Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan.
Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan.
J Adolesc Health. 2019 Oct;65(4):483-490. doi: 10.1016/j.jadohealth.2019.04.029. Epub 2019 Jul 11.
Healthcare access is important for achieving health equity across vulnerable social groups. However, stigma can be a barrier for accessing healthcare among black transgender and gender diverse youth (TGDY) in the U.S. Using a resilience approach, this article examines the role of gender affirmation within healthcare to determine if it can mitigate the negative relationship between stigma and healthcare use.
Data include responses from 110 black TGDY from 14 U.S. cities. Multiple logistic regression models were fit to determine relationships between stigma in healthcare (anticipated and enacted), gender affirmation in healthcare, and delayed/nonuse of primary care. Interaction terms were included to determine if gender affirmation moderates the relationship between stigma and healthcare nonuse.
In the main effects model, gender affirmation was the only variable statistically associated with healthcare nonuse. The interaction between gender affirmation and enacted stigma was not significant, but gender affirmation moderated the relationship between anticipated stigma and healthcare nonuse. For individuals who did not have their gender affirmation needs met, as anticipated stigma increased, healthcare nonuse also increased; however, this did not occur for those who had their gender affirmation needs met.
Findings suggest that gender affirmation within healthcare is important for increasing access to care among black TGDY. Interventions should consider how to increase gender affirmation among healthcare providers and within healthcare settings. Additional research using an intersectional approach to understand the experiences of black TGDY is needed to highlight the unique healthcare needs of this population.
医疗保健的可及性对于实现弱势群体的健康公平至关重要。然而，在美国，污名可能是黑人跨性别和性别多样化青年（TGDY）获得医疗保健的障碍。本文采用韧性方法，研究了医疗保健中性别认同的作用，以确定其是否可以减轻污名与医疗保健使用之间的负相关关系。
数据包括来自美国 14 个城市的 110 名黑人跨性别和性别多样化青年的回复。拟合多项逻辑回归模型，以确定医疗保健中的污名（预期和实施）、医疗保健中的性别认同和延迟/不使用初级保健之间的关系。纳入交互项以确定性别认同是否调节污名与医疗保健不使用之间的关系。
在主要效应模型中，性别认同是唯一与医疗保健不使用在统计学上相关的变量。性别认同与实施污名之间的交互作用不显著，但性别认同调节了预期污名与医疗保健不使用之间的关系。对于那些没有满足其性别认同需求的个体，随着预期污名的增加，医疗保健不使用也会增加；然而，对于那些满足其性别认同需求的个体，情况并非如此。
研究结果表明，医疗保健中的性别认同对于增加黑人跨性别和性别多样化青年获得医疗保健的机会非常重要。干预措施应考虑如何增加医疗保健提供者和医疗保健环境中的性别认同。需要采用交叉方法进行更多研究，以了解黑人跨性别和性别多样化青年的经历，突出这一人群独特的医疗保健需求。
