Experiences of and resistance to multiple discrimination in health care settings among transmasculine people of color

Abstract

Background Research shows that transmasculine people experience discrimination based on their gender identity and/or expression (i.e., cissexism) while obtaining health care. However, studies examining the experience of other forms of discrimination in health care settings among diverse subgroups of transmasculine individuals, including those from minoritized racial/ethnic backgrounds, are very limited. Methods Guided by intersectionality, we designed a qualitative research study to explore how transmasculine people of color experience—and resist—multiple, intersecting forms of discrimination in health care settings. Guided by a purposive sampling strategy, we selected 19 transmasculine young adults of color aged 18–25 years to participate in 5 mini-focus groups conducted between February and May 2019 in Boston, MA. Focus group transcripts were analyzed using a template style approach to thematic analysis that involved both deductive and inductive coding using a codebook. Coded text fragments pertaining to participants’ experiences of health care discrimination were clustered into themes and sub-themes. Results Transmasculine people of color described experiencing notable challenges accessing physical and mental health care as a result of structural barriers to identifying health care providers with expertise in transgender health, finding providers who share one or more of their social positions and lived experiences, and accessing financial resources to cover high health care costs. Further, participants discussed anticipating and experiencing multiple forms of interpersonal discrimination—both independently and simultaneously—in health care settings, including cissexism, racism, weight-based discrimination, and ableism. Moreover, participants described the negative impact of anticipating and experiencing multiple interpersonal health care discrimination on their health care utilization, quality of care, and mental and physical health. Lastly, participants discussed using various strategies to resist the multiple, intersecting forms of discrimination they encounter in health care settings, including setting boundaries with health care providers, seeking care from competent providers with shared social positions, engaging in self-advocacy, drawing on peer support during health care visits, and obtaining health information through their social networks. Discussion Efforts are needed to address cissexism, racism, weight-based discrimination, ableism, and other intersecting forms of discrimination in clinical encounters, health care institutions and systems, and society in general to advance the health of transmasculine people of color and other multiply marginalized groups.

A Quantitative Intersectionality Analysis of HIV/STI Prevention and Healthcare Access Among Transgender and Nonbinary People

“…This interpretation is consistent with IRTHJ and empirical data on experiences of discrimination and stigma among ethnoracial minority trans and nonbinary people. 4,17,23,25,26,40,41 Last, in line with IRTHJ's call to center embodied knowledge, this analysis was conducted in collaboration with the Seattle Trans and Non-binary Sexual Health (STARS) Advisory Board, a community advisory group of nine trans and nonbinary people from the Seattle area that met every 1-2 months between February 2021 and July 2022. Advisory Board members guided all stages of the statistical analysis, including the choice of health outcomes and demographic groups to study, determining which intersectional group to use as the reference in the statistical models, the selection of measures of statistical interaction that were most interpretable and useful to members of the transgender community, interpretation of results, and writing and revising the article.…”

“…This interpretation is consistent with IRTHJ and empirical data on experiences of discrimination and stigma among ethnoracial minority trans and nonbinary people. 4,17,23,25,26,40,41…”

“…18 There are also racial inequities within trans and nonbinary populations, whereby ethnoracial minority trans and nonbinary people disproportionately experience discrimination in healthcare settings, structural barriers to care (e.g., financial and limited providers), and poor health outcomes (e.g., cardiovascular disease and depression). [19][20][21][22][23][24][25][26][27][28] Racial disparities in HIV prevalence among transgender women have been well documented. For example, 2019 National HIV Behavioral Surveillance (NHBS) Data collected across seven US cities revealed that HIV prevalence was highest among Native American (65%), Black (62%), and Hispanic/Latina (35%) transgender women, and lowest among White transgender women (17%).…”

The resistance of transgender and gender expansive people: A scoping review.

“…Some research utilized a more extensive range of identity categories rather than umbrella terms (e.g., transgender). For example, Agénor et al (2022) included man or transgender man; transmasculine; GNC; nonbinary;…”

“…Across various studies, resistance is defined uniquely within marginalized communities. Agénor et al (2022) view resistance as active engagement against health care discrimination, emphasizing strategies such as self-advocacy and leveraging community support. Bryson et al (2020) A SCOPING REVIEW Together, these studies highlight resistance as a complex blend of individual and collective actions against discrimination and stigma, emphasizing the importance of systemic change to support the wellbeing of marginalized communities.…”