Transgender, Nonbinary, and Gender Diverse Health in the US Southeast: A Quantitative Look at the Influence of Gender Identity and Sexuality in a Sample of LGBT Southerners

Stigma, social and structural vulnerability, and mental health among transgender women: A partial least square path modeling analysis

“…LGBTQ; 1205 [30.2%] TGD) found that 16.3% of white TGD people and 20.2% of TGD people of color reported they often or always deal with mistreatment in order to receive health care, over 50% of TGD participants reported that "being LGBT changes how medical professionals act with them (p. 127)" and over 70% reported that often or always "Being in the South makes it harder for LGBTQ individuals to access quality medical care (p. 135)" (Johnson et al, 2022). Among that same sample, there were significantly higher prevalence of self-reported bipolar or mania diagnoses and HIV+ among TGD people of color compared to white TGD people (23.8% vs. 16%; 16.4% vs. 0.9% respectively; Johnson et al, 2022).…”

“…Previous research has found that unmet mental health needs significantly vary by race and/or ethnicity and region, with the burden of unmet needs concentrated among minoritized ethnoracial groups in the South (Kim et al, 2017). Best estimates report that the South has the greatest number of transgender and gender diverse (TGD) people than all other regions in the United States (Herman et al, 2022); however, many Southern US states lack protective legislation (non-discrimination or hate crime legislation based on gender; 13 of the 16 southern states) and restrict healthcare access (through failing to expand Medicaid, coupled with Denial of Care Rules), creating environments with high exposure to gender-based stigma and healthcare-related inequities (Johnson et al, 2022;Kaiser Family Foundation, 2022;Movement Advancement Project, 2023;Smart et al, 2022). As evidence, the largest and most recent sample of LGBTQ people in the Southern United States (N = 5716…”

“…Best estimates report that the South has the greatest number of transgender and gender diverse (TGD) people than all other regions in the United States ( Herman et al, 2022 ); however, many Southern US states lack protective legislation (non-discrimination or hate crime legislation based on gender; 13 of the 16 southern states) and restrict healthcare access (through failing to expand Medicaid, coupled with Denial of Care Rules), creating environments with high exposure to gender-based stigma and healthcare-related inequities ( Johnson et al, 2022 ; Kaiser Family Foundation, 2022 ; Movement Advancement Project, 2023 ; Smart et al, 2022 ). As evidence, the largest and most recent sample of LGBTQ people in the Southern United States ( N = 5716 LGBTQ; 1205 [30.2%] TGD) found that 16.3% of white TGD people and 20.2% of TGD people of color reported they often or always deal with mistreatment in order to receive health care, over 50% of TGD participants reported that “being LGBT changes how medical professionals act with them (p. 127)” and over 70% reported that often or always “Being in the South makes it harder for LGBTQ individuals to access quality medical care (p. 135)” ( Johnson et al, 2022 ). Among that same sample, there were significantly higher prevalence of self-reported bipolar or mania diagnoses and HIV+ among TGD people of color compared to white TGD people (23.8% vs. 16%; 16.4% vs. 0.9% respectively; Johnson et al, 2022 ).…”

“…As evidence, the largest and most recent sample of LGBTQ people in the Southern United States ( N = 5716 LGBTQ; 1205 [30.2%] TGD) found that 16.3% of white TGD people and 20.2% of TGD people of color reported they often or always deal with mistreatment in order to receive health care, over 50% of TGD participants reported that “being LGBT changes how medical professionals act with them (p. 127)” and over 70% reported that often or always “Being in the South makes it harder for LGBTQ individuals to access quality medical care (p. 135)” ( Johnson et al, 2022 ). Among that same sample, there were significantly higher prevalence of self-reported bipolar or mania diagnoses and HIV+ among TGD people of color compared to white TGD people (23.8% vs. 16%; 16.4% vs. 0.9% respectively; Johnson et al, 2022 ). Moreover, lack of anti-discrimination laws based on gender in the South, coupled with Denial of Care Rules exonerate nurses and other clinicians of any legal consequences if they deny TGD people care based on their personal or religious beliefs ( Redcay et al, 2021 ).…”

“…For example, in the largest national survey of transgender adults in the United States to date, researchers found that nearly 38% of Black transgender participants, and 43% of Hispanic participants were living in poverty, compared to 28% of the overall sample ( James et al, 2016 ). This is concerning because in a large sample of TGD people in the Southeastern US, over 50% of participants making under 50k a year reported that “they often or always delay seeking care due to out of pocket costs” ( Johnson et al, 2022 , p. 129). Altogether, these data and the current literature suggest that Black and Hispanic TW may be especially vulnerable to more severe PTSD and psychological distress due to cumulative structural disadvantages which limit access to health care.…”