Asheville-based nonprofit Campaign for Southern Equality, along with Western North Carolina Community Health Services, released a study last month detailing the health care experiences of transgender and nonbinary people. Transgender Health in the South centers on the experiences of a diverse focus group of people from transgender communities across six Southern states, including North Carolina.

Austin Johnson, who works as an assistant professor of sociology at Kenyon College in Gambier, Ohio, served as the principal investigator for the project. Johnson says that the report uncovered considerable barriers that transgender and nonbinary participants face when seeking medical care.

“What we found was that trans folks across all of these identity categories, different socioeconomic backgrounds, different educational backgrounds and gender backgrounds, were experiencing similar things throughout the South, which is difficulty accessing care,” Johnson says.

Words matter

Johnson explains that it isn’t uncommon for transgender people to experience indifference, disrespect and even refusal to provide treatment from health care professionals. Study participants reported that in some cases, even one demeaning or hostile incident with a health care professional could cause them to hide their gender identity or avoid seeking medical care altogether.

Ivy Gibson-Hill, community health program director at the Campaign for Southern Equality, says that doctors and other health care workers should use patient’s requested names and language when communicating with transgender individuals. Gibson-Hall, who uses gender-neutral pronouns, explains that misgendering patients could potentially open patients up to harassment or violence outside of the medical setting.

“One of the things that echoes my own experiences is just how important the front office staff is,” Gibson-Hill says. “People are being put in really dangerous situations when front office staff are calling them by the wrong names in front of waiting rooms full of people. It actually puts people in danger. That’s something that we heard from our participants and that’s a big reason why people are scared to go to the doctor.”

Dirty South

According to a 2016 study by the Williams Institute, an independent research group that focuses on sexual orientation and gender identity, 35 percent of the LGBTQ population in the United States resides in the South, including an estimated half million transgender people.

That’s why Scott Parker, director of development and collaborations at Asheville-based WNC Community Health Services, says research that focuses on the specific needs of transgender Southerners remains vital.

“What the report really was good at was taking people from the South and asking them these questions, asking them what it is that they needed and getting a truly southern perspective on providing transgender health care in the South,” Parker says.

A 2016 report from the Henry J. Kaiser Family Foundation states that Southerners lead the way in both poverty and chronic illness. Additionally, the National Center on Transgender Equality in 2015 estimated that transgender people are twice as likely to live in poverty as nontrans people. Parker says these factors overlap for trans individuals living in the South, which pushes access to proper care further out of reach. These issues, along with deep-rooted and prevalent religious attitudes, can leave transgender people feeling cut off from much-needed health care resources.

“A lot of transgender people live in rural areas where access to care is much more of a problem than for some of the folks in larger cities,” Parker says. “Living in the Deep South and in rural areas where access to high-quality and accepting health care for a trans population can be an obstacle.”

Parker says attitudes have been slowly shifting toward accepting nontraditional gender identities, even in the South.

“I grew up in the South and I grew up being told if a woman is behind you and you’re coming through a door, you always hold the door open for her. I always wondered why you didn’t do it for a man or another person. But that’s kind of evolving,” Parker says. “You open the door for everyone because they’re a human being.”

Best practices

Not all of the report’s conclusions were gloomy. Gibson-Hill says one encouraging piece from the project was learning the power of community support to help transgender people to feel more comfortable when advocating for their medical care. Those who had a support system, whether it be friends, family, or pro-trans groups or networks, reported feeling more resilient and empowered about their health care decisions.

“Even if it doesn’t feel like you’re doing health work, if you’re organizing and connecting trans folks with each other, that is affecting folks’ access to health care and the quality of the care that their accessing,” Gibson-Hill says.

Gibson-Hill says a newly expanded and updated referral guide will also follow on the heels of last month’s report. The 2019 edition of Trans in the South: A Guide to Resources and Services will include more than 400 trans-friendly primary care providers, legal advisers, therapists and more for 13 states across the South. The guide also provides information on insurance coding, hormone replacement therapy and HIV specialists within the region.

The Campaign for Southern Equality also plans to hold an online community discussion on Wednesday, Jan. 30, at 6 p.m. to provide an opportunity for researchers to reflect on their findings with advocates and health care providers while answering questions from the community (avl.mx/5kk).

Lead investigator Johnson says he hopes that the new report will help guide health care providers when choosing to treat those with nontraditional gender identities. Detailed examples within the study illustrate concrete ways in which providers can administer services while respecting transgender patients.

“I think that expecting providers to just know the answers is not the right way to go. We have to help them find the answers to how to treat trans people. When a provider is ready and saying, ‘I want to treat trans people and I want to do so respectfully and to provide the best clinical ability,’ we should be there to help them along with that,” Johnson says. “I see this report as a way to do that. We’re not necessarily just identifying problems, we’re providing a road map for solutions.”