"We don’t treat your kind": Assessing HIV health needs holistically among transgender people in Jackson, Mississippi

Abstract

HIV disproportionately impacts transgender communities and the majority of new infections occur in the Southern United States. Yet, limited data exists on contextual realities of HIV vulnerability and healthcare needs among transgender individuals in the Deep South. Addressing this gap in the literature, we assess the health needs, including barriers and facilitators to accessing healthcare, including and beyond HIV, from the perspective of transgender men and women in Mississippi. Between June-August 2014, in-depth, semi-structured qualitative interviews (n = 14) were conducted with adult transgender persons at an LGBT healthcare setting in Jackson, Mississippi. In-depth interviews lasted between 60–90 minutes and followed semi-structured format (themes probed: HIV vulnerability, healthcare needs, and availability of gender-affirming medical care). Audio files were transcribed verbatim and analyzed using Dedoose (v.6.1.18). Among participants (mean age = 23.3 years, standard deviation = 4.98), 43% identified as a transgender man or on a transmasculine spectrum, 43% as Black, and 21% self-reported living with HIV. HIV-related services were frequently described as the primary gateway to accessing healthcare needs. Nonetheless, participants’ primary health concerns were: gender affirmation processes (hormones, silicone, binding/packing); mental health; and drug/alcohol use. Stigma and discrimination were commonly reported in healthcare settings and health-related information was primarily attained through social networks and online resources. Results highlight gender identity alongside race and pervasive marginalization as key social determinants of transgender health in Mississippi. As Mississippi is one of several states actively debating transgender access to public accommodations, findings underscore the need to treat transgender health as a holistic and multidimensional construct, including, but moving beyond, HIV prevention and care.

Prevalence of Sexually Transmitted Infections and Human Immunodeficiency Virus in Transgender Persons: A Systematic Review

“…3 This enhanced visibility has highlighted the myriad health disparities affecting this community, including sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). 4,5 Particularly well studied is HIV in the trans feminine population. [6][7][8][9][10] For transgender women, HIV rates are disproportionately high compared to other high-risk groups like men who have sex with men (MSM) and sexual partners of people living with HIV.…”

Utilizing Mixed Methodology to Increase Cultural Competency in Research with Transgender and Gender Nonconforming Individuals

“…See Perez-Brumer et al for additional reading in this area. 9 The purpose of this preliminary pilot research was to assess both the acceptability and utility of the chosen assessment measures in a culturally competent manner when engaging with a TGNC population. The results from the focus groups guided the research to make any necessary changes to the overall study to ensure that the testing was completed both respectfully and accurately with a TGNC population before starting recruitment for the larger study, in which minority stress factors would then be explored.…”

“…Given recruitment in the Deep South, United States, several barriers contributed to difficulties in recruitment of TGNC individuals, including medical mistrust of providers by the TGNC community and experiences of transphobia in health care settings. 9 Recruitment occurred in two LGBT-specific health care facilities in the Deep South; however, given these barriers, participants may have been understandably reluctant to self-refer to engage in a research study in which they openly shared their thoughts and opinions to a cisgender researcher.…”

The Language of Women's Pain: Ideology and Critical Cultural Competencies in Pain Literacy

“…Health communication literature continues to grow in studies for critical communities, including addressing transgender gaps in access and visibility (Perez-Brumer et al, 2018), health disparities and discrimination in the LGBT+ community (Harvey and Housel, 2014), and poverty invisibility (Redman, 2010). Critical communities are defined here as counter-publics often pushed to the margins of public sphere and normative comprehension of healthcare, often because marginalized communities are seen as antagonistic to hegemonic status-quo discourses of power.…”