Social
The socio-economic characteristics and social determinants of health of a South African trans and gender nonbinary cohort Mary Carmody* Mary Carmody Rutendo Bothma Tonia Poteat Audrey Pettifor John Imrie
Background: Socio-economic status (SES) is often measured using individual indicators like education and income, representing possession of valued social and economic resources. This project describes participants’ socio-economic environment using structural experiences such as economic, food, and housing insecurity, and neighborhood walkability and safety. This broader SES definition explores differential access to resources (e.g., education, medical care, quality nutrition) as a proxy for the social environment, hypothesizing that this differential access impacts health.
Methods: Baseline data were collected from 670 gender-diverse participants between 2023-2024 in a prospective study in South Africa (SA). Descriptive statistics were calculated for individual and neighborhood-level SES indicators.
Results: The majority of participants (73.9%) identified as Black, were born in South Africa (95.1%), and had a grade 11-12 education (64.0%). Due to purposeful sampling, almost two-thirds (67.2%) were HIV positive. Nearly one-fifth (18.1%) had full-time employment, and a majority (60.7%) reported a monthly income ≤ R499 ($26.6). Half (51.5%) worried about having enough food in the past 3 months, with 22.1% not eating for a whole day on some days. Most participants reported stable housing, with 93.4% having access to water and electricity, but only 11.9% had backup power. Most participants agreed they had access to stores and services within walking distance. Almost half (48.8%) strongly agreed there was a lot of crime in their neighborhood, with 33.7% somewhat agreeing there was too much crime to go outside during the day and 53.6% strongly agreeing there was too much crime to go outside at night. Participants generally described their neighborhoods positively, with many somewhat agreeing that their neighborhood was clean, free from bad smells, had beautiful views, and was free of pollution.
Conclusions: Traditional SES indicators describe participants’ SES in one manner, while neighborhood quality and economic security provide additional insights. The cohort appears to have a marginally higher SES than typically found among persons living in rural communities in SA.. Future research should use a broader SES definition to proxy the social environment when examining health behaviors and outcomes.