Health Disparities
Perceived access to gender-affirming health care and everyday discrimination among transgender women of color in New York: The TURNNT Cohort Study Adam M. Whalen* Adam Whalen Alex Furuya Jessica Contreras Roberta Scheinmann Kim Watson Su Hyun Park John Schneider Cristina Herrera Sahnah Lim Chau Trinh-Shevrin Krish Bhatt Asa Radix Dustin Duncan
Background: Transgender people experience widespread discrimination. Access to gender-affirming health care may allow trans women to blend more easily into public life (i.e., “pass”) and avoid discrimination or harassment from others. We explored the relationship between perceived access to gender-affirming care and everyday discrimination among transgender women of color in New York.
Methods: We included 271 transgender women of color at baseline and 191 after 6 months of follow-up. Our exposure of perceived access to gender-affirming healthcare was dichotomized as full access (all needs met) and incomplete access. Discrimination was measured using the Everyday Discrimination Score, categorized as any experience of discrimination within the previous 6 months. We performed multivariable robust Poisson regression to obtain prevalence ratios (PRs) for the association between gender-affirming care access and discrimination, both at baseline and longitudinally. We adjusted for potential confounders including age, income, education, HIV status, race/ethnicity, and housing stability.
Results: At both visits most participants had access to health care, though only a third noted that all their gender-affirming care needs were being met. Almost 70% reported discrimination at baseline, and 56% reported discrimination at 6 months. At baseline, trans women with incomplete access to gender-affirming care were 9% more likely to report discrimination compared to those with full access, after adjustment (PR=1.09, 95%CI: 1.02-1.17). Baseline access to care was not associated with discrimination after 6 months of follow-up.
Conclusions: Access to gender-affirming health care is slightly protective against discrimination for transgender women of color, though this relationship does not hold over time. Gender-affirming care access should be protected and expanded, in addition to identifying other mechanisms for reducing transphobic discrimination.