Healthcarelessness for Transfolks

The National Center for Transgender Equality and the National Gay and Lesbian Task Force released the National Transgender Discrimination Survey: Report on Health and Health Care.

Not surprisingly, transfolks and gender non-conforming people face rampant discrimination in health care settings, are regularly denied needed care, and experience a range of health risks because they are transgender or gender non-conforming, according to this report of over 6,450 transgender and gender non-conforming people.

KEY FINDINGS

• Survey participants reported very high levels of postponing medical care when sick or injured due to discrimination (28%) or inability to afford it (48%);
• Respondents faced significant hurdles to accessing health care, including:
  
  • Refusal of care: 19% of our sample reported being refused care due to their transgender or gender non-conforming status, with even higher numbers among people of color in the survey;
  • Harassment and violence in medical settings: 28% of respondents were subjected to harassment in medical settings and 2% were victims of violence in doctor’s offices;
  • Lack of provider knowledge: 50% of the sample reported having to teach their medical providers about transgender care;

• Despite the barriers, the majority of survey participants have accessed some form of transition-related medical care; the majority reported wanting to have surgery but have not had any surgeries yet;
• If medical providers were aware of the patient’s transgender status, the likelihood of that person experiencing discrimination increased;
• Respondents reported over four times the national average of HIV infection, 2.64% in our sample compared to .6% in the general population, with rates for transgender women at 3.76%, and with those who are unemployed (4.67%) or who have engaged in sex work (15.32%) even higher;
• Over a quarter of the respondents misused drugs or alcohol specifically to cope with the discrimination they faced due to their gender identity or expression;
• A staggering 41% of respondents reported attempting suicide compared to 1.6% of the general population, with unemployment, low income, and sexual and physical assault raising the risk factors significantly.

RECOMMENDATIONS

• Anti-transgender bias in the medical profession and U.S. health care system has catastrophic consequences for transgender and gender non-conforming people. This study is a call to action for the medical profession;
  
  • The medical establishment must fully integrate transgender-sensitive care into its professional standards, and this must be part of a broader commitment to cultural competency around race, class, and age;
  • Doctors and other health care providers who harass, assault, or discriminate against transgender and gender non-conforming patients should be disciplined and held accountable according to the standards of their professions.

• Public and private insurance systems must cover transgender-related care; it is urgently needed and is essential to basic health care for transgender people.
• Ending violence against transgender people must be a public health priority, because of the direct and indirect negative effect it has on both victims and on the health care system that must treat them.
• Medical providers and policy makers should never base equal and respectful treatment and the attainment of government-issued identity documents on:
  
  • Whether an individual has obtained surgery, given that surgeries are financially inaccessible for large majorities of transgender people because they are rarely covered by either public or private insurance;
  • Whether an individual is able to afford or attain proof of citizenship or legal residency.
    Rates of HIV infection, attempted suicide, drug and alcohol abuse, and smoking among transgender and gender non-conforming people speak to the overwhelming need for:
    • Transgender-sensitive health education, health care, and recovery programs;
    • Transgender-specific prevention programs.
  • Additional data about the health outcomes of transgender and gender non-conforming people is urgently needed;
    
    • Health studies and other surveys need to include transgender as a demographic category;
    • Information about health risks, outcomes and needs must be sought specifically about transgender populations;
    • Transgender people should not be put in categories such as “men who have sex with men” (MSM) as transgender women consistently are and transgender men sometimes are. Separate categories should be created for transgender women and transgender men so HIV rates and other sexual health issues can be accurately tracked and researched.