Out about gender: Gender identity disclosure and health care for transgender patients in Virginia

We assessed whether transgender patients who experienced provider discrimination in the past are less likely to disclose their gender identity to future providers, and whether gender identity disclosure was associated with receiving HIV screening.

We used cross-sectional data from the Virginia Transgender Health Initiative Survey (2005-2006). A community sample of self-identified transgender adults who resided in Virginia completed either an online or paper survey. We fit generalized linear models to obtain relative risks, controlling for relevant covariates. We also stratified the analysis by sex assigned at birth.

Transgender people who reported past provider discrimination were more likely to report discomfort discussing transgender status with unknown providers (relative risk (RR)=1.25, 95% confidence interval [0.99-1.57]). In stratified analysis, this association was significant for transgender women (RR=1.55 [1.09-2.21]), but not for transgender men. Respondents who had not disclosed their gender identity to their current provider had a greater risk of never having had an HIV test (RR=1.89 [0.97-3.70]). In stratified analysis, this association was significant only for transgender women (RR=4.58 [1.22-17.15]).

Our findings suggest that transgender people, particularly transgender women, experience substandard care in their interactions with health care providers. More research is necessary to understand the characteristics of positive and negative doctor-patient interactions for transgender people, as well as the mechanisms through which gender identity disclosure affects the provision of care. Interventions improving physicians’ ability to provide knowledgeable, sensitive, and quality care to their transgender patients is critical to addressing the persistent health care disparities experienced by transgender populations