Health care access and utilization among transgender adults in Chennai: a cross-sectional study

Understanding regarding the healthcare needs and health seeking behaviour of transpersons is crucial to provide inclusive health care services. This study is an attempt to enhance knowledge about the overall health of the transgender community, analyzing their healthcare-seeking behaviours, the rationale behind their choices, and the barriers they face in accessing healthcare services in Chennai, South India, a large metropolitan city with a significant transgender population. This cross-sectional study involved 104 transgender adults recruited through snowball sampling in Chennai, Tamil Nadu. Data were collected using an interviewer-administered questionnaire, developed with inputs from community members, to assess patterns in seeking care for general and mental health complaints, screening for noncommunicable diseases and sexually transmitted infections, and gender reaffirmation procedure. Data was analyzed using JASP (Jeffreys Amazing Statistics Program) and Anthropac software was used for scree plot analysis. The choice of healthcare was primarily binary between private and government services for major, chronic illnesses and accidents. For minor, major, and chronic diseases transpersons preferred private facilities (45.2%, 61.3%, 66.7% respectively) and for STI screening government facilities (55.4%) were preferred. About 68.3% (71 of 104) of the participants had mental health symptoms in the past year, of those only 18% (13 of 71) sought therapy. Hormone replacement therapy (HRT) is a popular method of gender affirmation among transmen (86.6%). For gender reaffirmation services like HRT and Gender affirmation surgery (GAS), private facilities were preferred (48.21%, 75.7%). government facilities were not preferred for HRT because of non-availability and distrust; and for GAS because of perceived poor quality of services, delay in services, lack of availability and unawareness. The current healthcare utilization pattern among transgender people shows a preferential use of private facilities and the pattern varies depending on the type of health need. This requires introspection among healthcare policymakers to ensure inclusiveness. Our recommendation is to create gender sensitization modules for health-care workers, encourage private-public partnerships and run awareness campaigns about services offered to increase utilization of government services.