Experiences of and resistance to multiple discrimination in health care settings among transmasculine people of color

Madina Agénor^{1

2

3}, Sophia R Geffen^{4

5}, Dougie Zubizarreta⁶, Raquel Jones⁷, Shane Giraldo^{8

9}, Allison McGuirk¹⁰, Mateo Caballero^{9

11}, Allegra R Gordon^{12

13

14}

Affiliations

¹ Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA. madina_agenor@brown.edu.
² Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA. madina_agenor@brown.edu.
³ The Fenway Institute, Fenway Health, Boston, MA, USA. madina_agenor@brown.edu.
⁴ Johns Hopkins University School of Nursing, Baltimore, MD, USA.
⁵ Center for Health Equity Education and Advocacy, Cambridge Health Alliance, Cambridge, MA, USA.
⁶ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁷ Department of Psychology, University of Massachusetts Boston, Boston, MA, USA.
⁸ Department of Sociology, Simmons University, Boston, MA, USA.
⁹ Youth Community Advisory Board, Tufts University, Medford, MA, USA.
¹⁰ Department of Counseling Psychology, University of Wisconsin Madison, Madison, WI, USA.
¹¹ Department of Communication Studies, Northeastern University, Boston, MA, USA.
¹² Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
¹³ Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.
¹⁴ Department of Pediatrics, Harvard Medical School, Boston, MA, USA.

PMID: 35307008
PMCID: PMC8935683
DOI: 10.1186/s12913-022-07729-5

Experiences of and resistance to multiple discrimination in health care settings among transmasculine people of color

Madina Agénor et al. BMC Health Serv Res. 2022.

. 2022 Mar 21;22(1):369.

doi: 10.1186/s12913-022-07729-5.

Authors

Madina Agénor^{1

2

3}, Sophia R Geffen^{4

5}, Dougie Zubizarreta⁶, Raquel Jones⁷, Shane Giraldo^{8

9}, Allison McGuirk¹⁰, Mateo Caballero^{9

11}, Allegra R Gordon^{12

13

14}

Affiliations

¹ Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA. madina_agenor@brown.edu.
² Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA. madina_agenor@brown.edu.
³ The Fenway Institute, Fenway Health, Boston, MA, USA. madina_agenor@brown.edu.
⁴ Johns Hopkins University School of Nursing, Baltimore, MD, USA.
⁵ Center for Health Equity Education and Advocacy, Cambridge Health Alliance, Cambridge, MA, USA.
⁶ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁷ Department of Psychology, University of Massachusetts Boston, Boston, MA, USA.
⁸ Department of Sociology, Simmons University, Boston, MA, USA.
⁹ Youth Community Advisory Board, Tufts University, Medford, MA, USA.
¹⁰ Department of Counseling Psychology, University of Wisconsin Madison, Madison, WI, USA.
¹¹ Department of Communication Studies, Northeastern University, Boston, MA, USA.
¹² Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
¹³ Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.
¹⁴ Department of Pediatrics, Harvard Medical School, Boston, MA, USA.

PMID: 35307008
PMCID: PMC8935683
DOI: 10.1186/s12913-022-07729-5

Abstract

Background: Research shows that transmasculine people experience discrimination based on their gender identity and/or expression (i.e., cissexism) while obtaining health care. However, studies examining the experience of other forms of discrimination in health care settings among diverse subgroups of transmasculine individuals, including those from minoritized racial/ethnic backgrounds, are very limited.

Methods: Guided by intersectionality, we designed a qualitative research study to explore how transmasculine people of color experience-and resist-multiple, intersecting forms of discrimination in health care settings. Guided by a purposive sampling strategy, we selected 19 transmasculine young adults of color aged 18-25 years to participate in 5 mini-focus groups conducted between February and May 2019 in Boston, MA. Focus group transcripts were analyzed using a template style approach to thematic analysis that involved both deductive and inductive coding using a codebook. Coded text fragments pertaining to participants' experiences of health care discrimination were clustered into themes and sub-themes.

Results: Transmasculine people of color described experiencing notable challenges accessing physical and mental health care as a result of structural barriers to identifying health care providers with expertise in transgender health, finding providers who share one or more of their social positions and lived experiences, and accessing financial resources to cover high health care costs. Further, participants discussed anticipating and experiencing multiple forms of interpersonal discrimination-both independently and simultaneously-in health care settings, including cissexism, racism, weight-based discrimination, and ableism. Moreover, participants described the negative impact of anticipating and experiencing multiple interpersonal health care discrimination on their health care utilization, quality of care, and mental and physical health. Lastly, participants discussed using various strategies to resist the multiple, intersecting forms of discrimination they encounter in health care settings, including setting boundaries with health care providers, seeking care from competent providers with shared social positions, engaging in self-advocacy, drawing on peer support during health care visits, and obtaining health information through their social networks.

Discussion: Efforts are needed to address cissexism, racism, weight-based discrimination, ableism, and other intersecting forms of discrimination in clinical encounters, health care institutions and systems, and society in general to advance the health of transmasculine people of color and other multiply marginalized groups.

Keywords: Ableism; Cissexism; Discrimination; Health care; People of color; Racism; Resistance; Structural barriers; Transgender health; Weight-based discrimination.

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Conflict of interest statement

None of the authors have any competing financial or non-financial competing interest.

Figures

**Fig. 1**
Thematic map of themes and sub-themes pertaining to the experiences of and resistance to multiple discrimination in health care settings among transmasculine people of color (n = 19) from five focus groups

See this image and copyright information in PMC

References

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Experiences of and resistance to multiple discrimination in health care settings among transmasculine people of color

Affiliations

Experiences of and resistance to multiple discrimination in health care settings among transmasculine people of color

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources