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      “Tiptoeing Around the System”: Alternative Healthcare Navigation Among Gender Minorities in New Orleans

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          Purpose: Gender Minority (GM) individuals experience healthcare access barriers, including financial concerns and discrimination, which influence their health seeking behaviors. This study explores the alternative navigation strategies used by GM individuals to cope with these barriers and access care, both biomedical and complementary and alternative medicine (CAM).

          Methods: In-depth interviews were conducted with GM individuals ( n=18) and healthcare providers ( n=5) identified through purposive sampling. Semistructured guides were used to elicit information about healthcare seeking strategies and experiences. Transcribed interview data were coded, sorted, and analyzed for key themes.

          Results: Commonly discussed healthcare access barriers included the following: identifying a competent provider, costs and insurance obstacles, and anticipated discrimination. Respondents expressed a need for gender-affirming care within the biomedical system, and alternative navigation strategies to overcome access barriers, including travelling abroad for surgical procedures, ordering hormones online, and sharing with friends. Respondents discussed CAM principally related to emotional health, preferring CAM to biomedical offerings. Utilizing social networks to access all care modalities was common.

          Conclusions: The healthcare-seeking behavior of GM individuals demonstrates great resilience. This population is committed to accessing gender-affirming care regardless of the associated risks of care outside of provider supervision. The healthcare community needs to eliminate access barriers and support harm reduction strategies. CAM for emotional health support and the role of social networks in accessing care resources should be better integrated into care for this population.

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          Most cited references 31

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          Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7

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            Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization.

            To determine the independent predictors of attempted suicide among transgender persons we interviewed 392 male-to-female (MTF) and 123 female-to-male (FTM) individuals. Participants were recruited through targeted sampling, respondent-driven sampling, and agency referrals in San Francisco. The prevalence of attempted suicide was 32% (95% CI = 28% to 36%). In multivariate logistic regression analysis younger age (<25 years), depression, a history of substance abuse treatment, a history of forced sex, gender-based discrimination, and gender-based victimization were independently associated with attempted suicide. Suicide prevention interventions for transgender persons are urgently needed, particularly for young people. Medical, mental health, and social service providers should address depression, substance abuse, and forced sex in an attempt to reduce suicidal behaviors among transgender persons. In addition, increasing societal acceptance of the transgender community and decreasing gender-based prejudice may help prevent suicide in this highly stigmatized population.
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              HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention.

              This study described HIV prevalence, risk behaviors, health care use, and mental health status of male-to-female and female-to-male transgender persons and determined factors associated with HIV. We recruited transgender persons through targeted sampling, respondent-driven sampling, and agency referrals; 392 male-to-female and 123 female-to-male transgender persons were interviewed and tested for HIV. HIV prevalence among male-to-female transgender persons was 35%. African American race (adjusted odds ratio [OR] = 5.81; 95% confidence interval [CI] = 2.82, 11.96), a history of injection drug use (OR = 2.69; 95% CI = 1.56, 4.62), multiple sex partners (adjusted OR = 2.64; 95% CI = 1.50, 4.62), and low education (adjusted OR = 2.08; 95% CI = 1.17, 3.68) were independently associated with HIV. Among female-to-male transgender persons, HIV prevalence (2%) and risk behaviors were much lower. Most male-to-female (78%) and female-to-male (83%) transgender persons had seen a medical provider in the past 6 months. Sixty-two percent of the male-to-female and 55% of the female-to-male transgender persons were depressed; 32% of each population had attempted suicide. High HIV prevalence suggests an urgent need for risk reduction interventions for male-to-female transgender persons. Recent contact with medical providers was observed, suggesting that medical providers could provide an important link to needed prevention, health, and social services.

                Author and article information

                [ 1 ]Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine , New Orleans, Louisiana.
                [ 2 ]Department of Mental Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.
                Author notes

                Preliminary findings from this study were presented in a poster session at the 2018 LGBT Health Workforce Conference, on May 5, 2018; the WPATH Graduate Student Research Symposium in Transgender Health: Philadelphia Trans-Health Conference on September 8, 2017; and the Academy Health's Annual Research Meeting on June 24, 2017. An oral presentation of related preliminary findings was presented at the 2017 National LGBTQ Health Conference on April 29, 2017. Furthermore, table one was previously published in “Glick, J; Theall, K; Andrinopolous, K; Kendall, C. For Data's Sake: Dilemmas in the Measurement of Gender Minorities. Culture, Health & Sexuality. April 2018.”

                [ * ]Address correspondence to: Jennifer L. Glick, PhD, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Hampton House 749, Baltimore, MD 21205, E-mail: jglick5@
                Transgend Health
                Transgend Health
                Transgender Health
                Mary Ann Liebert, Inc. (140 Huguenot Street, 3rd FloorNew Rochelle, NY 10801USA )
                01 July 2018
                01 July 2018
                : 3
                : 1
                : 118-126
                © Jennifer L. Glick et al. 2018; Published by Mary Ann Liebert, Inc.

                This Open Access article is distributed under the terms of the Creative Commons License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Tables: 1, References: 40, Pages: 9


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