Needs Assessment of Transgender Virginians Living in Rural Areas

Background:  Between 2005 to 2006 a state-wide transgender task force was created and surveyed a sample of transgender individuals across the state as part of the Virginia Transgender Health Initiative Survey (VA THIS).  Results from this survey have been cited more than 190 times; despite that, researchers tended to focus only on the differences between genders (female-to-male spectrum vs male-to-female spectrum), leaving other factors largely unexplored.  While literature surrounding the lived experience of transgender people living in rural areas is sparse, most researchers have indicated that transgender individuals residing in rural areas have poorer outcomes than those living in more urban areas.

Objectives.  This study seeks to profile characteristics of transgender individuals residing in Virginia and identify differences in reported needs and gaps in services for persons in rural locations as opposed to urban/suburban locations.

Methods.  Secondary data from the VA THIS study was used for this project.  The data represents a non-probability sample of 350 transgender Virginians who answered questions related to 13 areas, including health care access, discrimination, employment, housing, substance abuse and knowledge of HIV prevention.   Given the current study’s focus on increasing our understanding of the experiences of rural transgender persons, responses for urban and suburban respondents were combined.  Thus, the analysis focuses on rural versus non-rural (urban/suburban) comparisons

Results.   Although results in several areas indicate that there are differences between rural and urban/suburban transgender individuals in Virginia, the differences were not as large as expected, particularly in employment status, education achieved, and access to health care, to name a few.  It is noted that one area of difference was located surrounding comfort in discussing transgender issues with one’s regular physician.  Despite the fact that more rural transgender individuals reported having a regular doctor, they were less likely to be “out” to their doctor.  Over 50% of rural respondents indicated fearing ridicule from health care professionals or fearing being denied treatment.

Conclusions.  Findings suggest that, while transgender persons have numerous unmet wellness-related needs there are few differences between rural and urban/suburban transgender individuals in this sample. This may be in part due to limitations in sampling techniques or the nature of the state of Virginia.  Specifically, while Virginia has 40 independent cities, many of these are not large urban areas.  Much of Virginia would be considered rural, but only 61 respondents reported residing in a rural area.  As the original survey recruited respondents via service providers, support groups, community events, a newsletter and informal peer networks, it is unlikely that the most rural transgender Virginians were included.  Transgender individuals living in these areas are likely to be the ones with the lowest access rates and highest needs.

Implications.  While this study revealed fewer differences between rural and urban/suburban transgender Virginians, it still indicates a need for increased resources state-wide.  Additionally, given the exploratory nature of this study, further investigation into the needs of transgender individuals living in the most rural areas of the nation is warranted.