Healthcare discrimination and factors associated with gender-affirming healthcare avoidance by transgender women and transgender men in Thailand: findings from a cross-sectional online-survey study

Abstract

Background Although discriminatory experiences of transgender people seeking healthcare services have been well-documented in several studies, differentiating those experiences based on gender identity/expression and related factors has been limited. The aim of this study was to compare the characteristics, experiences, attitude, and expectation toward accessing healthcare service and healthcare providers of transgender women and transgender men in Thailand. Methods A cross-sectional study was conducted from October 2017 to March 2018. The data were collected from transgender women and transgender men aged ≥ 18 years old who lived in Thailand using online platform via different websites and Facebook pages of local transgender group. Binary logistic regression was used to identify the factors related to the study outcomes. Results Of 186 transgender people who responded to the questionnaire and were eligible for the study, 73.7% (95% confidence interval [CI] = 66.7–79.8) were transgender women and 26.3% (95% CI = 20.2–33.3) were transgender men. Transgender women were more likely to seek general healthcare from non-traditional healthcare services (crude odds ratio [cOR] = 4.28; 95% CI = 1.55–11.81; P = 0.005), buy hormone treatment from non-traditional healthcare services (cOR = 3.89; 95% CI = 1.18–12.83; P = 0.026), and receive healthcare counseling from non-traditional healthcare providers (cOR = 5.16; 95% CI = 1.42–18.75; P = 0.013) than transgender men. According to the results of applying a multivariable model, transgender respondents who did not know that gender-affirming healthcare services existed in Thailand were more unwilling to receive counseling from gender-affirming healthcare providers than those who did (adjusted odds ratio = 3.70; 95% CI = 1.11–12.36; P = 0.033). Conclusions The findings from this cross-sectional study indicate that transgender women are more likely than transgender men to receive general healthcare and hormone treatment from non-traditional healthcare services and buy hormone treatment without a physician’s supervision. We also found approximately 15% of transgender individuals who did not receive gender-affirming counseling services. Continuing to improve access to care for the transgender community, increasing public relations channels may encourage transgender people to access more healthcare services.

Breaking barriers: How transwomen meet their healthcare needs

“…These findings align with previous studies that also observed that transgender women often obtain medication through unconventional means such as online purchasing without a prescription, sharing among friends or even stealing. 6 , 10 , 25 , 32 Obtaining medications from pharmacies without a prescription is consistent with findings reported by Sekoni et al 12 who found preferences by transgender women in utilising pharmacies to access medication. Seeking advice and recommendations from friends who have encountered similar health issues has also been documented by Augustaitis et al 16 in the United States.…”

The Role of Stigma and Resilience in Healthcare Engagement Among Transgender Latinas in the U.S. South: Baseline Findings from the ChiCAS Study

“…Minority stress theory [19][20][21] is useful for understanding how stigma influences healthcare use among trans Latinas through a focus on distal (e.g., discrimination and victimization) and proximal (e.g., internalized and anticipated stigma) minority stressors as well as resilience (i.e., strategies for responding to stress exposure). Minority Stress Theory recognizes that anti-trans stigma can contribute to poorer mental and physical health, including access to and use of health care [19][20][21][22][23][24][25]; this occurs when trans people anticipate or experience mistreatment within healthcare settings, which results in receiving poorer care and healthcare avoidance [8,13,26,27]. Research has also demonstrated that experiencing anti-trans stigma outside of the healthcare context can reduce use of healthcare services [22].…”

“…While prior research explored the role of stigma and resilience on healthcare use [18,22,25,26,28], it is unclear how the intersecting forms of stigma experienced by trans Latinas (e.g., related to gender identity, race/ethnicity, and perceived documentation status) may influence use of health care, including general health care experiences and access to medically supervised gender-affirming care. When considering the experiences of trans Latinas, it is important to consider an intersectionality framework [31][32][33][34], which identifies that multiple systems of oppression (e.g., racism, sexism, and cisgenderism) occur simultaneously and reinforce each other in ways that change the experiences of people with multiple marginalized identities.…”

Quality of life and level of satisfaction with pharmacotherapeutic follow-up in a transgender health center in Brazil

“…From this perspective, other important considerations about SDH in the transgender population include, for example, gender. Boonyapisomparn et al observed that transgender women had higher probabilities of accessing and utilizing non-conventional healthcare, such as undergoing procedures in inadequate environments and hormone usage without medical prescription, when compared to transgender men 9 .…”