Background : Hawaii has the largest state proportion of transgender adults in the nation with 81% of transgender individuals from diverse racial/ ethnic backgrounds. The dearth studies about transgender individuals in Hawaii focused on HIV a decade ago, with a recent study about anal cancer. To date, no studies have examined the general health concerns and health services experiences of transgender individuals in our current society with shifting policies that affirm gender (e.g. birth certificate, marriage equality), and organizations that provided gender care. This study utilizes the minority stress model and gender affirmation framework to explore transgender women’s health concerns and health service experiences in Hawaii.
Methods : Participants were recruited from a transgender community event on the western part of the island of Oahu, Hawaii in December 2017. The inclusion criteria were: i) 18 years and older, and ii) consent by action. Nine (N=9) individuals who considered themselves transgender women, or women, but were assigned male sex at birth partook in the two-part survey and interview questionnaire about community health concerns, health forms, and health services. Participants were given a $10 gift card incentive to a local grocery store. Qualitative data were transcribed and analyzed for emergent themes.
Results : Transgender women participants (N = 9) were 22-54 years of age with 88.9% of mixed ethnicity (e.g., Native Hawaiian, Filipino, Chinese, Samoan, European, Hispanic/Latino, and American Indian/ Alaska Native); 11.1% identified one race, Native Hawaiian. Survey data indicated that all participants were current hormones user (e.g., estradiol), and only one participant accessed surgery. About half (44.4%) of participants decline to respond to the organ inventory item on the health survey, and 55.6% reported having male genitalia. Nearly all (88.9%) participants legally changed their sex from male to female on their birth certificate. Qualitative data revealed that participants traveled about 25 miles from their home residence to access gender affirming care (e.g. hormone therapy) and were positive about their transitions. Older transgender women (30 and above) revealed experiences of stigma and discrimination in health clinics (e.g. waiting room) and their anxiety with being ‘clocked’ or outed as a transgender woman, which was a barrier for obtaining services. One younger participant shared of her mistreatment in one hospital, which forced her to seek services in another hospital. Participants health concerns were with diabetes, cancer, obesity, and heart disease with little mention of HIV. The desire to have children was also mentioned.
Conclusions : Given societal shifts with policies and health services that affirm, and support individuals chosen selves and gender, transgender participants were able to access gender care. They shared concern about diabetes, cancer, and heart disease in their community. More research is needed in these areas, as well as responses to survey items that enable transgender individuals to become visible in health surveillance systems. Transgender health disparities are still emerging and will become more visible with research.