A Qualitative Exploration of Perceived Health Issues Among Transgender Individuals in Atlanta and San Francisco

Background/Aims: To date, health literature concerning lesbian, gay, bisexual and transgender (LGBT) persons has grouped these individuals into a single LGBT community. Lack of knowledge about transgender or gender-nonconforming (T/GNC) individuals, specifically, precludes T/GNC health from the public health agenda. To address this gap, we undertook a qualitative exploratory study to examine the perceptions of health issues among T/GNC individuals, including the perceived barriers to accessing health care and reliable information about health care services. Methods: Data were drawn from 12 focus group discussions with 75 self-identified T/GNC men and women in Atlanta (n = 37) and San Francisco Bay Area (n = 38). Focus group discussions were stratified by gender and project site and were audio-recorded. The resulting transcripts were then reviewed for potential conceptual categories. Emergent themes were identified based on recurrence and on similarities/differences noted across the transcripts. Results: Preliminary analyses suggest that T/GNC participants are most concerned about HIV/AIDS, mental illness related to trauma and depression, cancer risk and the long-term effects of hormone use. Participants reported experiencing many barriers to receiving timely and effective health care services. These barriers included: 1) poor access to affordable care (primarily due to cost/lack of health insurance coverage), 2) poor availability of culturally competent care, 3) perceived discrimination by health care providers, 4) difficulties navigating complex health care systems, and 5) lack of reliable information about transgender health care services. Though participants felt that the Internet can be a helpful resource for identifying information about providers and services, many participants expressed concerns that online information was not always accurate and was frequently confusing and inadequate. Word-of-mouth and social media resources were perceived to be most helpful. Additional analyses using MAXQDA software will be conducted prior to the conference. Conclusion: Prior research demonstrates a deficiency in information regarding long-term health outcomes for T/GNC individuals. Our preliminary results indicate that T/GNC participants express concerns regarding the long-term effects of cross-sex hormones and surgery on chronic conditions like cancer, diabetes and cardiovascular disease. Additionally, despite recent advances in transgender care, many individuals experience significant barriers to accessing affordable, timely and culturally competent care and reliable information. Lessons learned from this study may inform future behavior-, health system- and policy-level interventions