Barriers to Health Care Access and Utilization Among Transgender Female Sex Workers in the United States: A Systematic Review of Literature from the Past 10 Years

Abstract

Background: Transgender women in the U.S are disproportionately affected by systemic trans-phobia that limits their options in getting jobs, housing, and health care. Many fall into poverty and have high disease burdens due to sexually transmitted infections, depression, and substance use. These hardships often play pivotal roles in some transgender women's entrance into sex work. In this systematic review, we seek to identify the main barriers to healthcare access and utilization among transgender sex workers (TGSWs). Methods: We collected articles from PubMed, Google Scholar, and JSTOR related to transgender sex work and health care in the past ten years. Keywords for these searches included “transgender sex workers” AND “access health care,” “health care utilization,” and specific known barriers (such as “discrimination”). Results: Our literature review identified five psychosocial barriers and five structural barriers to TGSWs' access to and utilization of health care. Psychosocial barriers included internalized stigma, fear of sex work disclosure, lack of comfort with doctor, concern of disease disclosure, and depression and substance use; Major structural barriers included health professionals' lack of knowledge about trans-health, traumatic past experiences within a healthcare context, pervasive transphobia, criminalization of sex work, and limited social support or isolation. Discussion: This review can help develop a more responsive health system for TGSWs in order to reduce health disparities. Future research should focus on TGSW coping and resilience, expanded access to mental health and chronic disease care, development of a physician training curriculum focused on trans cultural competency, and community-wide dismantling of transphobia.