Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA.
BMC Health Serv Res. 2022 Mar 21;22(1):369. doi: 10.1186/s12913-022-07729-5.
Research shows that transmasculine people experience discrimination based on their gender identity and/or expression (i.e., cissexism) while obtaining health care. However, studies examining the experience of other forms of discrimination in health care settings among diverse subgroups of transmasculine individuals, including those from minoritized racial/ethnic backgrounds, are very limited.
Guided by intersectionality, we designed a qualitative research study to explore how transmasculine people of color experience-and resist-multiple, intersecting forms of discrimination in health care settings. Guided by a purposive sampling strategy, we selected 19 transmasculine young adults of color aged 18-25 years to participate in 5 mini-focus groups conducted between February and May 2019 in Boston, MA. Focus group transcripts were analyzed using a template style approach to thematic analysis that involved both deductive and inductive coding using a codebook. Coded text fragments pertaining to participants' experiences of health care discrimination were clustered into themes and sub-themes.
Transmasculine people of color described experiencing notable challenges accessing physical and mental health care as a result of structural barriers to identifying health care providers with expertise in transgender health, finding providers who share one or more of their social positions and lived experiences, and accessing financial resources to cover high health care costs. Further, participants discussed anticipating and experiencing multiple forms of interpersonal discrimination-both independently and simultaneously-in health care settings, including cissexism, racism, weight-based discrimination, and ableism. Moreover, participants described the negative impact of anticipating and experiencing multiple interpersonal health care discrimination on their health care utilization, quality of care, and mental and physical health. Lastly, participants discussed using various strategies to resist the multiple, intersecting forms of discrimination they encounter in health care settings, including setting boundaries with health care providers, seeking care from competent providers with shared social positions, engaging in self-advocacy, drawing on peer support during health care visits, and obtaining health information through their social networks.
Efforts are needed to address cissexism, racism, weight-based discrimination, ableism, and other intersecting forms of discrimination in clinical encounters, health care institutions and systems, and society in general to advance the health of transmasculine people of color and other multiply marginalized groups.
研究表明，跨性别男性在获得医疗保健时会因其性别认同和/或表达（即顺性别主义）而受到歧视。然而，研究跨性别男性中不同亚群体在医疗保健环境中经历其他形式的歧视的研究非常有限，包括来自少数族裔背景的群体。
本研究以交叉性为指导，设计了一项定性研究，以探讨有色人种跨性别男性在医疗保健环境中经历和抵制多种交叉形式的歧视的方式。我们采用目的性抽样策略，选择了 19 名年龄在 18-25 岁之间的有色人种跨性别年轻人，于 2019 年 2 月至 5 月在马萨诸塞州波士顿进行了 5 次小型焦点小组讨论。采用模板式方法对焦点小组的转录内容进行主题分析，使用代码簿进行演绎和归纳编码。与参与者在医疗保健中经历歧视相关的编码文本片段被聚类为主题和子主题。
有色人种跨性别男性表示，由于难以找到具有跨性别健康专业知识的医疗保健提供者、找到具有一个或多个共同社会地位和生活经历的提供者以及获得高医疗保健费用的经济资源，他们在获得身体和心理健康保健方面面临显著挑战。此外，参与者讨论了在医疗保健环境中预期和经历多种形式的人际歧视，包括顺性别主义、种族主义、体重歧视和能力歧视，这些歧视是独立的，也是同时发生的。此外，参与者描述了预期和经历多种人际医疗保健歧视对他们的医疗保健利用、护理质量以及身心健康的负面影响。最后，参与者讨论了使用各种策略来抵制他们在医疗保健环境中遇到的多种交叉形式的歧视，包括与医疗保健提供者设定界限、向具有共同社会地位的合格提供者寻求护理、进行自我倡导、在医疗保健就诊期间获得同伴支持以及通过社交网络获取健康信息。
需要努力解决临床接触、医疗保健机构和系统以及整个社会中的顺性别主义、种族主义、体重歧视、能力歧视和其他交叉形式的歧视，以促进有色人种跨性别男性和其他多重边缘化群体的健康。
