MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01C5BE97.C01E7D90" This document is a Single File Web Page, also known as a Web Archive file. If you are seeing this message, your browser or editor doesn't support Web Archive files. Please download a browser that supports Web Archive, such as Microsoft Internet Explorer. ------=_NextPart_01C5BE97.C01E7D90 Content-Location: file:///C:/8D882234/Dissertation-MasterDocument.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Social Determinants of Transgender Health

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Social Determinants of Transgender Health<= /o:p>

Scout

Submitted in partial fulfillment of the

requirements for the degree

of Doctor of Philosophy

under the Executive Committee of the Graduate School of Arts and Sciences

COLUMBIA UNIVERSITY

2005

Scout

ABSTRACT

Social Determinants of Transgender Health<= /o:p>

Scout

Transgender people are “compromised survivors” who both experience and challenge gender-based oppression.= The term “transgender” describes a diverse population of people who= se identity does not conform to normative gender expectations. Transgender people experience adve= rse health outcomes unlikely to be biological in nature, and are best understoo= d in terms of social determinants of health. The social determinants fram= ework contextualizes transgender health outcomes, situating them within a larger social context of discriminatory gender oppression. Life history interviews with 13 transgender people, focus groups with 16 transgender people and 9 in-depth interviews with “key informants” suggest that stress, (lack of) social support, and social exclusion are the primary social determinants of transgender health. Violence-related stress is most pronounced. Violence against transgender peopl= e is associated with level of gender variance; transgender people who regularly “pass” as either gender reported lower frequency of violence. Almost all participants reported frequent fear of violence. Hair-trigger violence, or sudden unprovoked aggression, was an impor= tant phenomenon among male-to-female (MTF) vector transgender people. Violence is often experienced within sexual relationships or within the context of sex work. Internal gender oppress= ion creates another layer of stress, often manifesting itself through addictions. For some particip= ants, addiction problems were resolved on “transition” from birth to = true gender. Social support is wea= k or absent for many transgender people. Participants experience alienation from families-of-origin, friend networks, and potential romantic partners.= Social exclusion of transgender people further compromises their hea= lth status. Exclusion from health= care, education, housing, and employment means that transgender people often lack access to basic resources. So= me female-to-male (FTM) participants experience an improvement in social stand= ing if they “pass” as male, but this is tempered with concomitant exposure to gender bias. The demographic factors of SES, race, gender vector (MTF or FTM), and ability to pass as gender normative have an interactive effect with social determinant= s. A diverse participant pool allows for the observation of gender-related trends across race and class. The approach used to recruit a diverse group of part= icipants from a hard-to-reach population was successful and can serve to inform work with other populations.