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Chapter 6 - Impact of Stigma and Resilience on the Health of Transgender and Nonbinary People

from Section A - Contextual Transgynecology

Published online by Cambridge University Press:  22 December 2022

By
Elizabeth Kvach  and
Ryan O’Connell
Edited by
Mick van Trotsenburg ,
Rixt A. C. Luikenaar  and
Maria Cristina Meriggiola
Mick van Trotsenburg
Affiliation:
Sigmund Freud PrivatUniversität, Wien
Rixt A. C. Luikenaar
Affiliation:
Rebirth Health Center, Utah
Maria Cristina Meriggiola
Affiliation:
Università di Bologna
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Summary

This chapter will provide an overview of the stigma and resultant health disparities experienced by transgender and nonbinary (TNB) people worldwide, with a focus on disparities most relevant to clinicians providing sexual health and gynecologic care for transgender patients. Physical and mental health disparities impacting TNB populations have been widely documented, but clinical approaches frequently address individual risk factors and behaviors which contribute to only a small percentage of the disparities that occur. TNB people are embedded into political, economic, and social environments that contribute to stigma and make them more vulnerable to experiencing poor health outcomes as a population. This chapter offers a framework which considers the impact of structural forces and allows for a more holistic understanding of the underlying reasons for the dramatic differences in the health and well-being of TNB people as compared to cisgender populations. We will review evidence for the impact of resiliency factors on mitigating the negative impacts of stigma and ways in which healthcare professionals can promote resilience in their own practice with TNB patients.

Keywords

transgendernonbinarystigmahealth disparitiesresilience
Type
Chapter
Information
Context, Principles and Practice of TransGynecology
Managing Transgender Patients in ObGyn Practice
 , pp. 39 - 48
Publisher: Cambridge University Press
Print publication year: 2022

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References

Grant, J, Mottet, L, Tanis, J. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. National Center for Transgender Equality and National Gay and Lesbian Task Force. Published 2011. Available from: www.thetaskforce.org/wp-content/uploads/2019/07/ntds_full.pdfGoogle Scholar
James, S, Herman, J, Rankin, S, et al. The Report of the 2015 US Transgender Survey. Published 2016. Available from: www.ustranssurvey.org/Google Scholar
Scandurra, C, Bochicchio, V, Amodeo, A, et al. Internalized transphobia, resilience, and mental health: applying the psychological mediation framework to Italian transgender individuals. IJERPH 2018;15(3):508. https://doi.org/10.3390/ijerph15030508Google Scholar
McCann, E, Brown, M. Discrimination and resilience and the needs of people who identify as transgender: a narrative review of quantitative research studies. J Clin Nurs 2017;26(23–24):4080–4093. https://doi.org/10.1111/jocn.13913Google Scholar
Valente, PK, Schrimshaw, EW, Dolezal, C, et al. Stigmatization, resilience, and mental health among a diverse community sample of transgender and gender nonbinary individuals in the U.S. Arch Sex Behav 2020;49(7):2649–2660. https://doi.org/10.1007/s10508-020-01761-4CrossRefGoogle ScholarPubMed
Bockting, W, Coleman, E, Deutsch, MB, et al. Adult development and quality of life of transgender and gender nonconforming people. Curr Opin Endocrinol Diabetes Obesity. 2016;23(2):188–197. https://doi.org/10.1097/MED.0000000000000232Google Scholar
White Hughto, JM, Reisner, SL, Pachankis, JE. Transgender stigma and health: a critical review of stigma determinants, mechanisms, and interventions. Soc Sci Med 2015;147:222–231. https://doi.org/10.1016/j.socscimed.2015.11.010Google Scholar
Reisner, SL, Poteat, T, Keatley, J, et al. Global health burden and needs of transgender populations: a review. Lancet 2016;388(10042):412–436. https://doi.org/10.1016/S0140-6736(16)00684-XGoogle Scholar
Winter, S, Diamond, M, Green, J, et al. Transgender people: health at the margins of society. Lancet 2016;388(10042):390–400. https://doi.org/10.1016/S0140-6736(16)00683-8CrossRefGoogle ScholarPubMed
Link, BG, Phelan, JC. Stigma and its public health implications. Lancet 2006;367(9509):528–529. https://doi.org/10.1016/S0140-6736(06)68184-1Google Scholar
Phelan, JC, Link, BG, Dovidio, JF. Stigma and prejudice: one animal or two? Soc Sci Med 2008;67(3):358–367. https://doi.org/10.1016/j.socscimed.2008.03.022Google Scholar
Wesp, LM, Malcoe, LH, Elliott, A, Poteat, T. Intersectionality research for transgender health justice: a theory-driven conceptual framework for structural analysis of transgender health inequities. Transgend Health 2019;4(1):287–296. https://doi.org/10.1089/trgh.2019.0039Google Scholar
Chiam, Z, Duffy, S, Gonzalez, GM, Goodwin, L, Mpemba Patel, NT. Trans Legal Mapping Report 2019: Recognition Before the Law. ILGA World. Published 2020. Available from: https://ilga.org/trans-legal-mapping-reportGoogle Scholar
Rumbach, J. Towards inclusive resettlement for LGBTI refugees. Forced Migr Rev 2013;42:40–43.Google Scholar
Tabak, S, Levitan, R. LGBTI migrants in immigration detention. Forced Migr Rev 2013;42:47–49.Google Scholar
European Union Agency for Fundamental Rights. Current Migration Situation in the EU: Lesbian, Gay, Bisexual, Transgender and Intersex Asylum Seekers. Published 2017. Available from: https://fra.europa.eu/sites/default/files/fra_uploads/fra-march-2017-monthly-migration-report-focus-lgbti_en.pdfGoogle Scholar
Elias, NM. Transgender and nonbinary gender policy in the public sector. In: Oxford Research Encyclopedia of Politics. Oxford: Oxford University Press, 2019. https://doi.org/10.1093/acrefore/9780190228637.013.1168Google Scholar
Dunne, P. Transgender sterilisation requirements in Europe. Med Law Rev 2017;25(4):554–581. https://doi.org/10.1093/medlaw/fwx028Google Scholar
Nadal, KL, Davidoff, KC, Fujii-Doe, W. Transgender women and the sex work industry: roots in systemic, institutional, and interpersonal discrimination. J Trauma Dissociation 2014;15(2):169–183. https://doi.org/10.1080/15299732.2014.867572Google Scholar
Hughto, JMW, Reisner, SL, Kershaw, TS, et al. A multisite, longitudinal study of risk factors for incarceration and impact on mental health and substance use among young transgender women in the USA. J Public Health 2019;41(1):100–109. https://doi.org/10.1093/pubmed/fdy031CrossRefGoogle ScholarPubMed
Lerner, JE, Robles, G. Perceived barriers and facilitators to health care utilization in the United States for transgender people: a review of recent literature. J Health Care Poor Underserved 2017;28(1):127–152. https://doi.org/10.1353/hpu.2017.0014CrossRefGoogle ScholarPubMed
Safer, JD, Coleman, E, Feldman, J, et al. Barriers to healthcare for transgender individuals: Curr Opin Endocrinol Diabetes Obesity 2016;23(2):168–171. https://doi.org/10.1097/MED.0000000000000227CrossRefGoogle ScholarPubMed
Cicero, EC, Reisner, SL, Silva, SG, Merwin, EI, Humphreys, JC. Healthcare experiences of transgender adults: an integrated mixed research literature review. ANS Adv Nurs Sci 2019;42(2):123–138. https://doi.org/10.1097/ANS.0000000000000256Google Scholar
Rotondi, NK, Bauer, GR, Scanlon, K, et al. Nonprescribed hormone use and self-performed surgeries: “do-it-yourself” transitions in transgender communities in Ontario, Canada. Am J Public Health 2013;103(10):1830–1836. https://doi.org/10.2105/AJPH.2013.301348CrossRefGoogle ScholarPubMed
Padula, W, Baker, K. Coverage for gender-affirming care: making health insurance work for transgender Americans. LGBT Health 2017;4:244–247. https://doi.org/10.1089/lgbt.2016.0099Google Scholar
van den Brink, M, Dunne, P. Trans and Intersex Equality Rights in Europe – A Comparative Analysis. European Commission, 2018. Available from: https://ec.europa.eu/info/sites/info/files/trans_and_intersex_equality_rights.pdfGoogle Scholar
Brömdal, A, Mullens, AB, Phillips, TM, Gow, J. Experiences of transgender prisoners and their knowledge, attitudes, and practices regarding sexual behaviors and HIV/STIs: a systematic review. Int J Transgend 2019;20(1):4–20. https://doi.org/10.1080/15532739.2018.1538838CrossRefGoogle ScholarPubMed
Reisner, SL, Bailey, Z, Sevelius, J. Racial/Ethnic Disparities in History of Incarceration, Experiences of Victimization, and Associated Health Indicators Among Transgender Women in the U.S. Published. Women Health 2014;54(8):750–767.Google Scholar
Brömdal, A, Clark, KA, Hughto, JMW, et al. Whole-incarceration-setting approaches to supporting and upholding the rights and health of incarcerated transgender people. Int J Transgend. 2019;20(4):341–350. https://doi.org/10.1080/15532739.2019.1651684CrossRefGoogle ScholarPubMed
Brown, GR, McDuffie, E. Health care policies addressing transgender inmates in prison systems in the United States. J Correct Health Care 2009;15(4):280–291. https://doi.org/10.1177/1078345809340423CrossRefGoogle ScholarPubMed
Bockting, WO, Miner, MH, Swinburne Romine, RE, Hamilton, A, Coleman, E. Stigma, mental health, and resilience in an online sample of the US transgender population. Am J Public Health 2013;103(5):943–951. https://doi.org/10.2105/AJPH.2013.301241Google Scholar
Agius, S, Köhler, R. The Trans Crossroads: Trans People’s EU Employment Rights and National Gender Recognition Laws. Transgender Europe, 2014. Available from: https://tgeu.org/wp-content/uploads/2015/02/transcrossroads_screen.pdfGoogle Scholar
Major, B, O’Brien, LT. The social psychology of stigma. Annu Rev Psychol 2005;56(1):393–421. https://doi.org/10.1146/annurev.psych.56.091103.070137CrossRefGoogle ScholarPubMed
Sevelius, JM. Gender affirmation: a framework for conceptualizing risk behavior among transgender women of color. Sex Roles 2013;68(11–12):675–689. https://doi.org/10.1007/s11199-012-0216-5Google Scholar
Stephenson, R, Riley, E, Rogers, E, et al. The sexual health of transgender men: a scoping review. J Sex Res 2017;54(4–5):424–445. https://doi.org/10.1080/00224499.2016.1271863CrossRefGoogle ScholarPubMed
Sevelius, JM, Reznick, OG, Hart, SL, Schwarcz, S. Informing interventions: the importance of contextual factors in the prediction of sexual risk behaviors among transgender women. AIDS Educ Prev 2009;21(2):113–127. https://doi.org/10.1521/aeap.2009.21.2.113CrossRefGoogle ScholarPubMed
Baral, SD, Poteat, T, Strömdahl, S, et al. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis 2013;13(3):214–222. https://doi.org/10.1016/S1473-3099(12)70315-8Google Scholar
Pitasi, MA, Oraka, E, Clark, H, Town, M, DiNenno, EA. HIV testing among transgender women and men — 27 States and Guam, 2014–2015. Morb Mortal Wkly Rep 2017;66(33):883–887. https://doi.org/10.15585/mmwr.mm6633a3Google Scholar
Lake, JE, Clark, JL. Optimizing HIV prevention and care for transgender adults: AIDS 2019;33(3):363–375. https://doi.org/10.1097/QAD.0000000000002095CrossRefGoogle ScholarPubMed
Rich, AJ, Scheim, AI, Koehoorn, M, Poteat, T. Non-HIV chronic disease burden among transgender populations globally: a systematic review and narrative synthesis. Prev Med Rep 2020;20:101259. https://doi.org/10.1016/j.pmedr.2020.101259Google Scholar
Dragon, CN, Guerino, P, Ewald, E, Laffan, AM. Transgender medicare beneficiaries and chronic conditions: exploring fee-for-service claims data. LGBT Health 2017;4(6):404–411. https://doi.org/10.1089/lgbt.2016.0208Google Scholar
Downing, JM, Przedworski, JM. Health of transgender adults in the U.S., 2014–2016. Am J Prev Med 2018;55(3):336–344. https://doi.org/10.1016/j.amepre.2018.04.045Google Scholar
Connelly, PJ, Marie Freel, E, Perry, C, et al. Gender-affirming hormone therapy, vascular health and cardiovascular disease in transgender adults. Hypertension 2019;74(6):1266–1274. https://doi.org/10.1161/HYPERTENSIONAHA.119.13080Google Scholar
Chen, R, Zhu, X, Wright, L, et al. Suicidal ideation and attempted suicide amongst Chinese transgender persons: national population study. J Affect Disord 2019;245:1126–1134. https://doi.org/10.1016/j.jad.2018.12.011Google Scholar
Rotondi, NK, Bauer, GR, Travers, R, et al. Depression in male-to-female transgender Ontarians: results from the Trans PULSE Project. Can J Commun Mental Health 2011;30(2):113–133. https://doi.org/10.7870/cjcmh-2011-0020Google Scholar
Boza, C, Nicholson, Perry K. Gender-related victimization, perceived social support, and predictors of depression among transgender Australians. Int J Transgend 2014;15(1):35–52. https://doi.org/10.1080/15532739.2014.890558Google Scholar
Lee, H, Operario, D, van den Berg, JJ, et al. Health disparities among transgender adults in South Korea. Asia Pac J Public Health 2020;32(2–3):103–110. https://doi.org/10.1177/1010539520912594CrossRefGoogle ScholarPubMed
Heylens, G, Elaut, E, Kreukels, BPC, et al. Psychiatric characteristics in transsexual individuals: multicentre study in four European countries. Br J Psychiatry 2014;204(2):151–156. https://doi.org/10.1192/bjp.bp.112.121954Google Scholar
Virupaksha, HG, Muralidhar, D, Ramakrishna, J. Suicide and suicidal behavior among transgender persons. Indian J Psychol Med 2016;38(6):505–509. https://doi.org/10.4103/0253-7176.194908Google Scholar
Connolly, D, Gilchrist, G. Prevalence and correlates of substance use among transgender adults: a systematic review. Addict Behav 2020;111:106544. https://doi.org/10.1016/j.addbeh.2020.106544CrossRefGoogle ScholarPubMed

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