Defining Safety Among Gender-Diverse/Transgender People of Color

Background and Purpose: Transgender people experience higher levels of prejudice, discrimination, oppression, and violence than cisgender peers, and many feel unsafe when accessing healthcare services and during service provision, resulting in them forgoing care. These levels and feelings are often compounded for gender-diverse/transgender People of Color (POC). While extant literature has shown the impact that race and gender identity have on exposure to and experiences of prejudice, discrimination, oppression, and violence, no studies have explicitly explored how gender-diverse/transgender POC define safety, or to what extent safety is a factor in their readiness, willingness, and ability to engage with healthcare services. This study explored how gender-diverse/transgender POC define safety and how service providers can enhance gender-diverse/transgender POC’s feelings of safety when accessing and using services.

Methods: An initial semi-structured focus group with services providers who work with gender-diverse/transgender POC, many of whom identified as gender-diverse/transgender POC, explored how they as providers understand safety and feel their agencies work to meet the needs of gender-diverse/transgender POC. Individual interviews and a focus group were then conducted with gender-diverse/transgender POC to learn 1) How they define safety, 2) What aspects of community services and what actions of service providers contribute to them feeling safe or unsafe, and 3) How agencies can enhance their feelings of safety when receiving services. Thematic analysis was used to identify overarching themes and subthemes. Two research team members independently identified overarching themes which were discussed and consensus reached. Subthemes were then agreed upon and exemplary quotations identified.

Results: Twenty-six individuals participated in the interviews, many of whom expressed feeling empowered through sharing their narratives and being able to center their experiences. Three overarching themes were identified: Feeling Safe, Service Provider Actions, and Identity Acceptance. Feeling Safe referred to being free from reasonable harm, which was experienced through being fully accepted, feeling “seen and heard” in safe spaces, and being supported by biological, extended, and chosen family members. Service Provider Actions focused on providers using correct names and pronouns, monitoring their dispositions when interacting with clients and providing care, being cognizant of the environments where care is provided, and maintaining respectful policies and practices. Identity Enactment encompassed how individuals understood their identity and then enacted it. For some, being Black and gender-diverse/transgender are additive components of their identity, whereas for others either race or gender identity are prioritized depending on the situation.

Conclusion and Implications: Narratives related to safety often are shared only among community members, but this study enabled these narratives to be heard beyond those communities so that services providers can better understand what gender-diverse/transgender POC need when accessing healthcare services and how they can work to meet those needs. Safety is a feeling and sense of being impacted by others’ actions, thoughts, feelings, and environments. Providers contribute to clients’ feelings and experiences of safety through their choice of service location, the ways their services are structured, their verbal and non-verbal communication, them ensuring community representation, and their promotion of equal and equitable policies and practices.