Ashley Lacombe-Duncan, PhD, MSW
Transitional Postdoctoral Research Fellow and Assistant Professor
School of Social Work, University of Michigan
University of Michigan, School of Social Work
Nothing to disclose
Background : Intersectionality theory has been applied to understand how transgender (trans) stigma, defined as social exclusion and discrimination of trans people at structural, interpersonal, and individual levels, intersects with other types of stigma (e.g., HIV stigma) to impede access to healthcare among trans women living with HIV (WLWH). Intersectionality theory can also be used to highlight the contextual nature of oppression and how power relations are shifted within interpersonal relationships and institutional settings. However, scant published peer-reviewed literature has addressed trans WLWH’s coping or resistance in response to healthcare discrimination in the form of resilience or empowerment, limiting knowledge of the potential strengths of trans WLWH as individuals and a community. This qualitative study sought to describe resilience and empowerment exhibited by trans WLWH in response to intersecting stigmas in healthcare.
Methods : Semi-structured, individual interviews were conducted in 2017-2018 with a purposive sample of trans WLWH (n=11) (selected based on diverse identities/experiences and different levels of healthcare engagement) participating in a large, community-based cohort study in three Canadian provinces (Ontario, British Columbia, and Quebec). Framework analysis was used to identify key themes, patterns within themes between participants, and patterns across themes among participants.
Results : Three overarching themes were identified. (1) Responses to stigma and discrimination in healthcare. Trans WLWH exhibited resilience and actively resisted and transformed discriminatory healthcare settings. (2) Motivations, benefits, and consequences of responding to stigma and discrimination in healthcare. Trans WLWH were motivated to respond by perceived benefits to both self and others. Intrapersonal benefits included increased self-worth and challenging internalized stigma. Reduced social isolation was an interpersonal benefit. Trans WLWH also reported structural benefits, including increased economic resources and leverage for better treatment. Negative consequences included provider reactions, being further stereotyped, and decreased physical health in the form of experiencing HIV-related health complications and emotional wellbeing in the form of experiencing burnout. (3) Recommendations for systemic change to address stigma and discrimination in healthcare. Trans WLWH recommended trans inclusion in service delivery and program development and oversight. Participants recommended increased provider education, describing who should be trained (e.g., students), what they should learn about (e.g., the social context impacting trans WLWH), and how they should receive training (e.g., from trans WLWH).
Conclusions : Future studies can use intersectionality to highlight both inequities and strategies to promote empowerment of diverse populations of WLWH. Providers can work alongside trans WLWH from a strengths-based perspective to address intersecting stigmas in healthcare settings.