The American Academy of Nursing supports initiatives to address the health needs of transgender individuals (TI) and supports policy initiatives that reduce the heath care barriers that most TI encounter. There is a great need for the development of strategies and policies to eliminate the health care disparities of approximately 700,000 TI in the United States (
Gates, 2011
). Transgender is the term used for individuals who have gender identity and/or gender expression differing from the assigned sex at birth (Fenway Health, 2010
). In the United States, an obvious paradox exists for transgender patients; TI have unique health needs that require specialized health services, yet TI are unable to easily access the very health system designed to provide specialized services (Dewey, 2008
, Sperber et al., 2005
, Xavier et al., 2007
).It is critical to provide TI with appropriate and quality health care services (
Healthy People 2020, 2010
, Healthy People 2020, 2016
, Institute of Medicine, 2011
, Lim et al., 2014
, The Joint Commission, 2011
, Zuzelo, 2014
), and nurses must become educated about the health care needs and barriers faced by TI. TI have unique health care needs and disproportionately higher rates of more common health concerns (American College of Obstetricians and Gynecologists [ACOG], 2011
, Ard and Makadon, 2012
, Dewey, 2008
, Hussey, 2006
, Institute of Medicine, 2011
, Kenagy, 2005
, Namaste, 2000
, Sperber et al., 2005
, Xavier et al., 2007
). They are at increased risk of HIV and sexual violence (Giami and Le Bail, 2011
, Herbst et al., 2008
), depression, self-harm, substance abuse, and suicide (Center of Excellence [CoE] for Transgender Health at the University of California San Francisco, 2012
, Dutton et al., 2008
, Institute of Medicine, 2011
, Scourfield et al., 2008
, Williamson, 2010
). However, TI—as children, youth, adults, and the elderly—are not a monolithic group and like all patients, they have health needs that vary across the lifespan (Services and Advocacy for GLBT Elders (SAGE), 2016
, American Psychological Association, 2010
).American Psychological Association. (2010). The psychology of transgender [press release]. Retrieved from http://www.apa.org/news/press/releases/2015/11/psychology-transgender.aspx
The World Professional Association for Transgender Health Standards of Care (
Coleman et al., 2012
) views access to evidence-based health care as a right and barriers to access as discrimination. Discrimination negatively affects how individuals make decisions about accessing health care, thereby putting them at risk for short- and long-term adverse health outcomes (Grant et al., 2011
, Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M., Injustice at every turn: A report of the national transgender discrimination survey, National Center for Transgender Equality and National Gay and Lesbian Task Force, Washington, D.C. Retrieved from http://www.thetaskforce.org/static_html/downloads/reports/reports/ntds_full.pdf.
Prentice and Pizer, 2007
, Thrasher et al., 2012
, Weissman et al., 1991
). Too often, TI health experiences are characterized by uninformed health providers and discriminatory, institutional barriers. These barriers contribute to delays, missed diagnoses, and health disparities. There is an immediate need for comprehensive education for health professionals, medical staff, and administrators—and this education must be grounded in evidence-based research. Such education is essential to address discrimination and includes didactic learning and clinical experiences in schools of nursing and continuing education for practicing nurses.Increased knowledge of TI health concerns and the processes by which they engage in the health care system will better position health care providers to meet the unique needs of these individuals. Awareness of the process by which TI navigate through the health care system include moving forward, doing due diligence, finding loopholes, and making it (the system) work (
Roller et al., 2015
).Better access may be accomplished when health policy makers and health care providers become aware of the barriers and difficulties involved when TI navigate the health care system. Professional awareness of the navigational and policy barriers can facilitate the development of health care environments that are safe and help resolve inequities faced by TI. Providers should strive to provide timely, well-informed, and safe health care and, in turn, create a nonjudgmental health care environment (
Lambda Legal, 2013
). The goal should be for TI to have health outcomes comparable to those of cisgender (nontransgender) individuals.The American Academy of Nursing champions initiatives by the U.S. government, World Health Organization, health professional organizations, academic institutions, and hospitals to support TI unique health concerns and eliminate barriers to their health care.
Acknowledgment
The authors gratefully acknowledge the assistance of Cyndi Roller, PhD, in developing this position statement; indeed, her long-standing commitment to transgender individuals and her expertise related to transgender discrimination and minority status was invaluable. They also greatly appreciate the assistance of two of our Expert Panel members: Tonda Hughes, PhD, FAAN, provided insightful comments and Craig Phillips, PhD, FAAN, provided editorial assistance on the last draft of this statement.
References
- Committee opinion no. 512: Health care for transgender individuals.Obstetrics and Gynecology. 2011; 118: 1454-1458
American Psychological Association. (2010). The psychology of transgender [press release]. Retrieved from http://www.apa.org/news/press/releases/2015/11/psychology-transgender.aspx
- Improving the health care of lesbian, gay, bisexual and transgender people: Understanding and eliminating health disparities.2012 (Retrieved from)
- General prevention and screening.2012 (Retrieved from)
- Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7.International Journal of Transgenderism. 2012; 13: 165-232
- Knowledge legitimacy: How trans-patient behavior supports and challenges current medical knowledge.Qualitative Health Resarch. 2008; 18: 1345-1355
- Gynecologic care of the female-to-male transgender man.Journal of Midwifery and Women's Health. 2008; 53: 331-337
- Glossary of gender and transgender terms.2010 (Retrieved from)
- How many people are lesbian, gay, bisexual, and transgender?.2011 (Retrieved from)
- HIV infection and STI in the trans population: A critical review.Revue d'epidemiologie et de sante publique. 2011; 59: 259-268
Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M., Injustice at every turn: A report of the national transgender discrimination survey, National Center for Transgender Equality and National Gay and Lesbian Task Force, Washington, D.C. Retrieved from http://www.thetaskforce.org/static_html/downloads/reports/reports/ntds_full.pdf.
- Lesbian, gay, bisexual, and transgender health.2016 (Retrieved from)
- Transgender health fact sheet.Healthy People 2020, Washington, DC2010
- Estimating HIV prevalence and risk behaviors of transgender persons in the United States: A systematic review.AIDS and Behavior. 2008; 12: 1-17
- Slivers of the journey: The use of photovoice and storytelling to examine female to male transsexuals' experience of health care access.Journal of Homosexuality. 2006; 51: 129-158
- The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding.2011 (Washington, DC: The National Academies Press)
- Transgender health: Findings from two needs assessment studies in Philadelphia.Health and Social Work. 2005; 30: 19-26
- Creating equal access to quality health care for transgender patients: Transgender-affirming hospital policies.2013 (Retrieved from)
- Addressing health care disparities in the lesbian, gay, bisexual, and transgender population: A review of best practices.American Journal of Nursing. 2014; 114 (quiz 35, 45): 24-34
- Invisible lives: The erasure of transsexual and transgendered people.University of Chicago Press, London2000
- Delayed access to health care and mortality.Health Service Research. 2007; 42: 644-662
- Navigating the system: How transgender individuals engage in health care services.Journal of Nursing Scholarship. 2015; 47: 417-424
- Lesbian, gay, bisexual and transgender young people's experiences of distress: Resilience, ambivalence and self-destructive behaviour.Health and Social Care in the Community. 2008; 16: 329-336
- Discrimination.2016 (Retrieved from)
- Access to health care for transgendered persons: Results of a needs assessment in Boston.International Journal of Transgenderism. 2005; 8: 75-91
- Advancing effective communication, cultural competence, and patient- and family-centered care for the lesbian, gay, bisexual, and transgender (LGBT) community: A field guide.2011 (Retrieved from)
- Theory-guided selection of discrimination measures for racial/ethnic health disparities research among older adults.Journal of Aging and Health. 2012; 24: 1018-1043
- Delayed access to health care: Risk factors, reasons, and consequences.Annals of Internal Medicine. 1991; 114: 325-331
- Providing care to transgender persons: A clinical approach to primary care, hormones, and HIV management.The Journal of the Association of Nurses in AIDS Care. 2010; 21: 221-229
- The health, health-related needs, and lifecourse experiences of transgender Virginians.in: Health VDo Virginia Department of Health, Richmond, VA2007 (Retrieved from https://www.vdh.virginia.gov/epidemiology/DiseasePrevention/documents/pdf/THISFINALREPORTVol1.pdf)
- Improving nursing care for lesbian, bisexual, and transgender women.Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2014; 43: 520-530
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Published online: August 01, 2016
