GRSJ224/The Effects of Transgender Discrimination in Health Care Settings

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A photo taken at the Fresno Rainbow Pride Parade and Festival. This image showcases the Transgender Pride Flag and its colours: white, pink and blue.

Overview

Throughout history, the LGBTQ community have continuously faced countless acts of discrimination, prejudice, and inequality. Prior to the gay rights movement in the 1960's, homosexuality was viewed as unnatural and even warranted a ban that prevented homosexuals to seek any sort of federal employment. The injustice the LGBTQ community faced transcended this even further when homosexuality was classified as a mental disorder by the American Psychiatric Association (APA) in the year 1952. Over the past few decades there has been progression in gay/transgender rights however, most in the community still face some sort of discrimination. These acts of prejudice and discrimination are predominantly committed by those opposed to the gay rights movement. Discrimination against the LGBTQ community usually involves stereotyping, social stigma, unequal job opportunities, unfair treatment and access to healthcare.

Discrimination towards LGBTQ

What is Discrimination and why does it occur?

Discrimination is viewed as an unfair treatment towards a person based on their group or category such as gender, race and sexual orientation. There are several types of discrimination where attacks narrow into particular groups such as ageism, women, and the LGBTQ community. Discrimination can occur in one of two ways; the first, direct discrimination. This is when an individual commits an unfair act against someone directly based on their characteristics which often results in harassment. Secondly, another way discrimination can occur is through the form of indirect or systemic discrimination. Systemic discrimination is a form of unfair treatment or prejudice built into a system that puts certain people or groups at a disadvantage. Examples of discrimination can look like the following: A women making less than a man for doing the same work and having similar experiences or refusing to hire someone based on their gender or race.

Often times acts discrimination is coming from a place where individuals have differing views and morals. In other cases it could simply be due to nurture and how the individual was brought up to view things in a certain light. This black and white or right and wrong perspective does indeed exist and is the precursor to things such as harassment, exclusion, stereotyping, and in worst cases, physical violence.

LGBTQ Community

LGBTQ stands for lesbian, gay, bisexual, transgender, and queer or questioning. Prior to the gay rights movement and activism surrounding LGBTQ any type of homosexuality or same-sex ideology was viewed as an unnatural process that resulted in employment bans in the military, mental disorder classifications, abuse etc. Thanks to activism and LGBTQ movements over the past decades the narrative has now shifted to perpetrators of violence or discrimination against groups such as the LGBTQ as the criminals. Most social movements present today surrounding the LGBTQ are in support of equal opportunities, social acceptance, and equal rights.

How is the LGBTQ Community being discriminated?

Discrimination in the LGBTQ community is very prevalent and studies surrounding transgender college students showed that cis-gendered students faced significantly lower rates of discrimination compared to trans-individuals[1]. However, discrimination towards this group transcends just the student population. Transgender people who are in middle adulthood to late adulthood face equal if not greater amounts of discrimination within their cohort. Subtle forms of discrimination are more common such as verbal harassment or jokes such as "that's so gay!" or "you're so queer"[1]. These type of insults or discriminatory acts are often viewed as micro-aggressions, however can possibly lead to even more violent acts such as physical assault or threats. Furthermore, discrimination can also be committed through ignorance or negligence of certain responsibilities when dealing with people of the LGBTQ community due to the existing stigma in today's culture. An example of this may be represented in the differing quality of care in healthcare settings received by those who are transgender vs. cis-gendered individuals.

Discrimination within the LGBTQ community can occur anywhere such as the workplace, the park, or even a family function. Notably, one area where discrimination is very prevalent and negatively affecting the health and livelihoods of several within the LGBTQ community is in healthcare.

Treatment disparities in healthcare amongst transgender individuals

Quality of Care

Quality of care is predominant issue relating to treatment disparities. A study conducted by Gahagan has highlighted how LGBTQ respondents for a survey surrounding health care has witnessed one in three people reporting poor experiences[2]. Often times patients or individuals within the LGBTQ community struggle to disclose their gender identities in fear of shame and mistreatment due to its stigma. In a study conducted by Parameshwaran et al., they concluded that one of the possible reasons for self-harm in the LGBTQ community is related to gender identities[3]. However, medical students and clinicians often ignore this aspect towards treatment practices and apply heteronormative principles and beliefs towards all their individuals[3]. This is in fact consequential because people within the LGBTQ community are exposed to higher risks in terms of mental illnesses or HIV. By neglecting to apply or implement a tailored-plan clinicians are undoubtedly providing lower quality care to gay and transgender patients[3].

Implications/Consequences of Healthcare Discrimination towards Transgender People

Mental/Physical Health & Stigma

Stigma at structural, interpersonal, and individual levels is linked to negative health outcomes in transgender populations, such as depression, anxiety, suicide, substance abuse, and HIV[4]. Structural stigma encompasses social norms, beliefs, institutional policies and practices that adversely affect access to resources, opportunities, and the wellbeing of stigmatized groups. Having a gender identity that matches an individual’s sex characteristics is deemed socially normative[4], therefore, transgender people are stigmatized and marginalized for identifying differently. Stigma causes poor health in transgender people directly, by exerting chronic stress, a key factor in increasing rates of morbidity and mortality, as well as indirectly, by limiting access to health protective resources[4]. Furthermore, internalized stigma, either from others, or that one imposes on themselves, can inhibit a transgender person’s ability to cope with stressors and engaging in health-promoting behaviours[4], further eroding their mental and physical health.

Healthcare Avoidance

Transgender people often delay or avoid seeking necessary health care due to stigma and discrimination from health care providers. According to the National Transgender Discrimination Survey (NTDS), 1 in 4 transgender or gender nonconforming people have been denied equal treatment in health care settings[5]. Over 40% of transgender men have experienced verbal harassment, physical assault, or have been denied care at a doctor’s office or hospital[5]. In addition to discriminative practices, there is also an apparent deficit in knowledge on the part of health care professionals regarding the provision of care to transgender patients. The lack of physician knowledge about transgender health needs also serves as a barrier to health care utilization, as the ability to trust one will receive safe and appropriate care is a huge factor affecting health care access for transgender individuals[5].

Progressive Change

Moving forward it's imperative that more peer reviewed research about reducing the stigma surrounding the LGBTQ community and transgender individuals occurs[6]. Discrimination against transgender individuals begins in adolescence and continues well into adulthood. Unfortunately, due to the existing stigma surrounding this group, adverse health effects have been seen due to a variety of reasons as evidenced through the effects of healthcare discrimination. People within the LGBTQ should not feel afraid to seek healthcare, nor should they be treated differently if they choose to do so. Future changes we can make in order to change narrative and reduce transgender stigma in healthcare is through early education and training at the systemic level[5].The fears leading to things such as healthcare avoidance are often due to the knowledge gap that exists in the medical system regarding people within the LGBTQ community[5]. While it is equally important to eliminate direct discrimination, eliminating systemic discrimination can act as the stepping stone towards not only bettering the health of those who are gay or transgender, but reduce the stigma as well. By ensuring that the knowledge gap is filled within the systemic level, we are in turn reducing the associated implications such as healthcare avoidance and stigma.

References

  1. 1.0 1.1 Seelman, Kristie (2017). "Victimization and Microaggressions Targeting LGBTQ College Students: Gender Identity As a Moderator of Psychological Distress". Journal of Ethnic & Cultural Diversity in Social Work. 26: 112–125.
  2. Gahagan, Jacqueline (2018). "Improving pathways to primary health care among LGBTQ populations and health care providers: key findings from Nova Scotia, Canada". International Journal for Equity in Health. 17: 1–9.
  3. 3.0 3.1 3.2 Parameshwaran, Vishnu. ""Is the Lack of Specific Lesbian, Gay, Bisexual, Transgender and Queer/Questioning (LGBTQ) Health Care Education in Medical School a Cause for Concern? Evidence From a Survey of Knowledge and Practice Among UK Medical Students". Journal of Homosexuality. 64: 367–381.
  4. 4.0 4.1 4.2 4.3 White Hughto, Jaclyn (2015). "Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions". Social Science & Medicine. 147: 222–231.
  5. 5.0 5.1 5.2 5.3 5.4 Kim, Jaffee (2016). "Discrimination and Delayed Health Care Among Transgender Women and Men". Medical Care. 54: 1010–1016.
  6. Parker, Caroline (2018). "The Urgent Need for Research and Interventions to Address Family-Based Stigma and Discrimination Against Lesbian, Gay, Bisexual, Transgender, and Queer Youth". Journal of Adolescent Health. 63: 383–393.