Imagine that at every doctor’s appointment your provider called you by the wrong gender. Or even worse, they got rough with you or used slurs when addressing you.
Sadly, that can be a typical trip to the clinic for many of America’s estimated one million transgender people. A disturbing 70 percent of transgender and gender-nonconforming people have encountered some form of healthcare discrimination, per a national survey analyzing barriers to care. More than half of respondents reported being denied basic care, 20 percent described receiving verbal abuse, and almost one in 10 experienced physical abuse at the hands of a provider. Such widespread mistreatment leads transgender folks in general, and transgender women of color in particular, to shy away from the very care they need.
Meanwhile, America is experiencing an epidemic of sexually transmitted infections, and these vulnerable communities are especially impacted. STIs serve as a sort of barometer of broader issues around healthcare access, and transgender individuals are at greater risk for for myriad reasons.
The good news? Healthcare innovations are arming transgender individuals (and everyone!) with convenient, confidential tools to ask questions about sensitive health issues and access care.
How Disempowerment Creates Risk
Compared to the general public, the transgender community is “absolutely at higher risk for STIs,” says Jessica Horwitz, who spent more than a decade in gender-affirming primary care and HIV prevention, and is now VP of Clinical Services for Nurx.
The percentage of transgender people diagnosed with HIV in 2017 was a whopping three times higher than the national average, per the CDC, and Horwitz suggests these figures may even be an undercount. One study found nearly 40 percent of transgender women had contracted an STI within the last six months.
Stigma, marginalization, and past mistreatment in the healthcare system put transgender individuals at higher risk of contracting STIs and experiencing worse health outcomes in general, says Horwitz. Research shows this vulnerable population may contract STIs for reasons outside of their control. Transgender people experience higher rates of non-consensual sex, and often are less likely to insist on condom use due to feelings of low self-esteem or disempowerment.
For trans men, who are largely left out of the conversation, testosterone therapy can thin genital tissues, making them more susceptible to STIs, including HIV, adds Horwitz. This avalanche of societal, emotional and medical issues means “there’s even more need for good prevention and testing,” she maintains.
The problem? “Accessing good, affirming testing is incredibly challenging. That’s just the reality.”
Barriers to Gender-affirming STI Care
Healthcare deserts, lack of insurance, and poverty are among the structural barriers that can make accessing STI testing difficult if not impossible. Compounding the problem: Too few medical providers are competent at treating LGBTQ individuals (even if they want to be) and some outwardly discriminate against them.
In fact, one in four transgender individuals in a national survey reported being denied necessary sexual health services by medical staff. Even today, providers in some parts of the country wrongly conflate transgender women with men who have sex with men.
This mountain of barriers can leave transgender individuals with more questions than answers about STIs, says Horwitz, when the bottom line is STIs are all curable or totally manageable — if you know your status.
STI Testing for Transgender People
Many STIs are symptomless, which is why regular testing is essential. CDC guidelines suggest annual screening, but Horwitz favors testing every six months, or more often if you’re forgoing condoms or with new partners.
And by testing, she means going beyond standard blood or urine tests to screen allllll of your sexy parts: mouth, rectum and vagina. Why? A urine test may not catch an STI in your throat.
Early diagnosis — and treatment — of STIs can save you from serious medical complications, like infertility and increased risk of HIV.
If you’d rather skip the clinic, consider adding STI testing to your at-home self-care routine. Nurx now offers three quick and easy STI Home Test Kits. Take swabs or blood or urine samples in the privacy of your home, then drop the samples in the mail in a prepaid envelope. If you test positive, Nurx providers will either prescribe treatment directly, when appropriate, or will connect you with treatment near you. You can message them anytime with questions, and all of the Nurx providers are knowledgable and experienced in providing affirming care to trans and nonbinary individuals.
Maybe we can’t wipe out health care discrimination this instant. But Nurx is doing its part to empower more individuals to access fast, confidential testing and judgement-free treatment on their own terms.
This blog provides information about telemedicine, health and related subjects. The blog content and any linked materials herein are not intended to be, and should not be construed as a substitute for, medical or healthcare advice, diagnosis or treatment. Any reader or person with a medical concern should consult with an appropriately-licensed physician or other healthcare provider. This blog is provided purely for informational purposes. The views expressed herein are not sponsored by and do not represent the opinions of Nurx™.