A global cautionary tale: discrimination and violence against trans women worsen despite investments in public resources and improvements in health insurance access and utilization of health care

Abstract

Background To determine if improvements in social determinants of health for trans women and decreases in transphobic discrimination and violence occurred over three study periods during which extensive local programs were implemented to specifically address longstanding inequities suffered by the transgender community. Methods Interviewer-administered surveys from repeated cross-sectional Transwomen Empowered to Advance Community Health (TEACH) studies in 2010, 2013 and 2016-2017 in San Francisco collected experiences with transphobia violence and discrimination. Respondent-driven sampling was used to obtain a sample of participants who identified as a trans woman. Results Violence due to gender identity was prevalent; in each study period, verbal abuse or harassment was reported by over 83% of participants, and physical abuse or harassment was reported by over 56%. Adverse social determinants of health including homelessness, living below the poverty limit, methamphetamine use, depression, PTSD, and anxiety all significantly increased from 2010 to 2016. When testing for trends, housing discrimination and physical violence were both more likely in 2016-2017 compared to the two earlier study periods. Housing discrimination (aOR 1.41, 95% CI 1.00-1.98) and physical violence due to gender identity/presentation (aOR 1.39, 95% CI 1.00-1.92) both significantly increased from 2010 to 2016. Conclusion Our findings are particularly alarming during a period when significant public health resources and community-based initiatives specifically for trans women were implemented and could have reasonably led us to expect improvements. Despite these efforts, physical violence and housing discrimination among trans women worsened during the study periods. To ensure future improvements, research and interventions need to shift the focus and burden from trans people to cisgender people who are the perpetuators of anti-trans sentiment, stigma, discrimination and victimization.

Detectable viral load associated with unmet mental health and substance use needs among trans women living with HIV in San Francisco, California

“…In a recent study with 629 trans women living in San Francisco, the majority of participants (93%) reported experiencing anti-trans discrimination and 88.1% reported transphobic violence [ 28 ]. Another study found that almost a quarter of trans women in San Francisco reported discrimination in accessing health and medical services [ 40 ].…”

Experiences of violence and discrimination among LGBTQ+ individuals during the COVID-19 pandemic: a global cross-sectional analysis

“…[4][5][6][7][8][9][10] In certain areas of the world, there have also been reports that COVID-19 has been used to justify community crackdowns and antigay backlash, which in turn can push impacted communities further away from trusting government-sponsored initiatives like COVID-19 testing and vaccination campaigns. [11][12][13][14][15][16][17][18][19][20][21] Given the crucial role that governments play in combating COVID-19, it is all the more concerning when some of their representatives and policymakers exploit the pandemic as a guise for draconian precedents. Not only does it put these communities at additional risk, and it is a direct violation of international humanitarian and human rights law.…”

“…In the current body of COVID-19 literature, unintended impacts of COVID-19 prevention strategies include exacerbating existing health disparities and deepening social inequalities, especially among groups already marginalised by society, such aslesbian, gay, bisexual, transgender and queer (LGBTQ+) individuals, racial/ethnic minorities, immigrants, individuals living with disabilities and others 4–10. In certain areas of the world, there have also been reports that COVID-19 has been used to justify community crackdowns and antigay backlash, which in turn can push impacted communities further away from trusting government-sponsored initiatives like COVID-19 testing and vaccination campaigns 11–21. Given the crucial role that governments play in combating COVID-19, it is all the more concerning when some of their representatives and policymakers exploit the pandemic as a guise for draconian precedents.…”

Population size estimation of transgender women and men in Bhutan

“…Transgender women (TGW) have been shown to bear a disproportionate burden of HIV across all continents and a high prevalence of clinical depression, anxiety, and somatization [1][2]. To date, transgender persons remain under-represented in health research [1,5].…”

“…Therefore, it is not known if TGW in Bhutan experiences the disproportionate burden of HIV that persists in other countries [1]. Less is known about transgender men (TGM) in Bhutan, Asia, and globally [1,5].…”