The Effects of Survival Economy Participation on Transgender Experiences of Service Provider Discrimination

Background/Purpose:Transgender people face a variety of barriers when accessing or utilizing service providers. These include discrimination, rejection, and a lack of understanding towards issues of gender identity on the part of service providers. As some studies suggest, these barriers may be exacerbated when a transgender person is involved in survival economies, such as sex work or drug sales. It is crucial to attend to this understudied phenomenon due to the high numbers of transgender people involved in survival economies and their need for services.

This study investigates how transgender involvement in survival economies affects transgender experiences of service provider discrimination, in comparison to discrimination experienced by transgender people not involved in survival economies. It hypothesizes that participation in survival economies intensifies transgender vulnerability to service provider discrimination.  

This is a significant contribution to the field as it is the first large-scale quantitative study that centralizes an examination of survival economy participation on transgender experiences of service provider discrimination. As such, it provides a foundational understanding of the problem upon which to improve services.

Methods: This study utilizes cross-sectional data compiled through convenience sampling by the 2008-2009 National Transgender Discrimination Survey (NTDS), the most extensive sample of transgender people in the United States. The final sample size (N=4,927) includes only those transgender respondents who reported experiencing service provider discrimination. Approximately 10% of all transgender people in this study have participated in survival economies.

Multivariable logistic regression was conducted that collapsed experiences of service provider discrimination across ten different service settings, including doctor's offices or hospitals, emergency rooms, rape crisis centers, domestic violence shelters, mental health clinics, drug treatment programs, ambulances, government agencies or officials, police, and legal services clinics. The strength of association was estimated by calculating odds ratios (OR) with 95% confidence intervals (CI). Additionally, logistic regression sub-analysis was conducted that independently compared each of the ten service settings in terms of transgender experiences of discrimination.

Results:Logistic regression revealed that participation in survival economies is a significant predictor of a transgender person's increased odds of experiencing service provider discrimination. The full multivariate model shows that those participating in sex work have almost 3 times greater odds (OR: 2.83, CI: 2.20 – 3.63), and those participating in drug sales have approximately 1.5 greater odds (OR: 1.52, CI: 1.16 – 1.99), compared to those not participating in survival economies. The sub-analysis illustrates that sex work and drug sales continue to be significant predictors across multiple service settings, with drug treatment clinics demonstrating the highest increased odds for discrimination.

Conclusions and Implications: Findings suggest that service providers must attend to the specificity of transgender experiences in survival economies. Harm reduction, an approach already utilized to intervene on the micro level in survival economies, can be utilized for implementing organizational interventions that alter the macro structural power relations of service provider systems for the purposes of both reducing capacities for discrimination and promoting longevity among all transgender people.