Experiences of health care discrimination among transgender and gender nonconforming people of color: A latent class analysis.

Abstract

There is a paucity of research on the within-group differences in experiences of health care discrimination among transgender and gender nonconforming people of color. This study employs latent class analysis to identify mutually exclusive subgroups of TGNC POC based on responses to measures of health care discrimination. The association between demographic and health indicators and subgroup membership was also examined. Four subgroups were found: the low discrimination subgroup marked by a low probability of endorsing any indicator; the experienced discrimination subgroup marked by a high probability of being denied treatment and having to teach one's provider about TGNC people to receive appropriate care; the anticipated discrimination subgroup characterized by a high probability of postponing care and having to teach one's provider about TGNC people; and the experienced and anticipated discrimination subgroup marked by a high probability of all discrimination indicators. The experienced discrimination subgroup was more likely to be comprised of participants who reported $40,000-$59,000 income range, had graduate degrees, were "out" as transgender and had undergone hormone treatment and bottom surgery; the anticipated discrimination subgroup was more likely to be comprised of participants who identified as transgender men, reported $40,000-$59,000 income range, and had undergone hormone treatment; and the experienced and anticipated discrimination subgroup was more likely to be comprised of participants who identified as transgender men, multiracial, had graduate degrees, had public insurance, were "out," and had undergone hormone treatment, top surgery, and bottom surgery. Our findings have implications for health care practice, policy, and practitioners' education. Public Significance StatementThis study suggests that there are distinct subgroups of TGNC POC based on their reported experiences of discrimination in health care settings. There is also an association between demographic indicators and subgroup membership, which highlights the need to consider these factors to assess risk of discrimination and inform health care access improvements.

Exposure to Childhood Healthcare Discrimination and Healthcare Avoidance among Transgender and Gender Independent Adults during a Global Pandemic

“…This study expands the literature about TGI individuals’ healthcare experiences and utilization behaviors [ 1 , 2 , 3 , 4 , 10 , 12 , 18 ]; by documenting high rates of discrimination directed at TGI individuals in childhood, ranging from abusive (e.g., harsh language and refusal of care) to non-inclusive (e.g., lack of identity representation on medical documentation and forms). These findings indicate that TGI youth’s exposure to healthcare discrimination might diminish trust in healthcare institutions and providers necessary for their engagement in care (e.g., preventative care), trust in provider recommendations (e.g., vaccinations), and the improvement of their health outcomes (e.g., disease management) in adulthood.…”

“…Gender identity-related stigmatization, discrimination, and erasure in healthcare settings serve as central barriers to the accessibility and utilization of healthcare for individuals who embody transgender and gender independent (TGI) identities [ 1 , 2 ]. TGI individuals encounter direct and indirect forms of discrimination in healthcare settings, including healthcare providers’ lack of knowledge about their gender identities and healthcare needs, verbal and physical harassment, abuse, and denial of care [ 1 , 3 ]. Fear-based avoidance of healthcare among TGI individuals reporting exposure to past year healthcare discrimination has been documented [ 4 ].…”

“…Prior work has documented associations between exposure to discrimination and adverse outcomes, including psychological exhaustion, concern for physical and psychological safety, the anticipation of future discriminatory experiences, and avoidance of spaces that may result in discrimination and victimization [ 3 , 11 ]. The prevalence of individual forms of healthcare discrimination has also been documented (e.g., refusal or denial of trans-related care) using dichotomous variable responses (e.g., yes or no [ 1 , 3 , 12 ]). To the authors’ knowledge, no studies have evaluated the association between childhood exposure to healthcare discrimination and healthcare decision-making behaviors in adulthood among this population.…”

“It’s like having a superpower”: Reclaiming creativity and the intersectional experiences of trans young adults of color.

“…Trans people of color in the United States exist at the intersection of both racialized and gendered oppression, creating unique and complex experiences balancing survival in a white supremacist, cisnormative society and living as one’s authentic self 1 . In line with intersectionality (Crenshaw, 1991), it is important to investigate how trans people of color’s negative health outcomes are influenced by structural and interpersonal identity-based discriminatory forces such as cissexism, racism, as well as gendered racism (Alizaga et al 2022). Related literature, seeking to avoid a solely deficits-focused picture of this community, has simultaneously noted how trans people of color have tremendous strengths, leveraging resilience to navigate intersectional oppression (Singh, 2013; Singh et al, 2020).…”

Health and Access to Gender-Affirming Care During COVID-19: Experiences of transmasculine individuals and men assigned female sex at birth

“…Other studies have revealed similar and parallel findings. For example, Alizaga et al (2021) demonstrated that trans men were 3 times as likely to report anticipated health care discrimination and were more likely to have experienced discrimination when compared with their trans counterparts. Stanton et al (2021) reported that among a gender-expansive sample, trans men, AFAB nonbinary individuals, and trans women were most likely to report attending one behavioral health appointment.…”