At the American Public Health Association’s annual conference, I presented data gathered through SexLab’s NGender study. In this study, fifteen trans men who have sex with men were interviewed regarding aspects of their community, health access, and personal histories. For this presentation, I focused on self-identified barriers and solutions to accessing health care.
Many of the health barriers participants experienced related to the invisibility of their identity, and a lack of provider knowledge. When participants were able to locate resources for either trans* individuals or gay, bisexual, or queer men, they often reported being disappointed with the services they encountered. Most healthcare practitioners did not have the knowledge or baseline information for taking health measures like blood pressure or blood evaluations; as almost all participants were on a hormone regime, and many had also undergone surgery to make their bodies appear more traditionally masculine, the expected levels for health measures fell outside the standards for either men or women. Some of the services that were hailed as most supportive and affirming also had limited funding. Because of this, there were fewer avenues for low-income individuals to access the centers or practitioners. It was also difficult for participants to secure appointments at these centers, as they were understaffed and had a lower capacity. Though clinics that specialized in women’s health were shown to be the most accessible to participants, the attention paid to participants for being the only man in the waiting room kept many from returning to these centers and clinics. Thus, even when a participant was able to locate health services that were relevant to their needs, they weren’t always able to utilize those services.
Participants identified strategies they developed for working around these barriers. The importance of community was stressed in accessing care. Other people became advocates for themselves, keeping up-to-date on medical and legal information so they could provide guidance to doctors, or hold their position if their rights were being violated. Self-care was described as being important to participants as well: many thought of doctor visits as traumatic experiences, and took measures to protect themselves and make required repairs after.
Participants spoke extensively about what changes could be made to the medical system to make it more accessible and relevant to their needs. Cultural competency was stressed repeatedly throughout the interviews. Participants also stated that doctors and healthcare providers should ask more questions, rather than make assumptions. While parts of this related to gender identity, others were around sexual practices, food and nutrition accessibility, ability status, and work. Community-based organizations, participants felt, should distribute information around health, safety, and health care resources more widely. While these is great distrust for medical systems within trans populations, community centers that are already trusted advocates for sexuality and gender minorities in the area could educate and encourage critical consciousness within healthcare structures.
Interviews with trans-identified people with a myriad of sexual orientations yielded extensive information on structural barriers to accessing care. In the NGender study, substantial time was spent working through possible solutions to the stated issues with people who live and form relationships in the community being addressed. This can offer incredible insight into what the perceived healthcare needs of trans individuals are, and is important to ethical health practice in that it involves the targeted identity groups.
Contributing authors: Emily Pingel, MPH; Michael Moore, Kevin Jefferson, MPH; Jorge Soler, MPH; José Bauermeister, MPH, PhD
Downloaded version: Barriers to Care for Trans Men Who Have Sex with Men