220303 Discrimination in healthcare reported by transgender persons in Virginia: Results from a statewide needs assessment survey

Tuesday, November 9, 2010

Sari L. Reisner, MA , The Fenway Institute, Fenway Health and Harvard School of Public Heatlh, Boston, MA
Judith B. Bradford, PhD , Community Health Research, Virginia Commonwealth University, Richmond, VA
Background: Transgender persons are a highly stigmatized and understudied population. Little research to date has examined experiences of discrimination in healthcare settings among transgender persons, especially populations in the southern U.S. Methods: The Virginia Transgender Health Initiative Study (THIS) enrolled 350 transgender persons (229 male-to-female, 121 female-to-male) in a statewide needs assessment in 2005-2006 funded by the Virginia DPH. Participants completed a one-time survey capturing demographics, experiences of discrimination in healthcare, and health outcomes. Regression analyses examined predictors of self-reported discrimination in healthcare settings. Results: Overall, 24% of the sample reported ever experiencing discrimination by a doctor or other healthcare provider due to transgender status or gender expression. Factors significantly associated with experiencing discrimination by a healthcare provider were: family “not at all” or “not very” supportive of gender expression (OR=1.79; 95% CI=1.07-3.00; p=0.03), history of forced or unwanted sex (OR=2.95; 95% CI=1.41-6.15; p=0.004) and physical attack (OR=2.78; 95% CI=1.58-4.88; p<0.001) specifically due to gender identity or expression, and substance use, particularly use of stimulants (OR=1.85; 95% CI=1.12-3.05; p=0.02) and alcohol (OR=1.73; 95% CI=1.01-3.00; p=0.05). Conclusion: Discrimination in healthcare settings was associated with an array of complex health-related co-morbidities among transgender persons in this sample, including lack of family support, gender-based violence, and substance use. Provider training is warranted to ensure culturally competent care and interventions are urgently needed—at the structural-, community-, and individual-level—that address the healthcare needs of transgender populations, particularly in the context of cumulative stressors and experiences of discrimination across the life course.

Learning Areas:
Advocacy for health and health education
Planning of health education strategies, interventions, and programs
Social and behavioral sciences

Learning Objectives:
Describe experiences of transgender-related discrimination in healthcare among a sample of 350 transgender Virginians; discuss the implications of discrimination for transgender health across the life course.

Keywords: Health Disparities, Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Sari Reisner is the Epidemiology Projects Manager at The Fenway Institute, Fenway Health in Boston, Massachusetts. He has more than 8 years of experience coordinating and managing public health projects, including 3 years of professional grant writing experience and 5 years of experience managing research projects focused on the social and behavioral determinants of health. Reisner’s behavioral science research interests focus on the intersection of mental and physical health, including substance abuse intervention development, health psychology and behavioral medicine within the context of serious illness (HIV/AIDS and cancer), and the social epidemiology of mental illness and substance abuse in marginalized populations, in particular among gay, lesbian, bisexual, and transgender populations. He has co-authored more than 20 peer-reviewed journal articles (either published or in press), and has presented his work at both national and international scientific conferences, including the Annual Meeting of the Society of Behavioral Medicine, the American Public Health Association Annual Meeting, and the International AIDS Conference. In addition, he currently serves as a reviewer for Journal of Urban Health, AIDS Care, AIDS and Behavior, Traumatology, and JANAC, and is an editorial consultant for the American College of Physicians, Physicians Information and Education Resource (PIER). Reisner is a full-time Doctoral student at Harvard School of Public Health in the Department of Society, Human Development, and Health. He earned a Master’s degree from Brandeis University and a Bachelor’s degree from Georgetown University.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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