A global cautionary tale: discrimination and violence against trans women worsen despite investments in public resources and improvements in health insurance access and utilization of health care

• DOI: 10.1186/s12939-022-01632-5
• Publication Date: 2022-03-03T13:05:54Z
• Authors: Sean Arayasirikul; Caitlin Turner; Dillon Trujillo; Sofia L. Sicro; Susan Scheer; Willi McFarland; Erin C. Wilson
• Keywords: Male; Violence; Basic Behavioral and Social Science; Transgender Persons; Insurance; Social determinants of health; 03 medical and health sciences; 0302 clinical medicine; Sociology; 5. Gender equality; Clinical Research; Health Sciences; Behavioral and Social Science; Discrimination; Health services and systems; Humans; Transgender women; 10. No inequality; 360; Violence Research; Peace; Public health; Insurance, Health; Prevention; Research; 1. No poverty; Gender Identity; Gender Equality; 300; Justice and Strong Institutions; Policy and administration; 3. Good health; Human Society; Mental Health; Good Health and Well Being; Cross-Sectional Studies; Health; Public Health and Health Services; Female; Public Health; Health inequities; Health disparities; Public aspects of medicine; RA1-1270; Delivery of Health Care

Abstract Background To determine if improvements in social determinants of health for trans women and decreases in transphobic discrimination and violence occurred over three study periods during which extensive local programs were implemented to specifically address longstanding inequities suffered by the transgender community.

Methods Interviewer-administered surveys from repeated cross-sectional Transwomen Empowered to Advance Community Health (TEACH) studies in 2010, 2013 and 2016-2017 in San Francisco collected experiences with transphobia violence and discrimination. Respondent-driven sampling was used to obtain a sample of participants who identified as a trans woman.

Results Violence due to gender identity was prevalent; in each study period, verbal abuse or harassment was reported by over 83% of participants, and physical abuse or harassment was reported by over 56%. Adverse social determinants of health including homelessness, living below the poverty limit, methamphetamine use, depression, PTSD, and anxiety all significantly increased from 2010 to 2016. When testing for trends, housing discrimination and physical violence were both more likely in 2016-2017 compared to the two earlier study periods. Housing discrimination (aOR 1.41, 95% CI 1.00-1.98) and physical violence due to gender identity/presentation (aOR 1.39, 95% CI 1.00-1.92) both significantly increased from 2010 to 2016.

Conclusion Our findings are particularly alarming during a period when significant public health resources and community-based initiatives specifically for trans women were implemented and could have reasonably led us to expect improvements. Despite these efforts, physical violence and housing discrimination among trans women worsened during the study periods. To ensure future improvements, research and interventions need to shift the focus and burden from trans people to cisgender people who are the perpetuators of anti-trans sentiment, stigma, discrimination and victimization.