Assessment of Healthcare Access and Utilization Challenges among Transgender Individuals in District Rajanpur

Abstract

Background: The transgender community in Pakistan, like many other regions, faces significant marginalization and barriers in accessing and utilizing healthcare services. This study aims to shed light on these issues by assessing the socio-demographic profile, healthcare access, and utilization challenges faced by transgender individuals in District Rajanpur.

Objectives: 1. To determine the prevalence of healthcare access and utilization among transgender individuals. 2. To find the relationship between socio-demographic factors and healthcare access and utilization.

Methods: This analytical cross-sectional study employed snowball sampling to recruit transgender individuals in District Rajanpur. Data collection tool was piloted and assessed for reliability and validation.  The study examined various challenges to healthcare access, including financial constraints, fear of mistreatment, and the availability of gender-affirming treatments. Regression analysis was conducted to explore the relationship between socio-demographic variables and healthcare access/utilization.

Results: In this study, 59 transgender participants were included. The largest age segment was 29-39 years (37.3%). Trans females outnumbered trans males (55.9% vs. 44.1%). Most respondents were dancers (71.2%). Financially, the majority earned 11,000 to 20,000 PKR monthly (61.0%). Educationally, over half were uneducated (55.9%). Challenges included difficulty finding understanding healthcare providers (54.2%), hesitancy due to potential mistreatment (64.4%), and avoidance of healthcare services (69.5%). Financial barriers (74.6%) and medication access issues (69.5%) were common. Neglect within healthcare facilities affected 79.7% of respondents. Public hospitals (33.9%) and private clinics (32.2%) were commonly visited. Recent visits occurred within three months (39.0%) or last month (23.7%). Vaccinations (66.1%) and HIV testing (83.1%) were prevalent. Regression analysis revealed a significant relationship between monthly income and various healthcare-related variables. Higher income was associated with better access to gender-affirming treatments (β = 0.45, p < 0.01), counseling (β = 0.38, p < 0.05), and preferred healthcare facilities (β = 0.50, p < 0.01). Conversely, lower-income individuals faced more challenges in obtaining necessary medications (β = -0.42, p < 0.05) and were more likely to avoid healthcare visits due to financial constraints (β = -0.35, p < 0.05). Age, gender, and education also played critical roles in healthcare access. Older individuals (β = -0.30, p < 0.05) and those with higher education levels (β = -0.28, p < 0.05) were less likely to face difficulties in finding appropriate healthcare providers or to feel hesitant about visiting healthcare facilities. Trans females, however, faced greater challenges and were more likely to avoid healthcare services due to fear of mistreatment (β = 0.40, p < 0.01).

Conclusion: Transgender individuals in District Rajanpur face significant barriers in accessing and utilizing healthcare services, influenced by socio-demographic factors such as income, age, gender, and education. Addressing these challenges requires targeted interventions to improve healthcare provider understanding, reduce discrimination, and enhance financial support for this vulnerable population.