Health Disparities in Transgender People of Color

Transgender (trans) people of color experience numerous health disparities due to vulnerabilities and risk factors that limit their access to quality, consistent healthcare. As a member of two minority groups, transgender people of color tend to have poorer health outcomes than either White transgender people or cisgender people of color.

High rates of stigma, discrimination, and transphobia along with high levels of poverty, racism, and employment add to longstanding systematic inequities that run deep in American culture.

This article explains what health disparities are and how they affect transgender people of color. It also focuses on discrimination faced by transgender people who are Black or Latinx, including how it impacts access to healthcare.

What Are Health Disparities?

Health disparities are preventable diseases or conditions experienced by socially disadvantaged populations compared to socially advantaged populations.

As a member of two socially disadvantaged groups, transgender people of color are subject to health disparities on two fronts. These disparities can have an additive effect, increasing the risk of infection, disease, harmful behaviors, late diagnosis, morbidity (illness), and mortality (death).

Most research on trans people of color focuses on specific racial or ethnic groups rather than the population as a whole. That’s because what a Black or Latinx trans person might experience can differ from what an Asian or Native American/Alaskan Native trans person might experience, both on an individual and social level.

Even so, there are certain commonalities.

According to 2019 research from the Center for American Progress (CAP), transgender people are at consistently higher risk of certain harms than their cisgender heterosexual counterparts.

These include such risks as:

• Sexually transmitted infections: 7% transgender vs. 2% cisgender
• Smoking: 59% transgender vs. 39% cisgender
• Asthma: 22% transgender vs. 14% cisgender
• Mental health issues: 60% transgender vs. 37% cisgender
• Substance abuse: 25% transgender vs. 2% cisgender
• Contemplating suicide: 81% transgender vs. 30% cisgender
• Victim of sexual or physical assault: 48% transgender vs. 36%

The researchers concluded that discrimination and stigma significantly affect the physical, mental, and behavioral health of transgender adults. Compared with the general population, transgender people were not only at higher risk of HIV, substance use, mental illness, and sexual or physical violence but almost invariably had poorer outcomes (including early death).

According to the CAP: “This is particularly true for transgender people of color who experience multiple dimensions of individual and systemic discrimination.”

What Causes Health Disparities for Transgender People of Color?

The reasons for health disparities can vary between racial and ethnic groups. Typically, they are centered around high rates of poverty already existing in communities of color and high rates of stigma and discrimination coming from within and outside of communities of color.

The 2015 National Transgender Discrimination Survey (NTDS) remains one of the largest surveys of transgender people in the United States with over 27,000 respondents in all 50 states and the District of Columbia.

According to the findings of the survey, transgender people of color have different experiences when accessing healthcare than their White or cisgender counterparts. The combination of racial and gender minority status can impede healthcare access in a number of ways.

Here is a snapshot of that experience in transgender people in Black and Latinx communities.

Black Transgender Adults

Among Black transgender adults in the U.S.:

• 20% were unemployed, compared to 10% of Black people in the U.S.
• 38% were living in poverty, compared to 24% of Black people in the U.S.
• 67% said they would feel uncomfortable asking the police for help
• 42% have experienced homelessness at some point in their lives, while 22% experienced homelessness in the past year
• 53% have been sexually assaulted at some point in their lifetime, while 13% were sexually assaulted in the past year
• 34% had at least one negative experience with a healthcare provider in the past year
• 6.7% were living with HIV, 20 times the rate in the general population
• 41% experienced serious psychological distress in the past month, more than eight times the rate in the general population

Latinx Transgender Adults

Among Latinx transgender adults in the U.S.:

• 21% were unemployed, compared to 7% of Latinx people in the U.S.
• 43% were living in poverty, compared to 18% of Latinx people in the U.S.
• 59% said they would feel uncomfortable asking the police for help
• 31% have experienced homelessness at some point in their lives, while 14% experienced homelessness in the past year
• 48% have been sexually assaulted at some point in their lifetimes, while 12% were sexually assaulted in the past year
• 32% had at least one negative experience with a healthcare provider in the past year
• 1.6% were living with HIV, five times higher than the rate in the general population
• 45% experienced serious psychological distress in the past month, nine times the rate in the general population

Individuals faced with these issues are more likely to avoid or delay care, particularly if the police and healthcare systems have historically let them down.

This can make even manageable conditions worse or promote the spread of infection when a person fails to seek preventative treatments (like HIV PrEP). It can also lead to even more serious harm when a transgender person is reluctant to even access emergency room care.

Access to Transgender Health Care

Access to healthcare can be restricted or undermined by several factors. In addition to discrimination and maltreatment, the cost of treatment and a lack of health insurance are common barriers to care among transgender people of color.

According to a nationwide survey conducted by the CAP in 2020:

• 40% of transgender people postpone or avoid getting preventive screenings in the past year for fear of discrimination—including 54% of transgender people of color.
• 51% of transgender people postponed or avoided necessary medical care because they could not afford it—including 60% of transgender people of color.
• 50% of transgender people experienced some form of mistreatment (including the refusal of care, misgendering, and verbal or physical abuse) by a health provider in the past year—including 68% of transgender people of color.
• 46% of transgender people were denied gender-affirming care by a health insurer in the past year—including 56% of transgender people of color.
• 48% of transgender people either had no insurance or only partial coverage of gender-affirming care—including 54% of transgender people of color.
• 34% of transgender people reported that a health insurer refused to change their name or gender on health records—including 39% of transgender people of color.

In all six cases, being transgender and a person of color directly or indirectly restricted your access to healthcare compared to being transgender alone.

What Can Be Done

There is a growing awareness that healthcare providers should be better educated on the needs of transgender youth and adults. However, there is still a relative lack of research on the healthcare experiences of transgender people of color, outside the context of HIV.

Transgender people of color may experience healthcare disparities due to their multiple minority status, but they can also experience extraordinary resilience when supported by their families and communities.

Healthcare providers and associated personnel can help provide support by offering gender-affirming care to all patients, and by recognizing that the transgender umbrella covers people of all races and ethnicities.

Summary

As members of two socially disadvantaged and stigmatized groups, transgender people of color are disproportionately affected by preventable diseases and conditions.

These health disparities are driven not only by racism and homophobia but also by factors that limit a person’s access to healthcare, including poverty, homelessness, a lack of insurance, and distrust in healthcare systems.

Sexual and physical violence and a fear of the police can also drive transgender people of color from seeking any form of medical care or social service that they might otherwise need.