Health care needs and barriers to care among the transgender population: a study from western Rajasthan

• Published in: BMC health services research Vol. 24; no. 1; pp. 989 - 11
• Main Authors: Ahuja, Tanvi Kaur, Goel, Akhil Dhanesh, Gupta, Manoj Kumar, Joshi, Nitin, Choudhary, Annu, Suman, Swati, Taluja, Kajal, Mittal, Madhukar, Ghuman, Navdeep Kaur, Suthar, Navratan, Bhardwaj, Pankaj
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 26.08.2024; BioMed Central; BMC
• Subjects: Adult; Civil service; Data collection; Demographic aspects; Depression; Expenditures; Female; Focus Groups; GDP; Gender dysphoria; Gender identity; Gender-affirming care; Gross Domestic Product; Health aspects; Health care policy; Health facilities; Health services; Health Services Accessibility; Health Services Needs and Demand; Humans; India; Interviews as Topic; Male; Medical care; Mental depression; Mental Health; Middle Aged; Needs assessment; Non-communicable diseases; Qualitative Research; Research design; Sociodemographics; Transgender people; Transgender persons; Transgender Persons - psychology; Transgender Persons - statistics & numerical data; Young Adult; India; Non-communicable diseases; Health services; Depression; Focus groups; Mental Health; Transgender persons; Gender dysphoria
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-024-11010-2

Transgender people comprise an estimated 0.3-0.5% (25 million) of the global population. The public health agenda focuses on understanding and improving the health and well-being of gender minorities. Transgender (TG) persons often have complex healthcare needs and suffer significant health disparities in multiple arenas. The international literature suggests that this community is at a higher risk of depression, and other mental health problems, including HIV. Many transgender people experience gender dysphoria and seek specific medical needs such as sex reassignment surgeries, implants, hormonal therapies, etc., but are unable to access these services due to financial or social reasons. The objective of this study was to assess the healthcare needs and associated barriers experienced by transgender people in Western Rajasthan. A qualitative study was carried out in which multilevel stakeholder interviews were conducted using interview and focus group discussion guides. Data was analyzed using the qualitative thematic analysis technique. Findings reveal that transgender people have expressed their need to access health services for general health needs, including but not limited to mental health, non-communicable diseases, and infectious diseases. Barriers to healthcare services were identified on 3 levels: health system, social and personal. Health system barriers include policy, accessibility, affordability, and acceptability issues. Social factors such as inadequate housing, education, and job opportunities also play an important role in affecting the individual's health-seeking behavior. The knowledge of healthcare providers in this context was also limited in context of health insurance schemes, package of services available for transgenders and the importance of gender sensitive healthcare. Transgender people expressed the need for mental health services, programs targeting nutritional improvement, gender-affirmation procedures besides regular screening of non-communicable diseases as operational for males and females. Levels of barriers have been identified at various levels ranging from absence of targeted policies to individual behavior.