Understanding the health care needs of transgender and gender diverse people engaging with rural Australian sexual health centres: a qualitative interview study
Ava Del Tufo
A * , Rosalind Foster A B , Bridget Haire A , Christy E. Newman C , Anthony K. J. Smith C , Margaret Crowley D , Donna Burn E and Anna McNulty B F
A Kirby Institute, Wallace Wurth Building, Corner of High Street & Botany Street, UNSW Sydney, Sydney, NSW 2052, Australia.
B Sydney Sexual Health Centre, Level 3, Nightingale Wing, Sydney Eye Hospital, 8 Macquarie Street, Sydney, NSW 2000, Australia.
C Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2052, Australia.
D Dubbo Sexual Health Centre, 203 Brisbane Street, Dubbo, NSW 2830, Australia.
E Orange Sexual Health Centre, 96 Kite Street, Orange, NSW 2800, Australia.
F School of Population Health, UNSW, Samuels Building, F25, Samuel Terry Avenue, Kensington, NSW 2033, Australia.
Sexual Health 20(4) 339-346 https://doi.org/10.1071/SH22159
Submitted: 23 September 2022 Accepted: 8 May 2023 Published: 5 June 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: Although there is a presumption that LGBTQ+ people living in rural Australia will have poorer health outcomes than those living in metropolitan areas, minimal research has focused specifically on the perspectives of transgender and gender diverse (henceforth referred to as ‘trans’) people living in these regions. The purpose of this study was to understand what health and wellbeing means to trans people in a regional or rural community and identify their health needs and experiences.
Methods: A total of 21 trans people were recruited through two regional sexual health centres (SHC) and interviewed between April and August 2021. Data were analysed via reflexive thematic analysis. This paper focuses on participants’ accounts of health and wellbeing regarding gender affirmation, the experience of rural living, respectful holistic care, safety in rural communities, isolation, loneliness, and employment.
Results: The experience of living rurally can have both positive and negative impacts on the experiences of trans people. Participants reported experiences of stigma and discrimination, reduced employment opportunities and limited social interactions, which led to feelings of isolation and loneliness; however, they also reported high quality of care, particularly with the specific SHCs which supported this research.
Conclusion: Living rurally can impact both positively and negatively on the health and wellbeing of trans peoples, and the experiences of living in this environment are diverse. Our findings challenge the perception that rural trans people experience only poor health outcomes and shows the difference that key health services such as SHCs can make in supporting trans health.
Keywords: Australia, gender affirming care, gender diversity, LGBTQ+ health and wellbeing, qualitative analysis, rural and regional health, sexual and reproductive health, transgender health.
References
[1] Bretherton I, Thrower E, Zwickl S, Wong A, Chetcuti D, Grossmann M, et al. The health and well-being of transgender Australians: a national community survey. LGBT Health 2021; 8 42–9.| The health and well-being of transgender Australians: a national community survey.Crossref | GoogleScholarGoogle Scholar |
[2] Newman CE, Smith AKJ, Duck-Chong E, Vivienne S, Davies C, Robinson KH, et al. Waiting to be seen: social perspectives on trans health. Health Sociol Rev 2021; 30 1–8.
| Waiting to be seen: social perspectives on trans health.Crossref | GoogleScholarGoogle Scholar |
[3] Australian Institute of Health and Welfare. Rural & remote health. Canberra: AIHW; 2019.
[4] Dentato MP. The minority stress perspective. American Psychological Association. 2012. Available at https://www.apa.org/pi/aids/resources/exchange/2012/04/minority-stress
[5] Morandini JS, Blaszczynski A, Dar-Nimrod I, Ross MW. Minority stress and community connectedness among gay, lesbian and bisexual Australians: a comparison of rural and metropolitan localities. Aust N Z J Public Health 2015; 39 260–6.
| Minority stress and community connectedness among gay, lesbian and bisexual Australians: a comparison of rural and metropolitan localities.Crossref | GoogleScholarGoogle Scholar |
[6] Strauss P, Cook A, Winter S, Watson V, Wright Toussaint D, Lin A. Mental health issues and complex experiences of abuse among trans and gender diverse young people: findings from trans pathways. LGBT Health 2020; 7 128–36.
| Mental health issues and complex experiences of abuse among trans and gender diverse young people: findings from trans pathways.Crossref | GoogleScholarGoogle Scholar |
[7] Winter S, Diamond M, Green J, Karasic D, Reed T, Whittle S, et al. Transgender people: health at the margins of society. Lancet 2016; 388 390–400.
| Transgender people: health at the margins of society.Crossref | GoogleScholarGoogle Scholar |
[8] Robinson K, Bansel P, Denson N, Ovenden G, Davies C. Growing up queer: issues facing young australians who are gender variant and sexuality diverse. Young and Well Cooperative Research Centre; 2014.
[9] Hill AO, Bourne A, McNair R, Carman M, Lyons A. Private Lives 3: the health and wellbeing of LGBTIQ people in Australia. ARCSHS Monograph Series. La Trobe University; 2020.
[10] White Hughto JM, Reisner SL, Pachankis JE. Transgender stigma and health: a critical review of stigma determinants, mechanisms, and interventions. Soc Sci Med 2015; 147 222–31.
| Transgender stigma and health: a critical review of stigma determinants, mechanisms, and interventions.Crossref | GoogleScholarGoogle Scholar |
[11] Bowman S, Nic Giolla Easpaig B, Fox R. Virtually caring: a qualitative study of internet-based mental health services for LGBT young adults in rural Australia. Rural Remote Health 2020; 20 5448
| Virtually caring: a qualitative study of internet-based mental health services for LGBT young adults in rural Australia.Crossref | GoogleScholarGoogle Scholar |
[12] Steptoe A, Deaton A, Stone AA. Subjective wellbeing, health, and ageing. Lancet 2015; 385 640–8.
| Subjective wellbeing, health, and ageing.Crossref | GoogleScholarGoogle Scholar |
[13] Tan KKH, Treharne GJ, Ellis SJ, Schmidt JM, Veale JF. Gender minority stress: a critical review. J Homosex 2020; 67 1471–89.
| Gender minority stress: a critical review.Crossref | GoogleScholarGoogle Scholar |
[14] McCormack H, Nathan S, Varma R, Haire B. Dissonances in communication with sexual health consumers in an inner-Sydney sexual health clinic in relation to health literacy: a mixed-methods study. Health Promot J Austr 2021; 32 133–42.
| Dissonances in communication with sexual health consumers in an inner-Sydney sexual health clinic in relation to health literacy: a mixed-methods study.Crossref | GoogleScholarGoogle Scholar |
[15] Braun V, Clarke V. Successful qualitative research. Carmichael M, editor. London: Sage Publications Ltd; 2013.
[16] Braun V, Clarke V. To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales. Qual Res Sport Exerc Health 2021; 13 201–16.
| To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales.Crossref | GoogleScholarGoogle Scholar |
[17] Braun V, Clarke V. Thematic analysis: a practical guide. Sage Publications; 2021.
[18] Su D, Irwin JA, Fisher C, Ramos A, Kelley M, Mendoza DAR, et al. Mental health disparities within the LGBT population: a comparison between transgender and nontransgender individuals. Transgend Health 2016; 1 12–20.
| Mental health disparities within the LGBT population: a comparison between transgender and nontransgender individuals.Crossref | GoogleScholarGoogle Scholar |
[19] Sevelius JM, Patouhas E, Keatley JG, Johnson MO. Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus. Ann Behav Med 2014; 47 5–16.
| Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus.Crossref | GoogleScholarGoogle Scholar |
[20] Glynn TR, Gamarel KE, Kahler CW, Iwamoto M, Operario D, Nemoto T. The role of gender affirmation in psychological well-being among transgender women. Psychol Sex Orientat Gend Divers 2016; 3 336–44.
| The role of gender affirmation in psychological well-being among transgender women.Crossref | GoogleScholarGoogle Scholar |
[21] Australian Institute of Health and Welfare. 5.2 Rural and remote populations. Canberra: Australian Government; 2018.
[22] Wilkins R. The household, income and labour dynamics in Australia survey: selected findings from waves 1 to 14. Melbourne: Melbourne Institute of Applied Economic and Social Research The University of Melbourne; 2016.
[23] Australian Institute of Health and Welfare. 5.11 Rural and remote health. Canberra: Australian Institute of Health and Welfare; 2016.
[24] Smith E, Jones T, Ward R, Dixon J, Mitchell A, Hillier L. From Blues to Rainbows: mental health and wellbeing of gender diverse and transgender young people in Australia. Melbourne: The Australian Research Centre in Sex, Health and Society; 2014.
[25] Swank E, Frost DM, Fahs B. Rural location and exposure to minority stress among sexual minorities in the United States. Psychol Sex 2012; 3 226–43.
| Rural location and exposure to minority stress among sexual minorities in the United States.Crossref | GoogleScholarGoogle Scholar |
[26] Central West Rainbow Alliance. Dissolving of the Central West Rainbow Alliance. In: @CWRainbowAlliance, editor. 2019. Central West Rainbow Alliance.
[27] Edwards J. Invisibility, safety and psycho-social distress among same-sex attracted women in rural South Australia. Rural Remote Health 2005; 5 343
| Invisibility, safety and psycho-social distress among same-sex attracted women in rural South Australia.Crossref | GoogleScholarGoogle Scholar |
[28] Gottschalk L. Coping with stigma: coming out andliving as lesbians and gay men in regional and rural areas in the context of problems of rural confidentiality and social exclusion. Rural Soc Work Community Pract 2007; 12 31–46.
[29] Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull 2003; 129 674–97.
| Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence.Crossref | GoogleScholarGoogle Scholar |
[30] Australian Bureau of Statistics. Labour force, Australia. Canberra: Australian Government; 2021. Available at https://www.abs.gov.au/statistics/labour/employment-and-unemployment/labour-force-australia/latest-release
[31] Winter S. Lost in transition: transgender people, rights and HIV vulnerability in the Asia-Pacific region. Bangkok, Thailand: United Nations Development Program; 2012.
