Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6014, Baltimore, MD, 21205, USA.
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
BMC Public Health. 2024 Jan 20;24(1):243. doi: 10.1186/s12889-024-17764-y.
Transgender women (TW) experience significant inequities in healthcare access and health disparities compared to cisgender populations. Access to non-transition related healthcare is understudied among TW. We aimed to assess the association between access to care and gender minority stress and resilience factors among TW living with and without HIV in eastern and southern United States.
This study was a cross-sectional analysis of baseline data drawn from a cohort of 1613 adult TW from the LITE Study. The cohort permitted participation through two modes: a site-based, technology-enhanced mode and an exclusively online (remote) mode. Exploratory and confirmatory factor analyses determined measurement models for gender minority stress, resilience, and healthcare access. Structural equation modeling was used to assess the relationships between these constructs. Models were evaluated within the overall sample and separately by mode and HIV status.
Higher levels of gender minority stress, as measured by anticipated discrimination and non-affirmation were associated with decreased access to healthcare. Among TW living with HIV, higher levels of anticipated discrimination, non-affirmation, and social support were associated with decreased healthcare access. Among TW living without HIV in the site-based mode, resilience was positively associated with positive healthcare experiences and inversely associated with barriers to healthcare access. Among TW living without HIV in the online mode, anticipated discrimination was associated with barriers to healthcare access; resilience was positively associated with positive healthcare experiences and inversely associated with barriers to healthcare access.
Gender minority stress was associated with increased barriers to healthcare access among TW in the US, regardless of HIV status. Resilience factors did not mediate this effect. Interventions aiming to increase healthcare access among TW can be aided by efforts to mitigate drivers of gender minority stress and improve patient experiences in healthcare facilities.
与顺性别群体相比，跨性别女性（TW）在获得医疗保健方面存在显著的不平等和健康差距。TW 获得非变性相关医疗保健的研究较少。我们旨在评估在美国东部和南部生活的 TW 中，获得医疗保健的机会与性别少数群体压力和韧性因素之间的关联，无论其是否感染 HIV。
本研究是对 LITE 研究中 1613 名成年 TW 的基线数据进行的横断面分析。该队列允许通过两种模式参与：基于站点的、增强技术的模式和完全在线（远程）模式。探索性和验证性因子分析确定了性别少数群体压力、韧性和医疗保健获取的测量模型。结构方程模型用于评估这些结构之间的关系。在整个样本中以及按模式和 HIV 状态分别评估模型。
性别少数群体压力水平较高，如预期歧视和不认可，与医疗保健获取减少有关。在感染 HIV 的 TW 中，预期歧视、不认可和社会支持水平较高与医疗保健获取减少有关。在基于站点的模式下生活且没有 HIV 的 TW 中，韧性与积极的医疗保健体验呈正相关，与医疗保健获取障碍呈负相关。在在线模式下生活且没有 HIV 的 TW 中，预期歧视与医疗保健获取障碍有关；韧性与积极的医疗保健体验呈正相关，与医疗保健获取障碍呈负相关。
在美国，无论 HIV 状况如何，性别少数群体压力与 TW 获得医疗保健的障碍增加有关。韧性因素并没有调节这种影响。旨在增加 TW 获得医疗保健机会的干预措施可以通过减轻性别少数群体压力的驱动因素和改善患者在医疗保健设施中的体验来得到帮助。
