Housing insecurity and intersecting social determinants of health among transgender people in the USA: A targeted ethnography

Abstract

Background: Housing is an important social determinant of health (SDOH). Transgender people face a unique blend of discrimination and compromised social services, putting them at risk for housing insecurity and associated public health concerns.

Aims: This targeted ethnography explores housing insecurity as a SDOH among transgender people in the U.S.

Methods: In-depth interviews were conducted with transgender people (n = 41) throughout the U.S.A., identified through purposive sampling. A semi-structured guide was used to elicit personal stories and peer accounts of insecure housing experiences and coping strategies. Interviews were audio recorded and transcribed. Data was coded, sorted, and analyzed for key themes.

Results: Responses revealed pervasive housing insecurity and inter-related challenges. Respondents discussed how intersecting identities create unique constellations of vulnerability, which “intersect like a star.” Financial insecurity and interpersonal rejection were lead housing insecurity causes, often resulting in psychological strain, which was sometimes addressed with substances and sexual risk-taking. These factors were cyclically accompanied by financial and employment insecurity and a cascade of unmet social needs. Social support facilitated coping.

Discussion: Findings support increasing transgender housing security intervention resources that address intersecting and cyclical discrimination, trauma, housing, employment, and health issues.

Keywords:

• Housing insecurity
• intersectionality
• resilience
• social determinants of health
• transgender
• USA

Acknowledgments

The authors would like to thank all of the study participants who shared their time and stories with us, as well as the LGBT Community Center of New Orleans and BreakOUT! for participating in various stages of the project including research question development. We express deep appreciation to Jean-Michel Brevelle, Laura Durso, Brendon Holloway, and Kei Slaughter for reviewing manuscript drafts and providing indispensable insight. We also thank Kendra Davis, who helped with data transcription, Steph de Wolfe who assisted with preliminary coding, and Maya Deane-Polyak who assisted with data management, analysis, and manuscript review.

Declaration of conflict of interest

The authors state that they have no conflicts of interest to declare.

Notes

1 We use the terms ‘transgender’ as an umbrella term, acknowledging the great variety and preference in related language and identities, and constant evolution. Transgender is an umbrella term that describes individuals whose current gender is not fully congruent with their assigned sex at birth. Respondents’ self-ascribed gender identities are used throughout the article whenever possible.

2 In one instance the interviewer did not query the respondent for their racial identity.

Additional information

Funding

This study was supported by grants from the National Institutes on Alcohol Abuse and Alcoholism (NIAAA) (P60AA009803), and the Drug Dependence Epidemiology Training Program, NIH/NIDA (T32DA007292).