Transgender-Competent Health Care: Lessons From the Community

Jesse P. Zatloff, MPH; Silke A. von Esenwein, PhD; Sarah C. Cook, MD; Jason S. Schneider, MD; J. Sonya Haw, MD

Disclosures

South Med J. 2021;114(6):334-338. 

In This Article

Abstract and Introduction

Abstract

Objectives: Transgender (trans) individuals experience high discrimination levels when accessing medical and mental health care, resulting in poorer health outcomes compared with the general population and other minority populations. A community-based research design was used to elicit direct input from the trans community about critical trans-knowledgeable care components to address these disparities. The data collection included several focus groups with individuals recruited from the trans community. The information from this research guided the opening of the Gender Center, a centralized, multidisciplinary center of care for trans individuals within an urban safety-net hospital in Atlanta, Georgia.

Methods: The research team conducted five focus groups with 27 self-identified trans individuals between December 2016 and April 2017. Focus groups solicited the negative and positive experiences of trans individuals in the healthcare system and sought input about how best to serve this population.

Results: Analysis was done January through April 2020. Focus group participants identified financial difficulties, lack of insurance coverage, being underinsured, discrimination within the healthcare system and from providers, and a shortage of trans-competent providers as the most significant barriers to care. Participants emphasized the need to pay attention to creating a welcoming clinic environment, including trans-positive signage, and integrating trans staff members into the care team.

Conclusions: This study demonstrates the importance of community-based research in addressing health disparities for trans people. It also offers insight into the unmet healthcare needs of the trans community, describes typical healthcare-related experiences of trans individuals, and identifies critical elements for providing high-quality trans-appropriate health care.

Introduction

Transgender (trans) individuals represent 0.3% to 0.6% of the US population, or approximately 1 million people.[1,2] Trans individuals face significant barriers accessing high-quality health care, including primary, mental, and trans-related, or gender-affirming care.[3–5] Trans individuals often are excluded from population and lesbian, gay, bisexual, transgender, and queer (LGBTQ)-based research.[2,6] Even so, there is a body of literature showing significant health disparities and poor health outcomes in trans communities, including a high prevalence of human immunodeficiency virus (HIV),[7,8] substance use disorders,[9] and posttraumatic stress disorder.[10] Although the causes of these disparities are complex,[11,12] experiences of discriminatory and inadequate health care contribute to low utilization and poor health outcomes.[13,14] In particular, research on trans health care in the southern United States demonstrates pronounced health disparities.[15–18] Providers in this geographic area are more likely to refuse care for trans individuals,[19] and trans individuals living in the US South are less likely to self-disclose their gender identity.[17] This delays the seeking of necessary health services and leads to worse health outcomes.[20]

In 2015, a group of physicians and public health experts affiliated with an urban safety-net hospital in Atlanta, Georgia, began working to provide high-quality trans health care by creating a multidisciplinary clinic (the Gender Center) dedicated to providing comprehensive care for trans patients. Trans individuals make up approximately 0.75% of Georgia's total population, the fourth highest population percentage in the country. This makes Atlanta a "magnet city" for trans individuals living in the southeastern United States and underscores the importance of gender-affirming care in this location.[21] As part of this effort, community input was sought through a series of focus groups with individuals from the local trans community. The data gathered informed the design of the clinic and training of providers and staff. This article summarizes the findings of these focus groups and demonstrates the ability of community-based research models to inform structural change.

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