Smart Benjamin D, Mann-Jackson Lilli, Alonzo Jorge, Tanner Amanda E, Garcia Manuel, Refugio Aviles Lucero, Rhodes Scott D
Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Int J Transgend Health. 2020 Dec 17;23(1-2):164-177. doi: 10.1080/26895269.2020.1848691. eCollection 2022.
Research has shown that transgender and nonbinary people experience health disparities. However, few studies have explored, in-depth, the health-related experiences, perceptions, needs, and priorities of transgender women of color living in the U.S. South, a region that poses unique challenges to achieving health for transgender people. This study explored the social determinants of health, healthcare experiences, and health-related priorities of transgender women of color living in the U.S. South. Using a community-based participatory research approach, we conducted iterative in-depth interviews with 15 African American/Black and Latinx transgender women in North Carolina in May-July 2019 for a total of 30 interviews. We analyzed interview data using constant comparison, an approach to grounded theory. Participants' mean age was 34 (range 19-56) years. Twenty themes emerged that were categorized into three domains: (1) social determinants of health (family rejection; bullying, discrimination, and violence; isolation; policy barriers; mistrust in systems; employment obstacles; sex work; high cost of care; transportation barriers; church antagonism; and substance misuse), (2) healthcare experiences (emotional burden of healthcare interactions; name and gender misidentification; staff discomfort and insensitivity; sexual risk assumptions; and use of nonmedical or predatory providers), and (3) health-related priorities (understanding healthcare; respect at all levels of healthcare; inclusive gender-affirming care; and comprehensive resources). Transgender women of color living in the U.S. South face profound health barriers compounded throughout the life course and have unmet healthcare needs. Participants faced multilayered minority stressors: racial discrimination from society at large and within the LGTBQ community; gender identity discrimination within their regional context and racial/ethnic communities; and exclusion from existing health equity movements for transgender women of color, which often are found in and focus on larger urban communities. Health interventions mindful of this intersection are needed, including antidiscrimination policies and increasing gender-affirming healthcare access.
研究表明，跨性别者和非二元性别者存在健康差异。然而，很少有研究深入探讨生活在美国南部的有色人种跨性别女性与健康相关的经历、认知、需求和优先事项，该地区在跨性别者实现健康方面面临独特挑战。本研究探讨了生活在美国南部的有色人种跨性别女性的健康社会决定因素、医疗保健经历以及与健康相关的优先事项。采用基于社区的参与性研究方法，我们于2019年5月至7月在北卡罗来纳州对15名非裔美国/黑人及拉丁裔跨性别女性进行了反复深入访谈，共进行了30次访谈。我们使用持续比较法（一种扎根理论方法）分析访谈数据。参与者的平均年龄为34岁（范围为19至56岁）。出现了20个主题，分为三个领域：（1）健康的社会决定因素（家庭排斥；欺凌、歧视和暴力；孤立；政策障碍；对系统的不信任；就业障碍；性工作；高昂的医疗费用；交通障碍；教会的敌意；以及药物滥用），（2）医疗保健经历（医疗互动的情感负担；姓名和性别错误识别；工作人员的不适和冷漠；性风险假设；以及使用非医疗或掠夺性提供者），以及（3）与健康相关的优先事项（了解医疗保健；在各级医疗保健中受到尊重；包容性的性别肯定护理；以及全面的资源）。生活在美国南部的有色人种跨性别女性面临着贯穿一生的深刻健康障碍，且医疗保健需求未得到满足。参与者面临多层次的少数群体压力源：来自整个社会以及LGTBQ社区内部的种族歧视；在其地区背景和种族/族裔社区内的性别认同歧视；以及被排除在现有的针对有色人种跨性别女性的健康公平运动之外，这些运动通常出现在并专注于较大的城市社区。需要有考虑到这种交叉性的健康干预措施，包括反歧视政策和增加性别肯定医疗保健的可及性。
