Table 2.
Research on the Health of Transgender Migrants by Region and Country
| Author (year) | Location | Study design | Sampling method | Sample | Relevant findings | Health outcome |
|---|---|---|---|---|---|---|
| Alessi et al. (2017) | USA and Canada | Cross-sectional qualitative interviews | Purposive sample | 26 LGBT adults; 2 transgender men and 2 transgender women | Most participants migrated due to discrimination experienced because of their gender and/or sexual identity. Upon migration, participants experienced violence due to their immigration status, religion, and sexual and/or gender identity. | Violence |
| Alessi et al. (2018) | Vienna, Austria and Amsterdam, Netherlands | Mixed-methods; quantitative survey and qualitative interviews | Purposive sample | 38 LGBT participants; 5 transgender women; 2 gender nonconforming; 1 transgender man | 89.2% reported PTSD symptoms before migration. Most participants fled violence, abuse, family, war, government instability, and political persecution. Many participants described experiencing targeted violence from officials and other refugees during their migration journey. | Violence; mental health |
| Bianchi et al. (2014) | Bogota, Colombia | Cross-sectional; qualitative interviews | Convenience sample | 26 migrants; 12 transgender women | Transgender women experienced employment discrimination, which necessitated engaging in survival sex. Transgender women often experienced violence from clients and reported inconsistent condom use and low HIV testing rates. | Violence; sexual risk; HIV testing |
| Cerezo et al. (2014) | California, USA | Cross-sectional; qualitative interviews | Convenience sample | 10 Latina transgender women | Participants migrated due to discrimination; however, participants also experienced psychological distress due to a lack of emotional support, violence, and discrimination. In the USA, participants faced employment discrimination, which led to engaging in survival sex. | Violence; mental health |
| Cheney et al. (2017) | California, USA | Document analysis | Convenience sample | 45 documents from transgender women asylum seekers from Mexico | Participants had a poor quality of life in Mexico which included experiencing assaults and psychological distress | Violence; mental health |
| Crepet et al. (2016) | Italy | Cross-sectional; quantitative survey | Clinic based | 3588 migrants; 194 identified as transgender | 2.4% screened positive for at least 1 TB symptom. Trans patients had the highest probability of screening positive for TB | TB |
| Gowin et al. (2017) | USA | Document analysis | Convenience sample | 45 redacted declaration documents and psychological evaluations from transgender women asylum seekers from Mexico | Transgender women experienced a wide range of stressors, including verbal, sexual, and physical assault. All participants were diagnosed with PTSD. Although migration to the USA reduced stress, many continued to experience stress related to documentation status, income, and racism | Violence; mental health |
| Hwahng et al. (2019) | New York City, USA | Cross-sectional; Qualitative focus groups | Convenience sample | 13 Latina transgender women | Participants reported that support groups helped them form new support systems, access health care, build capacity, access educational and gender affirmation resources, and decreased alcohol use. | Access to Health care, including gender affirming care; Alcohol Use |
| Leyva-Flores et al. (2016) | USA | Cross-sectional; quantitative survey | Convenience sample | 4075 Central American migrants; 0.71% identified as transgender | Transgender participants had the highest HIV prevalence | HIV prevalence |
| Nemoto et al. (2011) | California, USA | Cross-sectional; quantitative survey | Convenience sample | 573 transgender women with a history of sex work; n=200 migrants | Not specified | Migration status did not significantly predict depression |
| Nuttbrock and Hwahng (2017) | New York City, USA | Cross-sectional; Quantitative survey | Convenience sample | 199 transgender women | Those who were foreign born had an increased odds of engaging in sex work and condomless sex. There were no differences by country of origin and HIV/STI incidence. | HIV risk |
| Palazzolo et al. (2016) | Washington, DC, USA | Cross-sectional; qualitative interviews | Convenience sample | 8 Latina transgender women | Most participants immigrated after experiencing violence in their country of origin. Participants who gained legal asylum reported greater control over their sexual relationships, improved access to services, and safer employment options. Legal name change was described as an important aspect of gender affirmation. Participants reported using nonprescribed hormone use and accessing HIV testing at Emergency Rooms. | Violence; HIV risk; HIV testing; access to health care |
| Rhodes et al. (2013) | North Carolina, USA | Cross-sectional; quantitative survey | Respondent Driven Sampling | 190 MSM and transgender women; 31 transgender women | Social support, sexual compulsivity, and self-esteem were associated with depressive symptoms. There were no differences between MSM and transgender women. | Mental health |
| Rhodes et al. (2015) | North Carolina, USA | Cross-sectional; photo voice | Convenience sample | 9 Latina transgender women | Transgender women experienced daily challenges, reported low accessing to gender affirming medical care, and engaged in unsafe coping strategies (i.e., alcohol, substance use, and condomless sex) due to stress | Access to health care, including medical gender affirmation; substance use; HIV Risk |
| Sausa et al. (2007) | California, USA | Cross-sectional; qualitative focus groups | Convenience sample | 48 transgender women of color | Sex work initiation often occurred through peers. Sex work was associated with violence, drug use, and STIs. Participants migrated to USA for a liberal and affirming society | Violence; substance use; STIs |
| Spizzichino et al. (1998) | Rome, Italy | Cross-sectional; medical chart review | Clinic based | 528 patients at Drug Treatment/AIDS Unit; 167 identified as transgender | One-third of transgender patients were engaging in sex work. HIV prevalence among transgender patients was 45.5%. Transgender patients reported lower heroin use but higher cocaine use than cisgender patients. Transgender patients living with HIV had greater retention in care and condom use than their cisgender counterparts. | HIV risk; access to health care |
| Spizzichino et al. (2001) | Rome, Italy | Cross-sectional, medical chart review | Clinic based | 353 transgender patients | HIV prevalence was 38.2%; patients from Brazil and those reporting a higher number of sexual partners had a greater odds of living with HIV | HIV prevalence |
| Yamanis et al. (2018) | Washington, DC, USA | Cross-sectional; quantitative survey | Convenience sample | 38 transgender women | Participants had a high prevalence of depressive symptoms (35%), lifetime suicide ideation (47%) and attempts (32%), and HIV prevalence (32%). | Mental health; HIV prevalence |
| Zaccarelli et al. (2004) | Rome, Italy | Cross-sectional; medical chart review | Clinic based | 437 transgender individuals | Approximately 31% were living with HIV and 15% reported injection drug use. Those who were living with HIV were more likely to not use condoms regularly | HIV incidence; drug use; HIV risk |
| Zehender et al. (2004) | Italy | Cross-sectional; quantitative case–control; medical chart review | Clinic based | 393 immigrants; 31.1% transgender women | All patients living with HIV and HTLV-1 were transgender women who engaged in sex work. Transgender women who engaged in sex work also had the highest prevalence of HTLV-2. | HTLV-1 and HTLV-2 prevalence |
HTLV, human T-lymphotropic virus; LGBT, lesbian, gay, bisexual, and transgender; MSM, men who have sex with men; PTSD, post-traumatic stress disorder; TB, tuberculosis.