Advertisement

Journal of General Internal Medicine

, Volume 34, Issue 10, pp 2068–2074 | Cite as

Healthcare Experiences of Transgender People of Color

  • Susanna D. HowardEmail author
  • Kevin L. Lee
  • Aviva G. Nathan
  • Hannah C. Wenger
  • Marshall H. Chin
  • Scott C. Cook
Origiinal Research

Abstract

Background

Transgender people and racial/ethnic minorities separately report poor healthcare experiences. However, little is known about the healthcare experiences of transgender people of color (TPOC), who are both transgender and racial/ethnic minorities.

Objective

To investigate how TPOC healthcare experiences are shaped by both race/ethnicity and gender identity.

Design and Participants

Semi-structured, in-depth individual interviews (n = 22) and focus groups (2; n = 17 total); all taken from a sample of TPOC from the Chicago area. All participants completed a quantitative survey (n = 39).

Approach

Interviews and focus groups covered healthcare experiences, and how these were shaped by gender identity and/or race/ethnicity. The interviews and focus groups were audio recorded, transcribed verbatim, and imported into HyperRESEARCH software. At least two reviewers independently coded each transcript using a codebook of themes created following grounded theory methodology. The quantitative survey data captured participants’ demographics and past healthcare experiences, and were analyzed with descriptive statistics.

Key Results

All participants described healthcare experiences where providers responded negatively to their race/ethnicity and/or gender identity. A majority of participants believed they would be treated better if they were cisgender or white. Participants commonly cited providers’ assumptions about TPOC as a pivotal factor in negative experiences. A majority of participants sought out healthcare locations designated as lesbian, gay, bisexual, and transgender (LGBT)-friendly in an effort to avoid discrimination, but feared experiencing racism there. A minority of participants expressed a preference for providers of color; but a few reported reluctance to reveal their gender identity to providers of their own race due to fear of transphobia. When describing positive healthcare experiences, participants were most likely to highlight providers’ respect for their gender identity.

Conclusions

TPOC have different experiences compared with white transgender or cisgender racial/ethnic minorities. Providers must improve understanding of intersectional experiences of TPOC to improve quality of care.

KEY WORDS

gay and lesbian health cultural competency primary care race and ethnicity underserved populations 

Notes

Acknowledgments

Morten Group recruited and interviewed participants. Pride Action Tank, a project of the AIDS Foundation of Chicago, kindly hosted our community feedback session.

Funding Information

This project was financially supported by the Agency for Healthcare Research and Quality (IU18 HS023050), and NIH CTSA UL1 TR000430. Dr. Chin was supported in part by the Chicago Center for Diabetes Translation Research (NIDDK P30 DK092949). Susanna Howard was supported in part by NIH NIDDK grant no. T35DK062719-29.

Compliance with Ethical Standards

This study was approved by the University of Chicago Biological Sciences Division Institutional Review Board.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

References

  1. 1.
    Grant JM, Mottet LA, Tani J, Harrison J, Herman JL, Keisling M. Injustice at every turn: a report of the national transgender discrimination survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force (US); 2011.Google Scholar
  2. 2.
    James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. The report of the 2015 U.S. transgender survey. Washington, DC: National Center for Transgender Equality (US); 2016.Google Scholar
  3. 3.
    Sugano E, Nemoto T, Operario D. The impact of exposure to transphobia on HIV risk behavior in a sample of transgendered women of color in San Francisco. AIDS Behav. 2006;10:217–225.CrossRefGoogle Scholar
  4. 4.
    Bradford J, Reisner SL, Honnold JA, Xavier J. Experiences of transgender-related discrimination and implications for health: results from the Virginia Transgender Health Initiative Study. Am J Public Health. 2013;103:1820–1829.CrossRefGoogle Scholar
  5. 5.
    Geiger HJ. Health disparities: what do we know? what do we need to know? What should we do?. In: Schulz AJ, Mullings L, eds. Gender, race, class, and health: intersectional approaches. San Francisco: Jossey Base; 2006. p. 261–288.Google Scholar
  6. 6.
    van Ryn M. Research on the provider contribution to race-ethnicity disparities in medical care. Med Care. 2002;40:I140–151.PubMedGoogle Scholar
  7. 7.
    Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340:618–626.CrossRefGoogle Scholar
  8. 8.
    Grollman EA. Multiple disadvantaged statuses and health: the role of multiple forms of discrimination. J Health Soc Behav. 2014;55:3–19.CrossRefGoogle Scholar
  9. 9.
    Tan JY, Baig AA, Chin MH. High stakes for the health of sexual and gender minority patients of color. J Gen Intern Med. 2017;32:1390–1395.CrossRefGoogle Scholar
  10. 10.
    Wilson EC, Arayasirikul S, Johnson K. Access to HIV care and support services for African American transwomen living with HIV. Int J Transgend. 2013;14:182–195.CrossRefGoogle Scholar
  11. 11.
    Cook SC, Gunter KE, Lopez FY. Establishing effective health care partnerships with sexual and gender minority patients: recommendations for obstetrician gynecologists. Semin Reprod Med. 2017;35:397–407.CrossRefGoogle Scholar
  12. 12.
    Eckstrand KL, Eliason J, St Cloud T, Potter J. The priority of intersectionality in academic medicine. Acad Med. 2016;91:904–907.CrossRefGoogle Scholar
  13. 13.
    Peek ME, Lopez FY, Williams HS et al. Development of a conceptual framework for understanding shared decision making among African-American LGBT patients and their clinicians. J Gen Intern Med. 2016; 31: 677–687.CrossRefGoogle Scholar
  14. 14.
    Purdie-Vaughns V, Eibach RP. Intersectional invisibility: the distinctive advantages and disadvantages of multiple subordinate-group identities. Sex Roles. 2008; 59: 377–391.CrossRefGoogle Scholar
  15. 15.
    Tan JY, Xu LJ, Lopez FY, et al. Shared decision making among clinicians and Asian American and Pacific Islander sexual and gender minorities: an intersectional approach to address a critical care gap. LGBT Health. 2016;3:327–334.CrossRefGoogle Scholar
  16. 16.
    Baig AA, Lopez FY, DeMeester RH, Jia JL, Peek ME, Vela MB. Addressing barriers to shared decision making among Latino LGBTQ patients and healthcare providers in clinical settings. LGBT Health. 2016;3:335–341.CrossRefGoogle Scholar
  17. 17.
    Chin MH, Lopez FY, Nathan AG, Cook SC. Improving shared decision making with LGBT racial and ethnic minority patients. J Gen Intern Med. 2016;31:591–593.CrossRefGoogle Scholar
  18. 18.
    Bornstein DR, Fawcett J, Sullivan M, Senturia KD, Shiu-Thornton S. Understanding the experiences of lesbian, bisexual and trans survivors of domestic violence. J Homosex. 2006;51:159–181.CrossRefGoogle Scholar
  19. 19.
    Miles MB, Huberman AM. Qualitative data analysis: An expanded sourcebook. Thousand Oaks, CA: Sage Publications; 1994.Google Scholar
  20. 20.
    Morgan DL. Focus groups as qualitative research. Thousand Oaks: Sage Publications; 1997.CrossRefGoogle Scholar
  21. 21.
    Strauss AL. Qualitative Analysis for Social Scientists. New York: Cambridge University Press; 1987.CrossRefGoogle Scholar
  22. 22.
    Morse JM, Richards L, Richards L. Read me first for a user’s guide to qualitative methods. Thousand Oaks: Sage Publications; 2002.Google Scholar
  23. 23.
    Crawford I, Allison KW, Zamboni BD, Soto T. The influence of dual-identity development on the psychosocial functioning of African-American gay and bisexual men. J Sex Res. 2002;39:179–189.CrossRefGoogle Scholar
  24. 24.
    Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003;139:907–915.CrossRefGoogle Scholar
  25. 25.
    DeMeester RH, Lopez FY, Moore JE, Cook SC, Chin MH. A model of organizational context and shared decision making: application to LGBT racial and ethnic minority patients. J Gen Intern Med. 2016;31:651–662.CrossRefGoogle Scholar
  26. 26.
    Whitehead J, Shaver J, Stephenson R. Outness, stigma, and primary health care utilization among rural LGBT populations. PLoS One. 2016;11:e0146139.CrossRefGoogle Scholar
  27. 27.
    Ettner R. Care of the elderly transgender patient. Curr Opin Endocrinol Diabetes Obes. 2013;20:580–584.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Susanna D. Howard
    • 1
    Email author
  • Kevin L. Lee
    • 2
  • Aviva G. Nathan
    • 1
  • Hannah C. Wenger
    • 1
  • Marshall H. Chin
    • 1
  • Scott C. Cook
    • 1
  1. 1.Section of General Internal MedicineUniversity of ChicagoChicagoUSA
  2. 2.Department of Urban Studies and PlanningMassachusetts Institute of TechnologyCambridgeUSA

Personalised recommendations