Unmet Health Care Needs Among Young Transgender Women at Risk for HIV Transmission and Acquisition in Two Urban U.S. Cities: The LifeSkills Study

Purpose: The physical health care needs of transgender women are not being adequately addressed in the United States. The current study adds to the literature on the state of health care among young transgender women (YTW) by describing the occurrence of unmet health needs among a sample of YTW and providing unique data on psychosocial and demographic factors associated with access to adequate care. Methods: Baseline data were analyzed from Project LifeSkills, an intervention study funded by the National Institutes of Health (NIH). YTW (N=300) between the ages of 16 and 29 were recruited from the Boston and Chicago metropolitan areas between 2012 and 2015. Data were collected on health care experiences, indicators of social marginalization, and sociodemographic information. The final analytic sample (N=273) was restricted to participants with complete data; participants that were removed did not significantly differ demographically from the final analytic sample retained. Bivariate logistic regression models examined the association between having unmet health care needs and sociodemographics, social marginalization, and health care utilization indicators. A final adjusted multivariable logistic regression model was constructed with independent variables that were statistically significant in bivariate models. Results: Overall, nearly a quarter (23%) of YTW indicated that they had unmet health care needs. In the final multivariable model adjusted for enrollment city, avoiding health care due to cost (adjusted odds ratio [aOR]=1.98, 95% confidence interval [CI]=1.05–3.76) and experiencing prior transgender-specific discrimination in a medical setting (aOR=4.54, 95% CI=2.30–8.95]) were associated with a greater odds of having unmet health care needs. Conclusion: YTW face significant barriers to accessing health care in the United States. Among this sample, prior experiences of discrimination and inability to afford health care increased YTW odds of having unmet health care needs. Efforts to improve the unmet health care needs among YTW should promote access to affordable, gender-affirming care.