Factors associated with healthcare avoidance among transgender women in Argentina

Abstract

IntroductionTransgender (TG) women in many settings continue to contend with barriers to healthcare, including experiences of stigma and discrimination. Argentina has a universal health care system and laws designed to promote healthcare access among TG women. However, little is known about barriers to healthcare access among TG women in this setting. The aim of this study was to explore individual, social-structural and environmental factors associated with healthcare avoidance among TG women in Argentina.MethodsData were derived from a 2013 nation-wide, cross-sectional study involving TG women in Argentina. We assessed the prevalence and factors associated with avoiding healthcare using multivariable logistic regression.ResultsAmong 452 TG women included in the study, 184 (40.7%) reported that they avoided seeking healthcare because of their transgender identity. In multivariable analysis, factors positively associated with avoiding seeking healthcare were: having been exposed to police violence (adjusted odd ratio [aOR] = 2.20; 95% CI: 1.26 – 3.83), internalized stigma (aOR = 1.60, 95% CI: 1.02–2.51), having experienced discrimination by healthcare workers (aOR = 3.36: 95% CI: 1.25 – 5.70) or patients (aOR = 2.57; 95% CI: 1.58 – 4.17), and currently living in the Buenos Aires metropolitan area (aOR = 2.32; 95% CI: 1.44 – 3.76). In contrast, TG women with extended health insurance were less likely to report avoiding healthcare (aOR = 0.49; 95% CI: 0.26 – 0.93).ConclusionsA high proportion of TG women in our sample reported avoiding healthcare. Avoiding healthcare was associated with stigma and discrimination in healthcare settings, as well as police violence experiences. Although further research is warranted, these finding suggests that socio-structural interventions tailored TG women needs are needed to improve access to healthcare among this population.

High Willingness to Use HIV Pre-Exposure Prophylaxis Among Transgender Women in Argentina

“…A more detailed description of our sample and recruitment procedures has been described previously. 5,37,38 …”

“…Additionally, to be consistent with previous research examining PrEP acceptability among transgender women, 32,44–46 we included a variable addressing lifetime gender-based discrimination in healthcare settings (yes vs. no), assessed with the question: “Due to your transgender identity, have you ever experienced discrimination from physicians, nurses, or other healthcare workers?” as defined in previous studies with this population. 5,37,38 …”

Perceived Barriers and Facilitators to Integrating HIV Prevention and Treatment with Cross-Sex Hormone Therapy for Transgender Women in Lima, Peru

“…Among TW in Peru, the high prevalence of cross-sex hormone use without physician prescription or medical supervision is well-documented [38–42]. In a 2009 survey, 87% of TW participants reported having ever used hormone therapy, though only 20% reported being prescribed hormones by a physician, and 66% reported obtaining hormones by a friend or acquaintance [3].…”

Negotiating Violence in the Context of Transphobia and Criminalization

“…The majority of research has focused on women sex workers with a growing body of research on trans sex workers –those whose gender identity or expression differs from their assigned birth sex—emerging in global settings (Bhattacharjya et al, 2015; Infante, Sosa-Rubi, & Cuadra, 2009; Rhodes, Simic, Baros, Platt, & Zikic, 2008; Socías, Marshall, Arístegui, Romero, et al, 2014). This research suggests that trans sex workers may be particularly vulnerable to violence due to a complex interplay of social-structural contexts.…”

“…It has been suggested that sex work is one of a few viable economic opportunities for trans individuals (Poteat et al, 2015; Xavier et al, 2013) and a relationship has been found between barriers to economic security and violence among trans persons (Lombardi, et al, 2001). Trans sex workers are also known to experience high rates of police-perpetuated violence in some settings (Rhodes, et al, 2008), and the adverse impact of such violence on healthcare avoidance by trans sex workers has been observed (Socías, Marshall, Arístegui, Romero, et al, 2014). Therefore, social-structural contexts shape trans persons’ experiences of violence and associated impacts on health.…”