Cisgenderism and transphobia in sexual health care and associations with testing for HIV and other sexually transmitted infections: Findings from the Australian Trans & Gender Diverse Sexual Health Survey.

Shoshana Rosenberg,Dustin T Duncan,Denton Callander,Vincent Cornelisse,Martin Holt,Mish Pony,Amir Baradaran,Teddy Cook,Liz Duck-Chong

doi:10.1371/journal.pone.0253589

Shoshana Rosenberg, Dustin T Duncan + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0253589

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Abstract

Transgender and gender diverse people have unique risks and needs in the context of sexual health, but little is known about sexual health care for this population. In 2018, a national, online survey of sexual health and well-being was conducted with trans and gender diverse people in Australia (n = 1,613). Data from this survey were analysed to describe uptake of sexual health care and experiences of interpersonal and structural cisgenderism and transphobia. Experiences of cisgenderism and transphobia in sexual health care were assessed using a new, four-item scale of 'gender insensitivity', which produced scores ranging from 0 (highly gender sensitive) to 4 (highly gender insensitive). Logistic and linear regression analyses were conducted to determine if experiences of gender insensitivity in sexual health care were associated with uptake and frequency of HIV/STI testing in the 12 months prior to participation. Trans and gender diverse participants primarily accessed sexual health care from general practice clinics (86.8%), followed by publicly funded sexual health clinics (45.6%), community-based services (22.3%), and general hospitals (14.9%). Experiences of gender insensitivity were common overall (73.2% of participants reported ≥2 negative experiences) but most common in hospitals (M = 2.9, SD = 1.3) and least common in community-based services (M = 1.3, SD = 1.4; p<0.001). When controlling for sociodemographic factors, social networks, general access to health care, and sexual practices, higher levels of gender insensitivity in previous sexual health care encounters were associated with a lower likelihood of recent HIV/STI testing (adjusted prevalence ratio = 0.92, 95% confidence interval [CI]:091,0.96, p<0.001) and less-frequent HIV/STI testing (B = -0.07, 95%CI:-0.10,-0.03, p = 0.007). Given the high rates of HIV and other STIs among trans and gender diverse people in Australia and overseas, eliminating cisgenderism and transphobia in sexual health care may help improve access to diagnostic testing to reduce infection rates and support the overall sexual health and well-being of these populations.

Highlights

Transgender and gender diverse people ( ‘trans’) often encounter a range of barriers to health care, which can significantly undermine access to and quality of care [1,2,3,4,5,6,7]
This paper presents a detailed investigation of sexual health care access and barriers among trans people in Australia
Participants ranged in age from 16 to 80 years old (M = 30.7, SD = 11.5), nearly half had an undergraduate or postgraduate degree (48.4%), most were Australian born (84.9%) and the majority lived in a major Australia city (82.0%)

Summary

Introduction

Transgender and gender diverse people ( ‘trans’) often encounter a range of barriers to health care, which can significantly undermine access to and quality of care [1,2,3,4,5,6,7]. Research has found that many trans people must navigate fears of stigma and discrimination when accessing health care of any kind [13], including interpersonal forms of transphobia that include being misgendered and being exposed to stigmatizing and discriminatory comments by clinicians and clinical staff [14,15,16,17,18]. These fears are often amplified for trans people of colour forced to contend with intersectional stigma and discrimination [19,20]

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