Abstract
Trans women face numerous structural barriers to health due to discrimination. Housing instability is an important structural determinant of poor health outcomes among trans women. The purpose of this study was to determine if experiences of intersectional anti-trans and racial discrimination are associated with poor housing outcomes among trans women in the San Francisco Bay Area. A secondary analysis of baseline data from the Trans *National study (n = 629) at the San Francisco Department of Public Health (2016–2018) was conducted. Multivariable logistic regression was used to analyze the association between discrimination as an ordered categorical variable (zero, one to two, or three or more experiences) and housing status adjusting for age, years lived in the Bay Area, and gender identity. We found that the odds of housing instability increased by 1.25 for every categorical unit increase (1–2, or 3+) in reported experiences of intersectional (both anti-trans and racial) discrimination for trans women (95% CI = 1.01–1.54, p-value < 0.05). Intersectional anti-trans and racial discrimination is associated with increased housing instability among trans women, giving some insight that policies and programs are needed to identify and address racism and anti-trans stigma towards trans women. Efforts to address intersectional discrimination may positively impact housing stability, with potential for ancillary effects on increasing the health and wellness of trans women who face multiple disparities.
Highlights
Trans women have a higher likelihood of unmet basic needs than the general population, such as inadequate food and housing, which have in turn been associated with poor health outcomes [1,2,3]
Descriptive statistics were calculated using univariate analysis for each type of discrimination, housing status, race/ethnicity, gender identity, age, and years lived in the Bay Area (Table 1)
Intersectional discrimination was associated with housing instability (OR = 1.25, 95% CI = (1.01, 1.54)) adjusting for years lived in the Bay Area, age, and trans identity
Summary
Trans women have a higher likelihood of unmet basic needs than the general population, such as inadequate food and housing, which have in turn been associated with poor health outcomes [1,2,3]. A study in Los Angeles (n = 517) that analyzed the relationship between hormone use and structural inequities (income, housing, and health insurance) among trans women found that more than half of study participants were unstably housed, 22.4% were marginally housed, and 34.8% were homeless [4]. The San Francisco Bay. Area has one of the highest costs of living indexes in the United States compared to the U.S average, and only 16% of housing in San Francisco is considered “affordable,” where rent amounts to 30% of one’s household income [7]. Public Health 2019, 16, 4521; doi:10.3390/ijerph16224521 www.mdpi.com/journal/ijerph
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