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基于跨性别者辨识度的医疗保健环境中自我报告的歧视:美国跨性别公民的横断面研究。

Self-Reported Discrimination in Health-Care Settings Based on Recognizability as Transgender: A Cross-Sectional Study Among Transgender U.S. Citizens.

机构信息

Masters Programme in Public Health, Faculty of Medicine, Lund University, Malmö, Sweden.

Social Medicine and Global Health, Department of Clinical Sciences CRC, Lund University, Jan Waldenströms gata 35, House 28, Floor 12, 205 02, Malmö, Sweden.

出版信息

Arch Sex Behav. 2018 May;47(4):973-985. doi: 10.1007/s10508-017-1028-z. Epub 2017 Aug 7.

Abstract

Discrimination has long been tied to health inequality. Rejected by families and communities because of their gender identity and gender-role behavior, transgender individuals are often socially marginalized. This study aimed to assess discrimination in health-care settings among persons self-identifying as transgender in the U.S. in relation to their recognizability as transgender, operationalized as how often they experienced that others recognized them as transgender. Data were obtained from the National Transgender Discrimination Survey (n = 6106 participants, assigned sex at birth = 3608 males, 2480 females, respectively). Binary logistic regressions were performed to examine associations between transgender recognizability and discrimination in health-care settings. Being recognized as transgender to any extent had a significant effect on perceived discrimination in health care. Always recognized as transgender showed significant associations with discrimination in a health-care setting (OR 1.48) and the following individualized health-care settings: social service settings (rape crisis and domestic violence centers, OR 5.22) and mental health settings (mental health clinic and drug treatment program, OR 1.87). Sex work and other street economy, which are known experiential factors affected by discrimination, were also significantly associated with discrimination in health-care settings. Discrimination in health-care settings is pervasive for transgender who are recognized as transgender. Public health efforts to improve access to equitable health care for transgender individuals may benefit from consideration of demographic, experiential, and medical risk factors to more fully understand the source of the seemingly excess risk of discrimination among persons recognized by others as being transgender.

摘要

长期以来,歧视一直与健康不平等有关。由于性别认同和性别角色行为,跨性别者常常被家庭和社区排斥,处于社会边缘地位。本研究旨在评估美国跨性别者在医疗保健环境中所面临的歧视,将其定义为他人对他们跨性别身份的认知程度,即他们经历他人识别其跨性别身份的频率。数据来自全国跨性别歧视调查(NTDS)(n=6106 名参与者,出生时的性别分配为 3608 名男性,2480 名女性)。采用二项逻辑回归分析来研究跨性别者在医疗保健环境中可识别程度与歧视之间的关系。在任何程度上被识别为跨性别者都会对医疗保健中的歧视感知产生显著影响。总是被识别为跨性别者与医疗保健环境中的歧视(OR=1.48)以及以下特定医疗保健环境中的歧视显著相关:社会服务环境(强奸危机和家庭暴力中心,OR=5.22)和心理健康环境(心理健康诊所和药物治疗计划,OR=1.87)。性工作和其他街头经济是已知的受歧视影响的经验因素,它们也与医疗保健环境中的歧视显著相关。对于那些被认为是跨性别的人来说,医疗保健环境中的歧视是普遍存在的。为改善跨性别者获得公平医疗保健的机会而开展的公共卫生工作可能需要考虑人口统计学、经验和医疗风险因素,以更全面地了解他人认为跨性别者所面临的歧视风险过高的原因。

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