Get the Facts:

Healthcare and Transgender and Gender-Nonconforming (TGNC) Patients

There Are More TGNC Persons Than You May Realize

Some healthcare professionals mistakenly believe that they never have encountered, nor will ever encounter, a TGNC patient. But it is estimated that at least 1.4 million Americans self-identify as TGNC. Some experts believe that this is a low estimate, since many TGNC persons chose not to disclose their gender identity for fear of discrimination, harassment, and/or abuse.1

TGNC Patients Face Significant Healthcare Disparities

TGNC Americans are more likely to have poor overall health and poor physical health, even though they have the same prevalence rates of chronic disease as cisgender Americans - that is, persons who identify as the gender assigned at birth.2

Transgender women - particularly transgender women of color - have the highest prevalence rate for HIV infection.3,4 Whereas 0.3% of all American adults are living with HIV, up to 30% of all transgender women of color are living with HIV.5,6

Historically TGNC Patients Have Negative Healthcare Encounters

Many TGNC persons actively avoid situations where their gender is not affirmed; this is especially true of healthcare encounters.7

Many TGNC persons report experiencing verbal and physical abuse either from healthcare professionals, staff, or other patients in the waiting room because of their gender identity.3,8-10

Many TGNC persons do not to seek out medical attention - even in emergency situations - for fear of harassment or abuse.5

TGNC patients in rural and Southern geographic areas are much less likely to utilize health care.11

Culturally Competent Healthcare Providers Conclusively Impact HIV Prevention and HIV Care

TGNC individuals are more likely to take pre-exposure prophylaxis (PrEP) from a TGNC-inclusive healthcare professional.12

Hormone therapy can be an incentive for patients to address HIV care, therefore, experts recommend that HIV providers become better versed in transgender healthcare, including hormone therapy utilization.13

Sexual-health counseling by culturally competent providers impacts prevention of HIV in TGNC persons.14

Gender-affirming strategies directly impact TGNC patients' adherence to PrEP, HIV-care engagement, and HIV-care retention rates.15-17

  1. Flores AR, Herman JL, Gates GJ, Brown TNT. How many adults identify as transgender in the United States? The Williams Institute. June 2016. http://williamsinstitute.law.ucla.edu/wp-content/uploads/How-Many-Adults-Identify-as-Transgender-in-the-United-States.pdf.
  2. Meyer IH, Brown TN, Herman JL, Reisner SL, Bockting WO. Demographic Characteristics and Health Status of Transgender Adults in Select US Regions: Behavioral Risk Factor Surveillance System, 2014. Am J Public Health. 2017;107:582-589.
  3. US Centers for Disease Control and Prevention. HIV Among Transgender People. https://www.cdc.gov/hiv/group/gender/transgender/index.html.
  4. Clark H, Babu AS, Wiewel EW, Opoku J, Crepaz N. Diagnosed HIV Infection in Transgender Adults and Adolescents: Results from the National HIV Surveillance System, 2009-2014. AIDS Behav. 2016 Dec 29. doi: 10.1007/s10461-016-1656-7. [Epub ahead of print]
  5. James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. (2016). The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.
  6. Herbst JH, Jacobs ED, Finlayson TJ, McKleroy VS, Neumann MS, Crepaz N. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav. 2008;12:1-17.
  7. Sevelius J. Gender affirmation: a framework for conceptualizing risk behavior among transgender women of color. Sex Roles. 2013;68:675-689.
  8. Poteat T, German D, Kerrigan D. Managing uncertainty: a grounded theory of stigma in transgender health care encounters. Soc Sci Med. 2013;84:22-29.
  9. Kosenko K, Rintamaki L, Raney S, Maness K. Transgender patient perceptions of stigma in health care contexts. Med Care. 2013;51:819-822.
  10. Roche K, Keith C. How stigma affects healthcare access for transgender sex workers. Br J Nurs. 2014;23:1147-1152.
  11. Whitehead J, Shaver J, Stephenson R. Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations. PLoS One. 2016;11: e0146139.
  12. Grant RM, Anderson PL, McMahan V, et al.; iPrEx study team. Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. Lancet Infect Dis. 2014;14:820-829.
  13. University of California, San Francisco Center of Excellence for Transgender Health. General prevention and screening: sexual health. http://transhealth.ucsf.edu/trans?page=protocol-screening#S8X. Accessed May 15, 2017.
  14. Golub SA, Gamarel KE, Rendina HJ, Surace A, Lelutiu-Weinberger CL. From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Patient Care STDS. 2013;27:248-254.
  15. Sevelius JM, Keatley J, Calma N, et al. "I am not a man": trans-specific barriers and facilitators to PrEP acceptability among transgender women. Glob Public Health. 2016:1-16.
  16. Sevelius JM, Patouhas E, Keatley JG, et al. Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus. Ann Behav Med. 2014;47:5-16.
  17. Sevelius JM, Carrico A, Johnson MO. Antiretroviral therapy adherence among transgender women living with HIV. J Assoc Nurses AIDS Care. 2010;21:256-264.