Public Health Management Corporation released a study last week — just ahead of the Transgender Day of Remembrance on Nov. 20 — that details the specialized health needs faced by the local transgender community and sheds light on how many of those needs are not being met.
The city’s Office of HIV Planning completed a report in 2006 that dedicated one section to the impact of the disease on the transgender community, but a wider assessment of the local trans population had not been conducted since the mid-’90s.
“Nothing had been done in a number of years that really gave a broader picture of discrimination, healthcare accesses, experience with healthcare providers, and pulled all of that into a wider picture,” PHMC research associate Lee Carson said.
PHMC met with a group of local transgender individuals and service providers in September 2007, and the working group recommended the agency use the $14,000 it had available from state funding through the Commonwealth Universal Research Enhancement Program to employ a needs-assessment of the community.
“For the first time in about a dozen years, we have an assessment of the needs of transgender and gender-variant individuals in Philadelphia,” said Gloria Casarez, the city’s director of LGBT affairs. “It shows us that there is still a lot of work to be done throughout various sectors. The report affirms the need for inclusive policies, the need for additional data collection and highlights key areas of concern for this population of people.”
Carson conducted several focus groups last year with 22 transgender individuals and used their insight to create a survey that was distributed at nine local organizations: ActionAIDS, AIDS Services in Asian Communities, The Attic Youth Center, The COLOURS Organization, Gay and Lesbian Latino AIDS Education Initiative, Mazzoni Center, Safeguards, Trans Masculine Advocacy Network and the William Way LGBT Community Center.
The survey garnered responses from 127 individuals, the majority of whom were African-American transwomen ages 18-24. Carson said these demographics do not necessarily provide an accurate representation of the entire transgender community.
“The organizations that we had helping us tap into a large transwomen of color population,” Carson said. “We were hoping we would have more diversity in our sample, but it is a convenient sample, so that does limit the generalizability of your findings.”
Of the respondents, 37 percent had obtained at least a high-school diploma or GED, with 13 percent having gone on to earn a bachelor’s degree and 15 percent having attended some college courses. Despite the educational level, however, the majority of the respondents — 39 percent — earn less than $10,000 annually.
The majority — approximately 30 percent — of respondents indicated they were currently unemployed. More than 30 percent of participants said they had been previously denied equal treatment or service in a work setting, and 25 percent had been verbally harassed or disrespected at a job.
“A lot of trans people are just not able to get in the front door,” Carson said. “There are a lot of barriers that exist.”
The dearth of steady employment and income could be having an impact on the health of the trans community, Carson said, noting that approximately 27 percent of respondents have no health insurance.
“Particularly for those people who are taking hormones, it’s very important that they’re followed by healthcare providers,” Carson said. “Regardless of gender identity, there are so many issues not related to transitioning that our bodies experience and not having health insurance and access to healthcare can open people up to so many other conditions that can get worse if they’re not being watched by a provider.”
While 68 percent of participants who’d reported taking estrogen or testosterone in the previous two years had obtained the hormones through a medical provider, about 40 percent also got the drugs from a friend, 23 percent ordered them online and 9 percent obtained them from someone they didn’t know well.
In terms of health conditions the community currently faces, approximately 26 percent responded they were HIV-positive and the majority of participants had reported being tested for the disease within the past six months. Approximately 12 percent of the respondents have hepatitis C and 10 percent reported having been diagnosed with high blood pressure.
About 58 percent of participants reported smoking cigarettes within the past two years, although 17 percent of those no longer smoke.
Participants reported using marijuana at a higher rate than any other substance; approximately 57 percent of respondents said they smoked marijuana more than five times over the past two years, which was higher than alcohol, which 50 percent of respondents used more that five times in the same period. About 22 percent of participants used cocaine, 19 percent used crack and 12 percent had taken ecstasy more than five times since 2007. Additionally, 4 percent reported using poppers, 3 percent reported using heroin, 3 percent reported using cough syrup (to get high) and 2 percent reported using crystal methamphetamine more than five times in the past two years.
While Carson noted that many of the survey respondents have medical conditions or are at-risk for certain conditions, many of those who have sought assistance at healthcare providers reported having negative experiences.
Seventeen percent of participants said they’d been denied equal treatment or service at a doctor’s office, hospital or emergency room, and 14 percent had been verbally harassed or disrespected in the same settings.
Many of the participants in the focus groups reported their healthcare providers do not understand what it means to be transgender or gender-variant; many continued to call them by their birth names, and one transman reported being sexually assaulted by his physician.
Carson said he learned that some transgender individuals striving to be accepted as part of the mainstream community are hesitant to receive care at an LGBT medical provider.
“Some people said that they didn’t want to go to an LGBT health center so they may go to other places, but the downside there is that these folks are probably not as competent around trans issues and say things and do things that are offensive and can turn them off toward ever coming back,” Carson said.
The report includes numerous structural recommendations, such as the actual enforcement of the city’s Department of Behavioral Health’s trans-inclusive nondiscrimination policy, and other governmental and institutional shifts that need to be made to help level the playing field for the transgender community.
“Trans people are still being discriminated against,” Carson said. “Policies may be in place at the administrative level, but they’re not being operationalized properly and no one’s there making sure that they’re operationalized.”
Carson said many of the focus-group participants also testified that they felt marginalized from the wider sexual-minority community, which he said reveals the need for increased education and awareness among local LGBs.
Though the study had limitations, Carson said he was interested in employing further research on health and social disparities facing the transgender community.
“We wanted people to realize what the experiences of these people are and then we hope to further build on that,” he said. “I also see this paper as an educational tool for the trans community themselves to know what exists for them and what their rights are.”
Jen Colletta can be reached at [email protected].