Exploring Transgender Legal Name Change as a Potential Structural Intervention for Mitigating Social Determinants of Health Among Transgender Women of Color

Abstract

The purpose of this exploratory study was to examine the effects of legal name change on socioeconomic factors, general and transgender-related healthcare access and utilization, and transgender-related victimization in a sample of young transgender women (transwomen) of color. A cross-sectional group comparison approach was used to assess the potential effects of legal name change. A convenience sample of young transwomen enrolled in a no-cost legal name change clinic were recruited to complete a 30-minute interviewer-guided telephone survey including sociodemographic and socioeconomic factors, health and well-being, health care utilization, transgender transition-related health care, and transgender-related victimization. Sixty-five transgender women of color (37 = pre-name change group; 28 = post-name change group) completed the survey. Results indicated that the transwomen in the post-name change group were significantly older than the pre-name change group. In age-adjusted analyses, the post-name change group was significantly more likely to have a higher monthly income and stable housing than the pre-name change group. No significant differences were observed for general healthcare utilization; however, a significantly greater percentage of transwomen in the pre-name change group reported postponing medical care due to their gender identity. In addition, a significantly larger proportion of transwomen in the pre-name change group reported using non-prescribed hormones injected by friends and experiencing verbal harassment by family and friends compared to transwomen in the post-name change group. Findings suggest that legal name change may be an important structural intervention for low-income transwomen of color, providing increased socioeconomic stability and improved access to primary and transition-related health care.

Intersectionality Research for Transgender Health Justice: A Theory-Driven Conceptual Framework for Structural Analysis of Transgender Health Inequities

“…One example of a structural-level intervention is Hill et al, who explored employment among transgender women of color who had received no-cost legal name change support and found that those who had legally changed their name had greater odds of being employed. 59 Supporting transgender people with accessible legal name changes can address the everyday marginalization that occurs within various institutional systems due to cisgenderism, thereby directly impacting social factors, such as housing and jobs that Wilson et al 13 identified were connected to HIV risk.…”

Similar, but different: drivers of the disproportionate HIV and sexually transmitted infection burden of key populations

“…Community empowerment interventions among sex workers have been associated with increased condom use and a reduction in HIV risk [56][57][58], while legislation to facilitate gender affirmation may be more beneficial in reducing risk among TP [59,60]. Community empowerment interventions among sex workers have been associated with increased condom use and a reduction in HIV risk [56][57][58], while legislation to facilitate gender affirmation may be more beneficial in reducing risk among TP [59,60].…”

“…Each KP group has specific issues that should be addressed in order to optimize their sexual health. Community empowerment interventions among sex workers have been associated with increased condom use and a reduction in HIV risk [56][57][58], while legislation to facilitate gender affirmation may be more beneficial in reducing risk among TP [59,60]. Other interventions may be appropriate for multiple groups.…”

Findings from Formative Research to Develop a Strength-Based HIV Prevention and Sexual Health Promotion mHealth Intervention for Transgender Women

“…6,8,11,13,36,37 That legal name and gender marker changes were perceived barriers to employment and health services is supported by recent research documenting this relationship. 38 In addition, as our participants reported, access to transgender-affirming, knowledgeable, and affordable health care providers and mental health care is a significant challenge for transgender women and supported by existing research. 12,15,[39][40][41] Our study highlights several research gaps.…”