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      Barriers to Health Care for Transgender Individuals

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          Abstract

          Purpose of Review

          Transgender persons suffer significant health disparities and may require medical intervention as part of their care. The purpose of this manuscript is to briefly review the literature characterizing barriers to health care for transgender individuals and to propose research priorities to understand mechanisms of those barriers and interventions to overcome them.

          Recent Findings

          Current research emphasizes sexual minorities’ self report of barriers, rather than using direct methods. The biggest barrier to health care reported by transgender individuals is lack of access due to lack of providers who are sufficiently knowledgeable on the topic. Other barriers include: financial barriers, discrimination, lack of cultural competence by providers, health systems barriers and socioeconomic barriers.

          Summary

          National research priorities should include rigorous determination of the capacity of the United States health care system to provide adequate care for transgender individuals. Studies should determine knowledge and biases of the medical work force across the spectrum of medical training with regard to transgender medical care; adequacy of sufficient providers for the care required, larger social structural barriers and status of a framework to pay for appropriate care. As well, studies should propose and validate potential solutions to address identified gaps.

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          Most cited references23

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          "I don't think this is theoretical; this is our lives": how erasure impacts health care for transgender people.

          For people who are transgender, transsexual, or transitioned (trans), access to primary, emergency, and transition-related health care is often problematic. Results from Phase I of the Trans PULSE Project, a community-based research project in Ontario, Canada, are presented. Based on qualitative data from focus groups with 85 trans community members, a theoretical framework describing how erasure functions to impact experiences interacting with the health care system was developed. Two key sites of erasure were identified: informational erasure and institutional erasure. How these processes work in a mutually reinforcing manner to erase trans individuals and communities and produce a system in which a trans patient or client is seen as an anomaly is shown. Thus, the impetus often falls on trans individuals to attempt to remedy systematic deficiencies. The concept of cisnormativity is introduced to aid in explaining the pervasiveness of trans erasure. Strategies for change are identified.
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            Worldwide burden of HIV in transgender women: a systematic review and meta-analysis

            The Lancet Infectious Diseases, 13(3), 214-222
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              Experiences of transgender-related discrimination and implications for health: results from the Virginia Transgender Health Initiative Study.

              We examined relationships between social determinants of health and experiences of transgender-related discrimination reported by transgender people in Virginia. In 2005 through 2006, 387 self-identified transgender people completed a statewide health needs assessment; 350 who completed eligibility questions were included in this examination of factors associated with experiences of discrimination in health care, employment, or housing. We fit multivariate logistic regression models using generalized estimating equations to adjust for survey modality (online vs paper). Of participants, 41% (n = 143) reported experiences of transgender-related discrimination. Factors associated with transgender-related discrimination were geographic context, gender (female-to male spectrum vs male-to-female spectrum), low socioeconomic status, being a racial/ethnic minority, not having health insurance, gender transition indicators (younger age at first transgender awareness), health care needed but unable to be obtained (hormone therapy and mental health services), history of violence (sexual and physical), substance use health behaviors (tobacco and alcohol), and interpersonal factors (family support and community connectedness). Findings suggest that transgender Virginians experience widespread discrimination in health care, employment, and housing. Multilevel interventions are needed for transgender populations, including legal protections and training for health care providers.
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                Author and article information

                Journal
                101308636
                33881
                Curr Opin Endocrinol Diabetes Obes
                Curr Opin Endocrinol Diabetes Obes
                Current opinion in endocrinology, diabetes, and obesity
                1752-296X
                1752-2978
                12 March 2016
                1 April 2016
                01 April 2017
                : 23
                : 2
                : 168-171
                Affiliations
                [a ]Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA
                [b ]Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
                [c ]Division of Adolescent Medicine, Department of Pediatrics. Ann & Robert H. Lurie Children’s Hospital of Chicago/Northwestern University, Chicago, IL, USA
                [d ]Program of Developmental Psychoendocrinology, Division of Gender, Sexuality, and Health, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY and NYS Psychiatric Institute, New York, NY
                [e ]Callen-Lorde Community Health Center, New York, NY
                [f ]Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA
                Author notes
                Correspondence to: Joshua D. Safer, MD, Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, 715 Albany Street, Room M-1016, Boston, MA 02467 USA, telephone +1 617-638-8530, jsafer@ 123456bu.edu
                Article
                PMC4802845 PMC4802845 4802845 nihpa767277
                10.1097/MED.0000000000000227
                4802845
                26910276
                1fa5a0be-7ac4-4ac8-b376-e8912463ceba
                History
                Categories
                Article

                health disparities,transgender,barriers to care,medical education,workforce needs

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