Intersectionality Research for Transgender Health Justice: A Theory-Driven Conceptual Framework for Structural Analysis of Transgender Health Inequities

Abstract

Transgender people experience intersecting forms of social marginalization and are disproportionately affected by health inequities. We elucidate a novel conceptual framework for transgender health research that theorizes the constructs and pathways through which social inequities produce health inequities for transgender populations. Drawing on theories of intersectionality and structural injustice, Intersectionality Research for Transgender Health Justice (IRTHJ) posits that social and health inequities affecting transgender populations are the result of status quo power relations produced within and between oppressive structures, institutional systems, and socio-structural processes. The IRTHJ framework delineates three main actions for improving transgender health research: (i) name intersecting power relations, (ii) disrupt the status quo, and (iii) center embodied knowledge. The authors show how IRTHJ provides tools for researchers to transform the design, implementation, and interpretation of transgender health research, and they discuss implications for programs, policy, and action for transgender health justice.

Country-level structural stigma, identity concealment, and day-to-day discrimination as determinants of transgender people’s life satisfaction

“…Without having assessed stigma directed toward other marginalized social statuses across levels, such as ethnic/racial minority, immigrant, or socioeconomic, the present study could not permit examining intersections of this stigma with stigma directed to gender minority identity. Research using an intersectional framework represents an important future direction for examining potential moderators of the associations found here [33]. Third, this study relies on a single-item indicator of life satisfaction.…”

“Feeling Safe, Feeling Seen, Feeling Free”: Combating stigma and creating culturally safe care for sex workers in Chicago

“…Providers are encouraged to engage in a practice of purposeful self-reflection to become aware of implicit bias, uncertainties, and power-dynamics that may be at play in order to create a culturally safe patient encounter [18]. This self-reflection can and should include tools for providers that help to build an awareness about how multiple aspects of identity (race/ethnicity, gender, sexual orientation, type of employment) multiply and are intersectionally influenced by the systems of oppression (racism, heteropatriarchy, cisgenderism, and capitalism) that either provide privilege and opportunity for certain identities, while creating marginalization and constraining opportunity for other identities [37].…”

“…The specific experiences of seeking care as a Black sex worker must further inform future trainings, which will require focused efforts and collaborations to engage and center the voices of Black sex workers. To that end, future studies informed by intersectionality as a framework could offer greater insight into the ways that multiple systems of oppression work to create a matrix of constrained opportunities that shape the unique realities and health needs of sex workers who occupy multiple social locations or identities on the basis of race, class, gender and sexual orientation [37,44]. Supporting care providers to gain an understanding of various needs and resources to promote the health of sex workers encourages respectful and individualized care of those most marginalized and vulnerable.…”

HIV and stigma in the healthcare setting

“…Some of the ways in which intersectional stigmas can be addressed in healthcare settings are to have comprehensive sensitisation and training programmes for healthcare providers on the multiple stigmas faced by marginalised communities; to have a sensitive and non‐judgemental medical and paramedical curriculum; and to raise consciousness among healthcare providers that they should provide non‐judgemental, non‐discriminatory and quality services to all the patients they see, irrespective of how their identities are viewed by the general public. Involving sexual and gender minorities as trainers in sensitisation/training programmes and in the design, implementation and evaluation of such interventions could enhance the appropriateness and effectiveness of such intersectional stigma reduction interventions (Chakrapani, Kaur, et al., 2020; Chakrapani, Newman, et al., 2020; Evans, 2019; Wesp, Malcoe, Elliott, & Poteat, 2019; Wilson, White, Jefferson, & Danis, 2019).…”