Factors associated with healthcare avoidance among transgender women in Argentina.

María Eugenia Socías,Inès Arístegui,Omar Sued,Pedro Cahn,Thomas Kerr,Brandon Dl Marshall,Marcela Romero

doi:10.1186/s12939-014-0081-7

Abstract

IntroductionTransgender (TG) women in many settings continue to contend with barriers to healthcare, including experiences of stigma and discrimination. Argentina has a universal health care system and laws designed to promote healthcare access among TG women. However, little is known about barriers to healthcare access among TG women in this setting. The aim of this study was to explore individual, social-structural and environmental factors associated with healthcare avoidance among TG women in Argentina.MethodsData were derived from a 2013 nation-wide, cross-sectional study involving TG women in Argentina. We assessed the prevalence and factors associated with avoiding healthcare using multivariable logistic regression.ResultsAmong 452 TG women included in the study, 184 (40.7%) reported that they avoided seeking healthcare because of their transgender identity. In multivariable analysis, factors positively associated with avoiding seeking healthcare were: having been exposed to police violence (adjusted odd ratio [aOR] = 2.20; 95% CI: 1.26 – 3.83), internalized stigma (aOR = 1.60, 95% CI: 1.02–2.51), having experienced discrimination by healthcare workers (aOR = 3.36: 95% CI: 1.25 – 5.70) or patients (aOR = 2.57; 95% CI: 1.58 – 4.17), and currently living in the Buenos Aires metropolitan area (aOR = 2.32; 95% CI: 1.44 – 3.76). In contrast, TG women with extended health insurance were less likely to report avoiding healthcare (aOR = 0.49; 95% CI: 0.26 – 0.93).ConclusionsA high proportion of TG women in our sample reported avoiding healthcare. Avoiding healthcare was associated with stigma and discrimination in healthcare settings, as well as police violence experiences. Although further research is warranted, these finding suggests that socio-structural interventions tailored TG women needs are needed to improve access to healthcare among this population.

Highlights

Transgender (TG) women in many settings continue to contend with barriers to healthcare, including experiences of stigma and discrimination
Factors positively associated with avoiding seeking healthcare were: having been exposed to police violence, internalized stigma, having experienced discrimination by healthcare workers or patients, and currently living in the Buenos Aires metropolitan area
Avoiding healthcare was associated with stigma and discrimination in healthcare settings, as well as police violence experiences

Summary

Introduction

Transgender (TG) women in many settings continue to contend with barriers to healthcare, including experiences of stigma and discrimination. Transgender (TG) women, the term for individuals who were assigned male sex at birth, but assume a feminine gender expression or identity, often experience multiple forms of oppression for transgressing gender norms, such as stigma, discrimination, isolation and economic hardship [1,2]. This marginalization, that is consequence of family, social and institutional transphobia, contributes to an increased risk of mental health problems, substance use and sexually transmitted infections. Due to barriers to transition-related medical care, use of non-prescribed hormones or injection of industrial silicone in non-sterilized environments is widespread among TG communities, posing additional risks for their health [24,25]

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