Background : Clear health disparities exist in both transgender populations and homeless youth, and transgender individuals are over-represented within homeless youth populations. However, no peer-reviewed research has yet explored the health needs and disparities of the transgender homeless youth population.
Methods : We conducted a cross-sectional qualitative study aiming to describe the key social and structural factors influencing the health disparities faced by homeless transgender youth in the San Francisco Bay Area. Semi-structured, in-depth interviews were conducted with (1) youth ages 19-24 , recruited through flyers at service provision sites and via snowball sampling, and (2) key informants. Topics explored included physical and mental health, identity, causes of homelessness, survival strategies, HIV risk, PrEP use, violence, stigma, and service access. Interviews were audio-recorded, transcribed, and double-coded. Salient themes were identified using a grounded theory approach.
Results : We completed 22 in-depth semi-structured interviews with homeless transgender youth (n=18) and key informants (n=4). Youth participants included 6 transfeminine youth, 3 transmasculine youth, and 9 youth who identified as genderqueer, nonbinary, agender or multiple genders. Our preliminary grounded theory model reflects the intersectional, interlocking nature of health concerns and social and structural factors among this group. Youth described a variety of health concerns, including mental health, HIV, sexually transmitted infections, drug use, violence, hygiene, food insecurity, infections, difficulty accessing primary and transgender healthcare, and restroom access. Youth repeatedly tied these health concerns to social determinants of health, emphasizing that stigma and structural barriers related to homelessness and being transgender limit access to resources needed for achieving health. As one youth said, “I just think [trans homelessness is] more intense and also harder to solve… The hardest part for my experience in being trans is just all of the different hoops that I've had to jump through just to get basic things. Because people tend to not want to take trans people seriously… It makes it harder to access housing, to access healthcare, and to have those issues addressed. It makes accessing therapy, mental health care a lot more difficult… It allows for more damage to be done to trans people.” Research participants also described protective factors that lent resilience, such as strong social networks and identity self-determination. Triangulation with data from key informants supported themes identified within the youth cohort.
Conclusions : Transgender homeless youth face significant health disparities, mediated by social and structural determinants of health. The social and structural factors highlighted in our study point to potentially modifiable targets for creating successful and sustainable health, wellbeing, and housing interventions by service provision organizations, clinics, and at policy levels.