Executive Summary
Social stigma and a lack of affordability keep many transgender people from pursuing needed care, according to a recent research paper.
- The term transgender refers to individuals whose sex at birth is different from their identity as male, female, or elsewhere along the gender spectrum. People who identify as transgender might live their lives as the opposite gender and might seek prescription pharmacologic therapy and/or surgical transformation. Transgender people might identify as heterosexual, lesbian, gay, or bisexual, or somewhere else along the spectrum of sexual identity.
- A 2011 Study Found That An Estimated 0.3% Of The U.s. Population Is Transgender, Equating To Approximately 700,000 People.
For many patients, discussing sexual history with a healthcare provider can be an uncomfortable experience. However, for many transgender people, the conversation never takes place because they aren’t seeking healthcare, according to a University of Buffalo (NY) researcher.
According to Adrian Juarez, PhD, a public health nurse and assistant professor in the University at Buffalo School of Nursing, social stigma, as well as a lack of affordability, keep many transgender people from pursuing needed care. Juarez gathered data during a preliminary study examining HIV testing access and heath-based decision-making in urban, transgender populations.1 The research was partially funded through a Junior Investigator Award from the American Public Health Association.
“There is evidence that healthcare providers do tend to be judgmental, and it’s unwelcoming,” said Juarez in a press statement accompanying the research. “People will refrain from going to healthcare providers if they have to deal with stigma and discrimination.”
Before using the term “transgender,” you should understand a patient’s gender identity. The National Center for Transgender Equality defines gender identity as “an individual’s internal sense of being male, female, or something else. Since gender identity is internal, one’s gender identity is not necessarily visible to others.”2 Gender expression and gender role conformity describe the extent to which a person does or does not adhere to expected gender norms and roles.3
The term transgender refers to individuals whose sex at birth is different from their identity as male, female, or elsewhere along the gender spectrum. People who identify as transgender might live their lives as the opposite gender and might seek prescription pharmacologic therapy and/or surgical transformation. Transgender people might identify as heterosexual, lesbian, gay, or bisexual, or somewhere else along the spectrum of sexual identity.3
According to an April 2015 issue brief from the Kaiser Family Foundation of Menlo Park, CA, data on those who identify as transgender are limited.3 A 2011 study found that an estimated 0.3% of the U.S. population is transgender, which equates to approximately 700,000 people.4
More access to data on the transgender population is coming. The Affordable Care Act has included new data collection requirements on disparities, which include sexual orientation and gender identity. The National Health Interview Survey, which serves as a major source of information on the health of the U.S. population, added a question on sexual orientation in its 2013 survey, with findings issued in July 2014.
The Affordable Care Act has expanded access to health insurance coverage for millions, including transgender individuals, and includes specific protections related to sexual orientation and gender identity. Such coverage is said to be necessary; according to a study of Massachusetts residents, transgender persons are the least likely among lesbian, gay, bisexual, and transgender (LGBT) individuals to self-report their health as “excellent” or “very good” (67% among transgender residents versus 79% for lesbian, gay, and bisexual residents). In the same study, transgender individuals were twice as likely to report limitations in daily activities due to impairment of health problems (33% versus 16% for lesbian, gay, and bisexual residents).5
Compounding the issue is the fact that the transgender population is much more likely to live in poverty and less likely to have health insurance than the general population.3 Survey results indicate nearly half (48%) of respondents postponed or went without care when they were sick because they could not afford care.6
Transgender women, particularly transgender women of color, are also at high risk of HIV, according to the Kaiser Family Foundation issue brief.3 Research indicates more than one in four (28%) are HIV positive, and most are unaware that they are infected.7
The Centers for Disease Control and Prevention (CDC) is leading programs totaling more than $185 million in HIV prevention funding for men who have sex with men (MSM) and transgender people, with a particular focus on addressing the needs of MSM of color. The agency announced its multi-faceted strategy in March 2015, with three new programs enabling health departments and local HIV prevention partners to deliver the most effective HIV prevention tools to these populations.
The agency is awarding up to $125 million over three years to state and local health departments to expand the use of pre-exposure prophylaxis for MSM and transgender people who are HIV-negative but at substantial risk and expand the use of ongoing medical care and antiretroviral treatment for people living with HIV. An additional investment of up to $60.5 million over four years from the Minority AIDS Initiative Fund from the Department of Health and Human Services will strengthen prevention efforts specifically for MSM of color.
In a statement, Jonathan Mermin, MD, MPH, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said, “We have more powerful HIV prevention tools than ever before. Now, we need to get them into the hands of the people who need them the most. By harnessing the power of recent scientific breakthroughs, we can change the course of the epidemic among MSM and transgender people, who continue to face the highest risk for infection in this country.”
- Juarez A. Examining the role of social networks on venue-based HIV testing access and decision making in an urban, transgendered population. Presented at the 2014 annual meeting of the American Public Health Association. New Orleans; November 2014.
- National Center for Transgender Equality. Transgender Terminology. Accessed at http://bit.ly/1Ktc3Qc.
- Ranji U, Beamesderfer A, Kates J, et al. Health and Access to Care and Coverage for Lesbian, Gay, Bisexual, and Transgender Individuals in the U.S. Accessed at http://bit.ly/1gH1BT5.
- Gates G. How many people are lesbian, gay, bisexual, and transgender? Accessed at http://bit.ly/1marFLw.
- Massachusetts Department of Public Health. The Health of Lesbian, Gay, Bisexual, and Transgender (LGBT) Persons in Massachusetts. Accessed at http://1.usa.gov/1F1t93c.
- National Center for Transgender Equality and National Gay and Lesbian Task Force. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Accessed at http://bit.ly/1teXC7Y.
- Centers for Disease Control and Prevention. HIV among Transgender People. Accessed at http://1.usa.gov/1iTQtX9.
