Discussing the Public Health Crisis of Transgender Healthcare & Policy with Dr. Arjee Restar

Q&A Feature of Arjee Restar’s “The Public Health Crisis State of Transgender Healthcare and Policy” (2024).

The U.S. currently faces an increasing number of anti-trans legislation that aim to restrict the rights and freedoms of transgender and nonbinary (described with the umbrella term of “trans”) persons,¹ particularly children and adolescents, in multiple areas including healthcare, employment, education. In a recent editorial published in the American Journal of Public Health, Arjee Javallena Restar (she/her), assistant professor of Epidemiology at the University of Washington, outlines the health impacts of anti-trans legislation and the ways in which HIV and other health researchers can proactively curb their impact.

As co-investigator of ATN 167: LEAP and member of the Assets, Resources, Challenges, and Context (ARCC) Scientific Leadership Group, Restar discusses how the fraught policy landscape impacts HIV research within and beyond the ATN.

Q: How does policy shape HIV and other health inequities for trans youth?

AR: Policies, especially those rooted in transphobia, negatively impact health disparities and inequities for trans youth, especially in terms of HIV access and outcomes, respectively.

From the public health literature, we know that in states where such legislation has passed, trans people are reporting either loss of access to healthcare or are feeling discouraged going to a provider for fear of being reported. Providers, too, are reporting a chilling effect for providing healthcare for their trans patients for fear of being attacked/targeted, which has happened in some hospitals. This has deep implications for preventing HIV inequities because most of the places where HIV is densely saturated (e.g. Ending the HIV Epidemic jurisdictions) are also places where our research has observed to have expansive anti-trans legislation (study findings forthcoming) that restrict access to social determinants of health based on gender (e.g. housing, employment, public accommodation).

So, these findings show that policies do not have to specifically address HIV for it to impact HIV outcomes or other outcomes like mental health, which is also documented to be well connected with having access to healthcare. Currently, over 100,000 trans youth are living in states with these expansive legislative bans.

Q: What is an example of how anti-trans legislation affect the health of trans youth?

AR: I’ll premise by stating that policies on anti-abortion may not seemingly be anti-trans at first glance, but applying an intersectional approach rooted in bodily autonomy makes these policies inherently anti-trans.

These policies undermine bodily autonomy, crucial for all individuals, including trans youth, to make informed decisions about their healthcare. When reproductive rights are restricted, it sets a precedent for limiting healthcare access and autonomy more broadly, extending to gender-affirming care and essential health services for trans individuals. We’ve seen these policies go hand-in-hand with almost the same states pushing for both policies in recent years.

For trans youth, the implications are profound. For example, trans youth who are sexually active or those who have the capacity to become pregnant do seek abortion services, particularly for unintended pregnancies. However, given that abortion policies can contribute to a culture of stigma and discrimination against those seeking bodily autonomy, trans youth with unintended pregnancies and who are already facing high stigma may find the healthcare system increasingly hostile. Additionally, clinics/hospital systems restricted by anti-abortion policies may also offer less inclusive care for trans youth, creating gaps in services like HIV prevention and treatment, mental health support, and gender-affirming care.

Q: How can HIV research respond to better address inequities among trans youth?

AR: HIV research has made progress in recognizing the social, medical, legal, and structural determinants of HIV inequities in trans youth, but more progress toward prioritizing community engagement from research investments can be made.

Trans youth are so creative and brilliant, and HIV research can respond better by harnessing and supporting trans youth’s talents through training and investments. We need the next generation of the HIV research workforce to be representative of trans communities. We need training programs that build and invest in the future of trans youth as leaders and decision-makers across sectors, given that economic and employment inequalities are still prevalent and are highly linked to HIV outcomes.

We can respond to this by having research projects like ATN 167: LEAP that make observable, actionable efforts into hiring and retaining trans staff/personnel and into providing transferable skills in their career trajectory to be competitive in the workforce. For this to happen, we must take community engagement seriously, and infuse it in our HIV research projects/programs.

Q: What is something that trans communities need?

AR: Now more than ever, especially with the numerous ongoing legal battles across the country – that are happening from the state level (e.g., gender-affirming care access) to the individual level (e.g., housing denial, insurance claims denial, and legal appeal), trans communities need allies in legal spaces.

We need to assess and reprioritize the legal needs of trans people and foster legal support and knowledge as an asset to trans communities. For example, we must deepen our connection to and with legal counselors, attorneys, and lawyers — we must think about how to develop multi-sectoral interventions like LEAP that have this legal component and invest in building partnerships and relationships with people who engage within judicial and legislative bodies.

To read more about this issue, check out the original editorial.

About the Researcher:

Arjee Javeliana Restar, PhD, MPH
ATN 167: LEAP Co-Investigator, ARCC SLG Member

Born in the Philippines, Arjee is now practicing public health to make visible the importance of health policies and equitable community resources in the lives and health of historically disadvantaged populations, including transgender, nonbinary, and gender diverse communities of color. Arjee’s research engagements in public health concentrate on promoting structural and behavior-based interventions to improve the health of communities affected by a multitude of adverse sexual and mental health outcomes, such as HIV and other sexually transmitted infections, sexual violence, and suicidality.

Footnotes:

  1. This article uses “trans” as an umbrella term for gender diverse communities, though not all nonbinary people identify as trans. Research demands that we categorize people in ways that are not always fully descriptive and inclusive of intersectionalities. This may create feelings of discomfort or further minimization, which is never our goal. This research is meant to serve the community and we are doing our best to collect and share data in intentional ways.