Exploring the utilization of targeted intervention services by transgender individuals in Uttarakhand, India: a qualitative study

Front Public Health. 2024 Dec 4:12:1476938. doi: 10.3389/fpubh.2024.1476938. eCollection 2024.

Abstract

Purpose: Transgender (TG) women face violence, discrimination, and stigma, which affect their mental health and hinder their access to targeted intervention (TI) services. This lack of access may increase the risk of human immunodeficiency virus/sexually transmitted infections (HIV/STIs). However, the utilization of TI services among transgender women in Uttarakhand, as well as across the country, remains understudied. The purpose of this study is to explore the utilization of TI services by the transgender community in Uttarakhand.

Methods: This qualitative study focused on non-government organizations (NGOs) that implement TI projects in Haridwar and Roorkee, Uttarakhand, India. From September 2023 to January 2024, 5 focus group discussions (FGDs) involving 24 transgender women and 9 in-depth interviews (IDIs) involving NGO staff were conducted. Thematic analysis, guided by the Anderson and Newman healthcare utilization model, was employed.

Results: Several barriers to service utilization were identified, including ritual beliefs, low health literacy, stigma, social isolation, financial insecurity, privacy concerns, and inefficient service delivery. Challenges in the implementation of the STI program and neglect of transgender women in health facilities were also reported. However, enabling factors such as trusted providers, supportive laws, and initiatives by NGOs and government agencies were recognized. Nonetheless, there remains a significant need for information on gender-affirming services and addressing other prevalent health issues within the transgender female community.

Conclusion: The study underscores the interplay of individual, social, and service-related factors affecting healthcare access among transgender women. Inclusive and high-quality healthcare services are necessary to address the complex sociocultural aspects influencing transgender women's healthcare access and utilization.

Keywords: barriers to service utilization; healthcare utilization model; qualitative study; targeted intervention (TI); transgender.

MeSH terms

  • Adult
  • Female
  • Focus Groups*
  • Health Services Accessibility / statistics & numerical data
  • Humans
  • India
  • Interviews as Topic
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care / psychology
  • Patient Acceptance of Health Care / statistics & numerical data
  • Qualitative Research*
  • Social Stigma*
  • Transgender Persons* / psychology
  • Transgender Persons* / statistics & numerical data

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This research was supported by National AIDS Control Organization, India. The funder had no role in the design of the study, data collection, analysis, interpretation of the data.