(P440) Trauma and Its Impacts on Sexual Healthcare Experiences Among Transgender Women in the Southeastern United States: A Qualitative Study

Background: Transgender women (TGW) are disproportionately affected by sexually transmitted infections (STI), including HIV, as well as mental health conditions. Experienced trauma threatens TGW’s commitment to their sexual healthcare. Yet, trauma-informed approaches to providing sexual healthcare could improve engagement. The objective of this qualitative study was to better understand the unique facets of trauma experienced by TGW living in the Southeastern United States (US), especially as they relate to sexual health.

Methods: TGW were recruited from local gender health clinics in Birmingham, Alabama. Participants completed a socio-demographic survey followed by audio-recorded, in-depth individual interviews. Framed by the Modified Social Ecological Model, interviews explored the nature of trauma, sexual health, and their intersection in TGW’s lives. Interview content was iteratively adapted as the study progressed if indicated. Thematic analysis was performed using NVivo software.

Results: Between August 2022-January 2023, 12 TGW were enrolled. Participants were 67% Black and 33% Caucasian with mean age of 33 years (±10 years). Mental illness was common; 83% reported a diagnosis, including depression (58%) and anxiety (33%). Current drug use was uncommon. Four participants (33%) reported living with HIV and six (50%) reported lifetime STI. Emergent themes suggest experienced trauma for TGW is characterized by poverty and unemployment, high prevalence of survival sex work, stigma associated with gender identity, physical and sexual violence, and lack of family support. Indeed, participants described the independent and cumulative impact of these factors on their daily lives, including sexual health. Racial inequalities and anti-trans legal policies augmented experienced trauma for this group. Medical mistrust was exacerbated by traumatic experiences at the hands of providers and the medical establishment within sexual healthcare settings. However, personal resilience and trans representation in healthcare settings were considered protective.

Conclusion: Because various experienced traumas and their cumulative effects are pervasive in the daily lives of TGW, targeted interventions to improve sexual health engagement must optimize personal strengths and provide holistic support. Moreover, negative systemic influences are ubiquitous in the Southeastern US, suggesting that routine assessment of their role on TGW healthcare engagement is warranted.