On-Campus Healthcare Experiences of Trans HBCU Students

Background and Purpose: Trans people of color (including transgender, non-binary, and other gender-expansive identities) experience health inequities related to their multiple marginalized identities. While historically Black colleges and universities (HBCUs) provide supportive learning environments for Black students, it is unclear if these protections extend to LGBTQ+ students. Yet positive healthcare experiences in early adulthood could improve relationships with healthcare providers and lead to better long-term health outcomes and quality of life.

As trans youth experience more and more barriers to accessing healthcare due to local- and state-legislative efforts, college may offer many trans students their first opportunity to receive gender-affirming or transition-related healthcare. There is currently little research addressing trans students at HBCUs, particularly around issues of health. This study addressed the following research question: What is the lived experience of trans HBCU students with accessing and utilizing on-campus physical and mental health services?

Methods: Descriptive phenomenology was used to assess the experiences of trans HBCU students with on-campus health services. A convenience sample was recruited via social media, e-mail to LGBTQ+ campus organizations and allies, and word of mouth. In-depth interviews were conducted with 18 self-identified trans HBCU undergraduate students who experienced a need for health or mental health services while attending college.

Intersectional Research for Trans Health Justice (IRTHJ) examines structures of domination, systems of inequality, and socio-structural processes to achieve change in health. This study used the IRTHJ framework to center the voices and perspectives of participants to share rich descriptions and personal experiences and assess what Black trans students seek from quality healthcare providers. One-on-one interviews were conducted via Zoom, with recordings transcribed verbatim. NVivo was then used for a descriptive phenomenological analysis.

Results: Participants reported experiences ranging from positive to negative, with many experiences in between. Students discussed experiences with both on- and off-campus healthcare providers, as well as campus climate, involvement in campus-based LGBTQ+ community, and interactions with fellow students, faculty, and staff. Despite some negative experiences on campus and with on-campus healthcare, many students were optimistic about future care and showed resiliency in dealing with challenges. Regarding the intersection of race and gender identity, some students experienced racial discrimination from white healthcare providers despite HBCUs generally being Black-affirming spaces. By contrast students reported few negative experiences from the Black community related to their gender identity.

Conclusions and Implications: The findings from this exploratory study will inform the next phase of research to obtain more comprehensive and generalizable data regarding the experiences of trans people of color regarding higher education and healthcare. Receiving gender-affirming care during emerging adulthood may empower individuals to better manage their healthcare and improve long-term outcomes. Based on these findings, HBCU leaders can consider ways to improve the services that trans students receive. By welcoming trans students and providing affirming experiences with healthcare, HBCUs have the opportunity to reduce future inequities in employment, healthcare, housing, and other areas that limit the lives of trans people of color.