Running Head: TRANSGENDER HEALTH CARE 1

Health Care Disparities in the Transgender Population

Ariane Caday

Professor Kathy S. Faw RN, MSN

Bon Secours Memorial College of Nursing

NUR 3113

November 5, 2016

Honor Code “I pledge..”

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Health Care Disparities in the Transgender Population

The transgender population represents a diverse range of people from different races,

ethnicities, ages, socioeconomic statuses, and identities. However, this population of social and

gender minorities is connected together by the shared experiences of stigma and discrimination.

As a result, transgender people face trivial challenges in accessing high-quality, culturally

competent health care services. Transgender health is important as the disparities that exist for

this population continue to encourage transphobia, decrease access to care, and deter health-

seeking behaviors. As this population is becoming more prevalent worldwide, clinicians must be

informed about transgender health care in order to deliver exceptional care that transcends

discrimination and eliminates such disparities.

Social Determinants of Health

Social determinants of health are factors that contribute to or detract from health of

individuals and communities. These determinants include: social environment, economic

environment, physical environment, individual characteristics and behaviors, income and social

status, education, genetics, health services and gender. Transgender individuals can be described

as having “gender identities, expressions, or behaviors that are inconsistent with social norms

associated with their natal sex” (Khan, 2013, p. 379). An intersection of this population may

desire to adopt a gender different from the one assigned at birth, while others may defy binary

gender classifications en masse by adopting features from both genders or rejecting both genders

entirely. Another intersection may desire to seek medical treatment to transition to another

gender by undergoing medical procedures. Given the diversity of the transgender population, it is

not surprising that the social determinants of health for this population can vary dramatically.

However, the biggest common element that is shared altogether is the lack of access to health
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care. Discrimination against the transgender population can make it difficult for attaining quality

health care; individuals do not seek it out as often as needed or they delay seeking care until

health conditions are more serious. Transphobia in the health care system, therefore, can have

detrimental consequences for transgender health, such as higher levels of depression and suicide,

higher rates of alcohol, tobacco, and drug use, and greater risks for sexually transmitted

infections.

Evidence-based Interventions Addressing Health Needs

The transgender population has a multitude of health needs that still need to be heavily

addressed today. In a study performed by the National Center for Transgender Equality,

participants reported poor access to health care due to significant hurdles, including: upright

refusal of care, violence and harassment, and lack of knowledge on the providers’ end. 19% of

respondents were denied service altogether by providers due to their transgender or gender non-

conforming status (Grant, Mottet, & Tanis, 2011, p. 5). Furthermore, over 28% of respondents

reported verbal harassment in medical settings, while 2% reported being physically attacked. As

a result of harassment and physical attacks, many transgender patients are significantly deterred

from seeking care. If patients were not initially denied service, respondents often then

encountered ignorance about the basic tenets of transgender health, in which they found

themselves having to teach their providers about transgender medical care (Grant, Mottet, &

Tanis, 2011, p. 6). These three factors have discouraged health-seeking behaviors in this

population, ultimately reducing the likelihood of following through with routine checkups,

preventative care, and emergency care. However, the most prevalent hurdle is that transgender

people are less likely than other groups in the LGBT community to have health insurance. With

over 88% of respondents delaying care due to inability to afford it and failing to obtain
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preventative medicine, poor long-term health outcomes have been to known to be the result

(Grant, Mottet, & Tanis, 2011, p. 7).

The best approach for providers to begin addressing the health needs of transgender

patients is by creating a welcoming environment and promoting inclusive patient care. It is

essential for health care providers to “show openness, use inclusive language, welcome and

normalize individuals” regardless of sexual orientation and gender identity, and to use the

knowledge they gain from each and every patient in their practice (Fidelindo, Brown, & Kim,

2014, p. 33). Developing cultural competence by being aware of personal biases and

compensating for knowledge deficits through education are integral components for change.

Specific strategies can include posting the hospital’s nondiscrimination policy or patient bill of

rights, revising intake forms to be inclusive of a wider range of sexual orientations and gender

identities, refraining from making assumptions about a person’s sexual orientation or gender

identity based on appearance, having clinicians educate themselves more about transgender

medical care, listening to and reflecting on the patients’ choice of language, and fostering nurses

to be the bridge for which they can provide culturally sensitive care, among many more

strategies. “Habits of self-awareness and reflection, ongoing professional development, and

implantation of best practices are all essential to providing culturally competent care for LGBT

people” (Fidelindo, Brown, & Kim, 2014, p. 33). As further research yields more information

regarding transgender health disparities and how to address such needs, there is hope to see more

evidence-based interventions being implemented that can further educate providers.

The Millennium Development Goals comprises of eight target specific goals to progress

towards “a new vision for humanity.” Addressing the health disparities that exist in the

transgender population can be tied to several of these goals, including: promoting gender
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equality and combating HIV/AIDS. Making strides to ensure that transgender health care is

inclusive will help combat a long history of discrimination and lack of awareness, thus

advocating for equity among all sexual orientations and gender identities. A significant health

vulnerability for this population is the number of reported HIV/AIDS infections, with a rate of

2.64%, over four times the rate of HIV infection in the general United States adult population.

According to the National Center for Transgender Equality, “Among survey participants, 91% of

those who reported being HIV positive identified as either Male-to-Female or gender non-

conforming on the Male-to-Female spectrum” (Grant, Mottet, & Tanis, 2011, p. 13). By

addressing the problem from its root - poor access to health care - those at risk or who are

already infected with HIV/AIDS can have better opportunities to seek emergency care and

preventative medicine, thus combating the prevalence of AIDS.

Global Approach in Addressing “Health for All”

In order to reduce the barriers that cause the transgender population to forego health

care, several global approaches may be implemented. First, healthcare organizations will need

direct experience working with transgender patients so that they can be more educated and

otherwise skilled on how to be transgender-inclusive. Transgender patients are already reluctant

to seek care due to damaging experiences of discrimination, harassment and violence, and

limited provider knowledge. Second, eliminating transgender health disparities will never just be

a matter of increased education, but a matter of policy. By implementing customized protocols

specific to each patient, transgender-inclusion will be enlightening on both ends of the patient-

provider spectrum. Reducing the disparities that exist in the transgender population will further

promote optimal health for all in both general and LGBT communities. More importantly, global

efforts to reduce the rate of HIV/AIDS infections will be beneficial for all. Promoting education,
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disqualifying biases and ignorance, and delivering culturally competent care can ultimately deter

the development of such diseases, leaving a positive impact on global health.

Conclusion

The success of health care systems and organizations depends on the quality of care being

delivered. Patient centered care in regards to the transgender population requires providers to be

culturally sensitive of their patients’ lives, modify current practices to be inclusive, and be

educated on transgender specific health issues. The vulnerability areas of behavioral health, HIV

prevention, and transgender transition care are at their very peak in the cry for being addressed.

By taking the steps to become a culturally competent health care provider, transgender patients

can indeed receive high quality care and high quality of life.
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References

Grant, Jaime M., Mottet, Lisa A., & Tanis, Justin. (2011). National transgender discrimination

survey report on health and health care. National Center for Transgender Equality, 1-23.

Khan, Liza. (2013). Transgender health at the crossroads: legal norms, insurance markets, and

the threat of healthcare reform. Yale Journal of Health Policy, Law, and Ethics, 11(2),

376-417.

Lim, Fidelindo A., Brown Jr., Donald V., & Kim, Sung M. (2014). Addressing health care

disparities in the lesbian, gay, bisexual, and transgender population: a review of best

practices. American Journal of Nursing, 114(6), 24-34.