Gender minority stress and access to health care services among transgender women and transfeminine people: results from a cross-sectional study in China
Open Access
- 14 October 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Infectious Diseases
- Vol. 21 (1), 1-9
- https://doi.org/10.1186/s12879-021-06782-5
Abstract
Transgender and gender diverse individuals often face structural barriers to health care because of their gender minority status. The aim of this study was to examine the association between gender minority stress and access to specific health care services among transgender women and transfeminine people in China. This multicenter cross-sectional study recruited participants between January 1st and June 30th 2020. Eligible participants were 18 years or older, assigned male at birth, not currently identifying as male, and living in China. Gender minority stress was measured using 45 items adapted from validated subscales. We examined access to health care services and interventions relevant to transgender and gender diverse people, including gender affirming interventions (hormones, surgeries), human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) testing, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). Multivariable regression was used to measure correlations between gender minority stress and access to health care service. Three hundred and twenty-four people completed a survey and data from 277 (85.5%) people were analyzed. The mean age was 29 years old (standard deviation [SD] = 8). Participants used hormones (118/277, 42.6%), gender affirming surgery (26/277, 9.4%), HIV testing (220/277, 79.4%), STI testing (132/277, 47.7%), PrEP (24/276, 8.7%), and PEP (29/267, 10.9%). Using gender affirming hormones was associated with higher levels of discrimination (adjusted odds ratio [aOR] 1.41, 95% confidence interval [CI] 1.17–1.70) and internalized transphobia (aOR 1.06, 95%CI 1.00–1.12). STI testing was associated with lower levels of internalized transphobia (aOR 0.91, 95%CI 0.84–0.98). Our data suggest that gender minority stress is closely related to using health services. Stigma reduction interventions and gender-affirming medical support are needed to improve transgender health.Funding Information
- the Graduate Tuition Incentive Scholarship and Dissertation Completion Fellowship, The Graduate School, The University of North Carolina at Chapel Hill
- the STD/HIV T32 Predoctoral Training Program from the National Institute of Allergy and Infectious Diseases (5T32AI007001-42)
- the United States Department of Education Fulbright-Hays Doctoral Dissertation Research Abroad fellowship
- National Natural Science Foundation of China (81903371)
- National Social Science Fund of China (No. 19CSH018)
- National Key Research and Development Program of China (2017YFE0103800)
- Center for AIDS Research, University of North Carolina at Chapel Hill (NIAID 5P30AI050410)
- National Institutes of Health (R25 AI140495, NIAID K24AI143471)
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