Instability in Housing and Medical Care Access: The Inequitable Impacts of the COVID-19 Pandemic on U.S. Transgender Populations

Felt, Dylan; Xu, Jianren; Floresca, Ysabel Beatrice; Fernandez, Ella Segovia; Korpak, Aaron K.; Phillips, Gregory; Wang, Xinzi; Curry, Caleb W.; Beach, Lauren B.

doi:10.1089/trgh.2021.0129

Cited by 23 publications

(8 citation statements)

References 24 publications

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“…Even the Williams Institute guidance, cited above, has been appropriately critiqued for its over-emphasis on capturing information about birth sex, as opposed to current gender identity and modality. Approaches which do not unnecessarily ask for birth sex have also been effectively used to generate nuanced demographic categories based on gender (Felt et al, 2021). We also encourage organizations that provide evaluation training, including universities and professional organizations, to offer and make mandatory ongoing learning on the topic of LGBTQ+ Evaluation, with a particular emphasis on culturally responsive LGBTQ+ Evaluation.…”

Section: Demographic Data Collectionmentioning

confidence: 99%

Transforming the Paradigm for LGBTQ+ Evaluation: Advancing a Praxis of LGBTQ+ Inclusion and Liberation in Evaluation

Phillips

Felt

Perez‐Bill

et al. 2022

American Journal of Evaluation

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Lesbian, gay, bisexual, transgender, queer, intersex, Two-Spirit, and other sexual and gender minority (LGBTQ + ) individuals encounter numerous obstacles to equity across health and healthcare, education, housing, employment, and other domains. Such barriers are even greater for LGBTQ + individuals who are also Black, Indigenous, and People of Color (BIPOC), as well as those who are disabled, and those who are working-class, poor, and otherwise economically disadvantaged, among other intersecting forms of oppression. Given this, an evaluation cannot be equitable for LGBTQ + people without meaningfully including our experiences and voices. Unfortunately, all evidence indicates that evaluation has systematically failed to recognize the presence and value of LGBTQ + populations. Thus, we propose critical action steps and the articulation of a new paradigm of LGBTQ + Evaluation. Our recommendations are grounded in transformative, equitable, culturally responsive, and decolonial frameworks, as well as our own experiences as LGBTQ + evaluators and accomplices. We conclude by inviting others to participate in the articulation and enactment of this new paradigm.

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Section: Demographic Data Collectionmentioning

confidence: 99%

Transforming the Paradigm for LGBTQ+ Evaluation: Advancing a Praxis of LGBTQ+ Inclusion and Liberation in Evaluation

Phillips

Felt

Perez‐Bill

et al. 2022

American Journal of Evaluation

Self Cite

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“…For example, many of the risk factors (e.g., discrimination, rejection, victimization, internalized stigma) and protective factors (e.g., community connectedness) that studies identified are included within the GM stress model (Hendricks & Testa, 2012; Testa et al, 2015). Hatzenbuehler et al’s (2013) theory of stigma as a fundamental cause of health disparities, which subsequent studies have supported specifically among U.S. GM populations (Felt et al, 2023), similarly posits that stigma both produces health-impairing stressors and disrupts access to health-protective resources. In alignment with this theory, included studies frequently connected health care barriers, obstacles to transitioning, and uncertain access to social resources to mental health concerns among GM older adults.…”

Section: Discussionmentioning

confidence: 99%

Mental health of gender minority older adults in the United States: A systematic review.

Kerr,

Davoudpour,

Phillips

et al. 2024

Psychology of Sexual Orientation and Gender Diversity

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“…Importantly, socio-economic deprivation resulting from stigma and discrimination also impedes people's access to the resources needed to support their wellbeing, particularly among trans people experiencing multiple intersecting forms of oppression [75,76]. For example, anti-trans stigma has been shown to disrupt people's educational trajectories and adversely affect educational attainment in adulthood, subsequently limiting access to employment opportunities and stable housing, which in turn perpetuates high rates of poverty and financial precarity relative to cisgender people [30,70,[77][78][79][80][81][82][83][84][85][86]. This precarity may also lead to participation in sex work-thus conveying increased vulnerability to HIV transmission if engaging in condomless sex with clients and increased risk of surveillance, profiling, carceral system involvement due to the widespread criminalization of sex work [84,87].…”

Section: Discussionmentioning

confidence: 99%

HIV pre‐exposure prophylaxis programme preferences among sexually active HIV‐negative transgender and gender diverse adults in the United States: a conjoint analysis

Watson,

Listerud,

Drab

et al. 2024

J Int AIDS Soc.

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IntroductionCurrent implementation efforts have failed to achieve equitable HIV pre‐exposure prophylaxis (PrEP) provision for transgender and gender‐diverse (trans) populations. We conducted a choice‐based conjoint analysis to measure preferences for key attributes of hypothetical PrEP delivery programmes among a diverse online sample predominantly comprised of transmasculine and nonbinary individuals in the United States.MethodsBetween April 2022 and June 2022, a national online survey with an embedded conjoint analysis experiment was conducted among 304 trans individuals aged ≥18 years in the United States to assess five PrEP programme attributes: out‐of‐pocket cost; dispensing venue; frequency of visits for PrEP‐related care; travel time to PrEP provider; and ability to bundle PrEP‐related care with gender‐affirming hormone therapy services. Participants responded to five questions, each of which presented two PrEP programme scenarios and one opt‐out option per question and selected their preferred programme in each question. We used hierarchical Bayes estimation and multinomial logistic regression to measure part‐worth utility scores for the total sample and by respondents’ PrEP status.ResultsThe median age was 24 years (range 18–56); 75% were assigned female sex at birth; 54% identified as transmasculine; 32% as nonbinary; 14% as transfeminine. Out‐of‐pocket cost had the highest attribute importance score (44.3%), followed by the ability to bundle with gender‐affirming hormone therapy services (18.7%). Minimal cost‐sharing ($0 out‐of‐pocket cost) most positively influenced the attribute importance of cost (average conjoint part‐worth utility coefficient of 2.5 [95% CI 2.4−2.6]). PrEP‐experienced respondents preferred PrEP delivery in primary care settings (relative utility score 4.7); however, PrEP‐naïve respondents preferred pharmacies (relative utility score 5.1).ConclusionsParticipants preferred programmes that offered PrEP services without cost‐sharing and bundled with gender‐affirming hormone therapy services. Bolstering federal regulations to cover PrEP services and prioritizing programmes to expand low‐barrier PrEP provision are critical to achieving equitable PrEP provision. Community‐engaged implementation research conducted by and in close collaboration with trans community stakeholders and researchers are needed to streamline the design of patient‐centred PrEP programmes and develop implementation strategies that are salient to the diverse sexual health needs of trans patients.

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Instability in Housing and Medical Care Access: The Inequitable Impacts of the COVID-19 Pandemic on U.S. Transgender Populations

Cited by 23 publications

References 24 publications

Transforming the Paradigm for LGBTQ+ Evaluation: Advancing a Praxis of LGBTQ+ Inclusion and Liberation in Evaluation

Transforming the Paradigm for LGBTQ+ Evaluation: Advancing a Praxis of LGBTQ+ Inclusion and Liberation in Evaluation

Mental health of gender minority older adults in the United States: A systematic review.

HIV pre‐exposure prophylaxis programme preferences among sexually active HIV‐negative transgender and gender diverse adults in the United States: a conjoint analysis

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