Fear of Practitioner Bias and Confidentiality Breaches are Barriers to HIV Prevention among Transgender Youth, Study Finds

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Celia B. Fisher, PhD, Director of Fordham University’s Center of Ethics and Education, explores transgender youth healthcare and HIV prevention in a recently published article titled:  Perceived Barriers to HIV Prevention Services for Transgender Youth. The article, published in the journal LGBT Health, examines the perceptions that transgender youth have of primary care providers, specifically those related to gender and sexual minority (GSM) identity and sexual health.

Transgender youth and adults have been recognized as a “key population at risk for HIV and other sexually transmitted infections (STIs).” This population also reports “significantly lower lifetime rates of HIV testing relative to cisgender gay and bisexual men.” Transgender individuals report discrimination in the healthcare setting and that fear of that discrimination could delay in postponing medical services. These patterns could also be a factor in transgender youth seeking medical services, but “little is known” about the link between anticipating GSM stigma in healthcare and HIV/STI preventive services.

The study was conducted via an Internet survey of 288 trans masculine, trans feminine, or gender nonbinary youth. Participants were asked about their GSM identity, disclosing that identity, gender-affirming services, and their concerns about PCP stigma and confidentiality. Only 25% of the youth surveyed felt that their PCP was “helpful about GSM-specific health issues.” Similarly, a quarter of the youth reported they were less likely to discuss GSM-specific health issues with their PCP because they were afraid that information would be disclosed to their parents. Fisher reports these concerns were magnified among those youth under the age of 18 as well as those not out to their parents about their gender identity. The fear of being “outed” to parents as well as GSM stigma are likely to be a factor in the HIV/STI healthcare disparities in transgender youth.

“To our knowledge, this study is the first to explore how transgender youth perceive communication with their PCPs about gender identity, sexual orientation, sexual activity, and sexual health information,” said Fisher. She continued, “the results of the study emphasize the need for transgender-inclusive training for PCPs so that transgender youth will feel comfortable discussing their gender identity, sexual orientation, and, most importantly, their sexual health needs to healthcare providers in the future.”


For LGBT resources, please visit RELAY (Research and Education for LGBT and Allied Youth). RELAY is a project of Fordham University’s Center for Ethics Education which looks to advance the conversation about health for lesbian, gay, bisexual, and especially trans youth. Please also visit the resource page for creating an LGBTQ-inclusive classroom.

Celia B. Fisher, Ph.D. is the Fordham University Marie Ward Doty University Chair in Ethics and Director of the Center for Ethics Education and the HIV and Drug Abuse Prevention Research Ethics Training Institute. Fisher’s Decoding the Ethics Code: A Practical Guide for Psychologist, is now in its fourth edition from Sage Publications.

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