Date of Award

8-14-2019

Publication Type

Doctoral Thesis

Degree Name

Ph.D.

Department

Social Work

Keywords

health care access, health care discrimination, intersectionality, transgender, trans men

Supervisor

Gorey, K.M.

Rights

info:eu-repo/semantics/openAccess

Abstract

Transgender people experience pervasive interpersonal and structural discrimination within the health care system, which impact their ability to access appropriate and inclusive health care. Their invisibility is sustained by a cultural milieu wherein non-trans identities are privileged and an assumption is made that all people are cisgender. Transgender populations consist of a diverse spectrum of gender and other intersecting identities. Yet, there is a paucity of research about how each subgroup experiences discrimination, especially if they belong to more than one marginalized community. More specifically, transgender men have been underrepresented in research and little is known about the factors which affect their ability to access care. Guided by the theoretical framework of intersectionality and two conceptual models of health care access, the aims of this study are to: (a) compare barriers to health care among transgender men versus transgender women and non-binary/gender queer people; (b) examine factors which may increase the risk of experiencing health care discrimination or potentiate the ability to access care; and (c) examine the interaction of gender identity with other factors that can influence health care access in the United States. It was hypothesized that transgender men were more likely to experience barriers to health care access than transgender women and non-binary/gender queer people. Additionally, it was hypothesized that racial minority group status and living in poverty were risk factors while having health insurance and disclosure of trans identity were protective factors in the ability to access health care. It was further hypothesized that transgender men’s disadvantage would be greater among racial minority group members and those living in poverty, and that the gender identity divide would be smaller among those who had health insurance or had disclosed their trans identity. Logistic regression analyses were conducted using a non-elder, adult subsample of the 2015 U.S. Transgender Survey (N = 14, 540) which was implemented by the National Center for Transgender Equality. Results found that transgender men experienced greater disadvantage than transgender women in many dimensions of health care access. Living in poverty was a risk factor, while having health insurance was observed to be a protective factor in health care access in the United States. Disclosure of trans identity served as a protective or risk factor, depending on the outcome being examined. Moreover, a significant interaction was observed with gender identity by disclosure. There was evidence to suggest that transgender men who did not disclose their trans status experienced greater vulnerability in health care access. The results of the present study can be used to illuminate the inter and intragroup differences within the transgender population in their health care access and to extend the current knowledge base about the experiences of trans men. Social workers and other health care professionals need to increase their understanding about the complexities and multiplicities of gender, and to develop cultural competency in serving the transgender population.

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