilience, coping, and survival. The study supports an increase of resources for T/GNC housing access and interventions that address the cyclical discrimination, housing, and employment issues this population faces with a consideration of the historical and current structural barriers impeding their access to safe, stable, long-term housing.
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Affiliation(s)
- Jennifer L Glick
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Alex Lopez
- Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
| | - Miranda Pollock
- School of Medicine, Section of Community and Population Medicine, Louisiana State University Health Sciences Center - New Orleans, New Orleans, LA, 70112, USA
| | - Katherine P Theall
- Global Community Health and Behavioral Sciences and LSUHSC Comprehensive Alcohol and HIV Research Center (CARC), Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
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Bowling J, Baldwin A, Schnarrs PW. Influences of health care access on resilience building among transgender and gender non-binary individuals. Int J Transgend 2019; 20:205-217. [PMID: 32999607 DOI: 10.1080/15532739.2019.1595807] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: Health care disparities between transgender/gender non-binary individuals and the general population are well-documented and related to both interpersonal and institutional discrimination. Resilience has been found to buffer the negative health effects of discrimination among gender diverse individuals as well as other stigmatized populations. Aims : The purpose of this study was to identify and understand resilience related to health and health care among a community sample of transgender and gender non-binary individuals in the southern United States. Methods: We conducted 35 longitudinal photo elicitation interviews with 21 participants among a community sample of transgender and gender non-binary individuals in the Southern US. Interview transcripts were coded using thematic analysis and themes were organized according to the Resilience Activation Framework. Results: Overall, individual and community-level resources within the domains of social and human capital were frequently activated to navigate challenges related to seeking and receiving health care. Lack of access to resources in economic and political capital domains constrained resilience. Discussion: This work demonstrates how stakeholders can identify target areas for interventions and policy change aimed at improving resilience in transgender and gender non-binary communities by utilizing the Resilience Activation Framework. In our sample, we found that resources should be directed toward building economic and political capital at the community level so participants have the ability and opportunity to marshal such resources.
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Affiliation(s)
- Jessamyn Bowling
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Aleta Baldwin
- Department of Kinesiology, Health & Nutrition, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Phillip W Schnarrs
- Division of Community Engagement and Health Equity, Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX
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