Hernandez Christopher J, Santos Glenn-Milo, Wilson Erin C
University of California, Berkeley School of Public Health, Division of Infectious Diseases and Vaccinology, Berkeley, California, USA.
San Francisco Department of Public Health, San Francisco, California, USA.
Health Equity. 2020 Jun 23;4(1):263-271. doi: 10.1089/heq.2019.0104. eCollection 2020.
Undocumented immigrant trans Latinas face significant barriers to attaining gender-affirming health care and may use nonprescribed feminizing hormones. Without medical supervision, nonprescribed hormone use may lead to adverse health outcomes. This study aimed to determ if a history of being an undocumented immigrant was associated with nonprescribed hormone use among trans Latinas. We conducted a secondary analysis using baseline data from the 2016 Trans National study done in the San Francisco Bay Area. Two hundred five trans Latinas participated in the study, of whom 75 (37%) reported a history of being undocumented. We fitted a multivariable logistic regression model to determine whether having a history of being an undocumented immigrant was associated with nonprescribed hormone use while controlling for age, income, time living in San Francisco, history of sex work, and history of problems with accessing health care. The prevalence of nonprescribed hormone use was 55.9% among trans Latinas overall; however, for trans Latinas with a history of undocumented immigration status, the prevalence was 68%. There was a significant, independent association between nonprescribed hormone use and undocumented status (adjusted odds ratio [aOR]=3.20; 95% confidence interval [CI]=1.47-6.97). We also found that having a history of sex work was associated with nonprescribed hormone use (aOR=5.72; 95% CI=2.69-12.18). The prevalence of nonprescribed hormone use among trans Latinas was high and is associated with a history of undocumented status and sex work. These associations may indicate health care avoidance related to concerns of being criminalized due to their documentation status or source of income (i.e., sex work) among trans Latinas. These findings underscore the need to reduce barriers in gender-affirming care to increase access to medically supervised hormone use, particularly among individuals with a history of undocumented status and engaged in sex work.
无证移民跨性别拉丁裔女性在获得性别确认医疗保健方面面临重大障碍，可能会使用非处方女性化激素。在没有医疗监督的情况下，使用非处方激素可能会导致不良健康后果。本研究旨在确定无证移民史是否与跨性别拉丁裔女性使用非处方激素有关。我们使用2016年在旧金山湾区进行的跨性别全国性研究的基线数据进行了二次分析。205名跨性别拉丁裔女性参与了该研究，其中75人（37%）报告有无证移民史。我们拟合了一个多变量逻辑回归模型，以确定有无证移民史是否与使用非处方激素有关，同时控制年龄、收入、在旧金山居住的时间、性工作史以及获得医疗保健的问题史。总体而言，跨性别拉丁裔女性中使用非处方激素的患病率为55.9%；然而，对于有无证移民史的跨性别拉丁裔女性，患病率为68%。使用非处方激素与无证身份之间存在显著的独立关联（调整后的优势比[aOR]=3.20；95%置信区间[CI]=1.47-6.97）。我们还发现，有性工作史与使用非处方激素有关（aOR=5.72；95%CI=2.69-12.18）。跨性别拉丁裔女性中使用非处方激素的患病率很高，并且与无证身份和性工作史有关。这些关联可能表明，跨性别拉丁裔女性由于担心因其身份文件状况或收入来源（即性工作）而被定罪，从而回避医疗保健。这些发现强调了减少性别确认护理中的障碍的必要性，以增加获得医疗监督的激素使用的机会，特别是在有无证身份和从事性工作的人群中。
