University of Michigan, Ann Arbor, USA.
Florida State University, Tallahassee, USA.
J Interpers Violence. 2021 Dec;36(23-24):NP13054-NP13076. doi: 10.1177/0886260520905091. Epub 2020 Feb 11.
Transgender and nonbinary (TNB) individuals experience high rates of myriad types of victimization, including in health care settings. Many TNB people avoid medical visits for fear of mistreatment and, when they do visit a provider, report negative experiences (e.g., denial of services, misgendering, verbal abuse). These negative experiences are heightened for TNB individuals who have an intersecting marginalized identity (e.g., low socioeconomic status, disability). Using data from the 2015 United States Transgender Survey, the largest survey of TNB individuals in the United States to date, the present study examines differential experiences of victimization in health care settings by TNB identity and other demographics (i.e., race, age, class, educational level, disability). A series of multivariate logistic regressions were run to determine adjusted odds ratios (AORs) for TNB individuals recently (i.e., in the past year) experiencing four forms of victimization: (a) doctor/health care provider used harsh or abusive language; (b) doctor/health care provider was physically rough or abusive; (c) patient was verbally harassed in health care setting; and (d) patient experienced unwanted sexual contact in health care setting. Frequency of victimization varied by gender identity and type of victimization; the most prevalent form was verbal harassment by a doctor/provider (5.84%) and the least prevalent was unwanted sexual contact in a health care setting (1.20%). Although findings varied by form of violence, generally, regression models demonstrated elevated odds of experiencing some form of health care victimization for those who were transgender compared with genderqueer, biracial/multiracial compared with White, low income compared with higher income, and disabled compared to non-disabled. In addition, odds ratios for victimization increased with age and, for some forms, increased with low educational attainment. We discuss the need for increased mandatory trainings for providers to reduce discriminatory and violent behavior toward TNB patients, as well as intersectional research to better ascertain the extent and nuance of victimization within TNB health care.
跨性别和非二元性别（TNB）个体经历了多种类型的受害，包括在医疗保健环境中。许多 TNB 人因担心受到虐待而避免就医，而当他们确实去看医生时，会报告负面体验（例如，拒绝服务、性别歧视、言语虐待）。对于那些具有交叉边缘化身份（例如，低社会经济地位、残疾）的 TNB 个体，这些负面体验更为严重。本研究使用了 2015 年美国跨性别调查的数据，这是迄今为止对美国 TNB 个体进行的最大规模调查，研究考察了 TNB 身份和其他人口统计学因素（即种族、年龄、阶层、教育水平、残疾）对医疗保健环境中受害经历的差异。进行了一系列多变量逻辑回归，以确定最近（即过去一年）经历以下四种受害形式的 TNB 个体的调整比值比（AOR）：（a）医生/医疗保健提供者使用苛刻或辱骂性语言；（b）医生/医疗保健提供者身体粗暴或虐待；（c）患者在医疗保健环境中受到言语骚扰；（d）患者在医疗保健环境中遭受不受欢迎的性接触。受害频率因性别认同和受害类型而异；最常见的形式是医生/提供者的言语骚扰（5.84%），最不常见的是医疗保健环境中的不受欢迎的性接触（1.20%）。尽管调查结果因暴力形式而异，但一般而言，与性别认同为非二元性别的个体相比，与跨性别个体相比，回归模型显示出经历某种形式的医疗保健受害的可能性更高；与白人相比，与混血儿/多种族裔相比；与高收入相比，与低收入相比；与非残疾相比，与残疾相比。此外，对于一些形式的暴力，受害的比值比随着年龄的增长而增加，并且对于某些形式的暴力，随着教育程度的降低而增加。我们讨论了需要对提供者进行更多强制性培训，以减少对 TNB 患者的歧视和暴力行为，以及进行交叉研究，以更好地确定 TNB 医疗保健中的受害程度和细微差别。
