A Preliminary Assessment of Selected Social Determinants of Health in a Sample of Transgender and Gender Nonconforming Individuals in Puerto Rico

Abstract

Purpose: Transgender and gender nonconforming (GNC) people continue to experience suboptimal health care, social exclusion, and lower quality of life. Globally, lack of access to services, institutional violence, and public harassment have been reported. However, there is limited data on transgender health in Puerto Rico and the Caribbean. The purpose of this study is to assess the social determinants of health and wellbeing of transgender and GNC people living in Puerto Rico.Methods: Utilizing a community-based participatory research approach, 52 self-identified transgender and GNC individuals living in Puerto Rico completed a survey, which included questions on access to health care services, social support, and violence, among others. Data were collected from March to Ma y of 2015 and descriptive statistical analysis was conducted.Results: Most of the participants reported experiences of discrimination across multiple social settings, most commonly at school (70.6%) and work (67.4%). Regarding experiences of violence, more than half (65.4%) had been verbally attacked in a public space. Many reported that access to gender-affirming health care services is difficult in Puerto Rico (88.5%) due to lack of knowledgeable providers (59.6%) and discomfort during the encounter (55.8%). The main perceived priority for their wellbeing was a transgender health care center.Conclusion: Although the LGBT equality movement has reached great milestones, access to gender-affirming health services and safe educational and work spaces are still needed. Findings from the study provide guidance for actions to reduce health disparities by addressing the needs for health and wellbeing among transgender and GNC individuals.

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“…Although limited to a smaller sample size (n=59), we encountered similar findings in a study on the social determinants of health of transgender populations in Puerto Rico. 7 In this study, the main barrier to healthcare was the lack of knowledge from healthcare providers (59.6%). Study participants also identified discomfort in health encounters (55.8%) and provider discrimination (42.3%) as part of their experiences.…”

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“…The TNB community experiences significant disparities across all determinants of health, including higher rates of homelessness, unemployment, and poverty. [14][15][16][17] Additionally, experiences of violence and victimization are frequent for TNB individuals and results in long-lasting effects on both the individual and the community. 15,18,19 According to the National Transgender Discrimination Survey, 40% of TNB people reported suicide attempts, as compared with 4.6% of the general population.…”

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“…As well, lesbians have been found to consult doctors less frequently than heterosexual women and report having fewer pap tests (Tjepkema, 2008 ). Transgender people, in particular, face unique barriers to accessing appropriate health care regarding reproductive health and transition surgeries (Bauer et al, 2009 ; Hudson, 2019 ; Institute of Gender & Health, 2012 ; Martinez-Velez et al, 2019 ). Access to appropriate sexual health education and resources for queer youth are also ongoing health equity concerns (Johns et al, 2019 ; McKenzie, 2015 ).…”