By Qainat Khan

WBUR

On a break from her job near South Station, Vivian Taylor was on her way in to use the station's ladies' room when a man suddenly blocked her way, she recalls.

"Where do you think you're going?" he asked her, threateningly.

"I didn't want to have a confrontation while I was at work, but it was a very unsettling experience," said Taylor, a transgender woman who served in Iraq in 2009 and 2010. "For about the next half hour, that fella just stood there — as if he was on guard — standing there glaring at me in front of the door to the bathroom."

A survey out today suggests Taylor's experience is not uncommon. The results, based on 452 responses, show that almost two-thirds of transgender and gender non-conforming Massachusetts residents experienced discrimination last year in public places, including transportation, retail and health care settings.

The survey, conducted by The Fenway Institute at Fenway Health and the Massachusetts Transgender Political Coalition, found that respondents who reported discrimination had an 84 percent increased risk of adverse physical symptoms associated with stress — such as headaches, upset stomachs and pounding hearts — and a 99 percent increased risk of emotional symptoms compared to respondents who reported no such discrimination in the past year.

"It's a hard thing to have to go through the world just having to be that conscious of your own safety," Taylor, who was a respondent on the survey, said. "That's a very stressful experience, to just always know that it's possible that somebody is going to come after you for no other reason than what you look like, or how you dress, or what your voice sounds like."

The survey also found that 20 percent of respondents postponed or did not seek health care because of prior discrimination in a medical setting. Five percent of respondents said a health care provider refused to provide them with care because of their gender identity.

"The fear of not wanting to be discriminated against, the fear of not being seen for who you are and respected, I think, is a really powerful one," Sari Reisner, an epidemiologist and co-author of the survey, said. "The reality is that for transgender people, being socially gender affirmed is very, very important. So going into an encounter — especially a medical encounter [can] be a pretty vulnerable proposition. Depending on what exam you're undergoing, you may need to undress, you may need to disclose personal health information."

Reisner says we can think about trans people's fear to seek medical care in the context of what's known as a minority stress model in medical literature, which posits that for racial, ethnic and sexual minorities, social stressors harm health.

"We could talk about a gender identity social stress model, where discrimination that's enacted, where somebody experiences discrimination, then that makes them anticipate future discrimination," Reisner said. "So you might see postponement of care as anticipatory: not accessing care because they've already been discriminated against."

While the method — a cross-sectional survey — cannot establish a causal relationship between experiencing discrimination and having negative health outcomes, Reisner says the link is statistically significant.

"The probability of having a particular negative health outcome is increased as a function of people experiencing discrimination," Reisner said.

The link could be causal, Reisner said, but further studies are needed to determine that.

The survey has a number of recommendations, including providing cultural competency training to health care providers and frontline staff.

Another recommendation in the survey includes adopting a statewide law — now pending in the Legislature — making it illegal to discriminate in public accommodations on the basis of gender identity.

Massachusetts already has a nondiscrimination law that makes it illegal to discriminate on the basis of gender identity in housing, employment, credit and education.

"If there are laws protecting folks, then trans folks don't have to worry about being at the mercy of an individual's feelings about trans people," Taylor said. "If trans people are just left at the mercy of public opinion, then that's a dangerous place for us to be."