Trans and gender diverse peoples' perspectives on sexual health services in the united kingdom

Introduction

Trans and/or gender diverse (TGD) people in the UK are less likely to access sexual health services (SHS) than cisgender people and more likely to report negative service experiences. The BASHH Gender and Sexual Minorities Special Interest Group (GSM SIG) developed expert recommendations for TGD-inclusivity but lacked evidence from service users. This study aimed to address this gap by asking TGD people for their perspectives on how SHS could be more inclusive.

Methods

TGD people (n=53) took part in semi-structured interviews (n=32) and focus groups (n=21). Participants were aged between 17 and 71 years and recruited nationally through community organisations and social media. Data were analysed using inductive thematic analysis, using NVivo. The study design, materials, and analysis were informed by patient and public involvement (PPI) with TGD people and an advisory committee of TGD charities and SHS clinicians.

Results

Expectations for inclusive care in SHS were low, based on poor experiences in other healthcare settings. Participants wanted services to engage with the diverse lived experiences and needs of TGD people. Their recommendations aligned with GSM SIG, including service set-up (e.g., gender options on forms, gender neutral toilet facilities) and consultations (e.g., asking/sharing pronouns, gender-neutral language). Participants described TGD inclusivity as produced through the interaction of service users, staff, and clinical spaces. For example, they critically assessed hallmarks of LGBT inclusivity (e.g., Pride flags in waiting areas), preferring those that signified meaningful engagement with TGD care (e.g., Trans or Progress Pride flags). Although participants recognised the value of specialised TGD services, not all were able or willing to access them.

Discussion

These findings provide insight into what a sample of TGD people in the UK consider important to inclusive SHS and reinforce GSM SIG recommendations. Importantly, they highlight the need for ongoing and active engagement with TGD-inclusivity across all SHS.