Effect of discrimination and stigma on health care access: Qualitative research with transgender tennesseans

This qualitative study explored the impacts of discrimination and stigma on health care access for rural and urban transgender individuals. Two focus group discussions were conducted with self-identified transgender individuals in the Nashville and Knoxville regions of Tennessee March of 2010. Four major themes emerged from these discussions: (1) transgender individuals believe that their health care providers' attitudes and behavior toward them belie a lack of respect and that their health care is compromised as a result; (2) transition health care is frequently impeded by physicians and health insurance companies who do not recognize gender transition as a medical necessity; (3) anti-transgender discrimination in rural and urban communities in Tennessee has led transgender individuals to expect similar treatment from their health care providers as well; (4) participants prioritized the need for more health care providers who are knowledgeable about transgender health, and emphasized the importance of advocacy and social support in facilitating health care access. Participants who had previously received health care outside of Tennessee also made comparisons between Tennessee and other cities or states where they had better access to transgender health care. This study concluded that medical education and other professional health care training must be improved to address the health care needs of transgender individuals, particularly those who live in Tennessee and comparable regions in the U.S. Also, research is lacking in key areas of transgender health, including the implementation of a medical curriculum that successfully incorporates transgender health care, and inadequate funding opportunities exist for such research. Finally, the anti-transgender attitudes of health care providers should be addressed from within the health care profession, and through education, community advocacy for transgender rights, and the passage of anti-discrimination laws which are transgender-inclusive, specifically the Employment Non-Discrimination Act currently sidelined in the U.S. Senate.