Dr. Diana Tordoff sheds light on unseen barriers in healthcare for transgender and nonbinary communities

Dr. Diana Tordoff sheds light on unseen barriers in healthcare for transgender and nonbinary communities

November 20, 2023   224

Intersectional Barriers to HIV/STI Healthcare Among Washington State Transgender and Nonbinary Communities


Recent research spearheaded by Dr. Diana Tordoff from the Seattle Trans and Non-binary Sexual Health (STARS) Advisory Board and the Duerr HIV Outcomes, Prevention, and Epidemiology (HOPE) Group has cast a vital spotlight on the intersectional barriers in healthcare access for transgender and nonbinary communities. This study is pivotal in understanding and addressing the nuanced challenges faced by these often marginalized groups in the healthcare system, particularly in HIV/STI healthcare.

Understanding the Core Issues

The study underscores a stark reality: transgender and nonbinary individuals frequently encounter systemic obstacles in accessing healthcare. This is largely due to institutional biases and a lack of trans-competent medical providers. These barriers are not just confined to specialized care but also extend to routine, preventative health services. The study emphasizes that these challenges are acutely pronounced in services related to sexual and reproductive health.

The Impact of Limited Access

The research brings to light that restricted access to HIV/STI testing and preventative tools like pre-exposure prophylaxis (PrEP) has led to a heightened risk and increased rates of HIV/STI transmission within the transgender community. This trend is particularly alarming as it directly impacts the health and wellbeing of these individuals.

Intersectional Research Methodology

Dr. Tordoff’s approach to this research is notably intersectional, focusing on identifying and addressing the compounded inequities faced by communities at the intersection of various social identities. The study employs quantitative intersectionality methods to analyze how experiences shaped by race and gender identity influence HIV/STI prevalence and healthcare accessibility.

In-Depth Study Analysis

The study involved an extensive examination of five HIV/STI surveillance data sources across Washington state from 2019-2021. This approach provided a comprehensive and diverse dataset, including over 1,600 transgender and nonbinary participants. The research team meticulously analyzed differences in insurance coverage, HIV/STI prevalence, testing, and PrEP usage, taking into account the critical factors of race and ethnicity.

Revealing Disparities

The findings reveal that transgender women of color are disproportionately uninsured and more impacted by HIV/STIs. A significant proportion of the higher HIV/STI prevalence in this group is attributed to the intersectional synergism of racialized and gendered experiences. Moreover, there are notable inequities in PrEP access, particularly among trans men and nonbinary individuals assigned female at birth.

Wider Implications in the Healthcare System

The study also sheds light on the broader systemic issues within the healthcare system. Despite the increased incidence of HIV in transgender communities, these groups are largely underrepresented in clinical trials. This exclusion has led to a lack of comprehensive data to inform effective clinical care for transgender people.

Community Engagement and Future Directions

A key aspect of this research is its community-based approach, conducted in close collaboration with the STARS Advisory Board. This involvement ensures that the voices and experiences of transgender and nonbinary communities are central to the research process. The study advocates for expanding access to trans-inclusive models of HIV/STI prevention and PrEP delivery, addressing barriers rooted in cissexism and structural racism.

Expanding Research and Policy

Dr. Tordoff’s work highlights the need for more inclusive research practices and policy changes that consider the diverse needs of transgender communities. By disaggregating data by gender, race, and ethnicity, researchers can better understand and serve these communities.


Dr. Tordoff's study is a significant contribution to our understanding of the intersectional barriers to healthcare faced by transgender and nonbinary individuals. It calls for an urgent need to reform healthcare practices and policies to be more inclusive, equitable, and responsive to the needs of these communities.



  1. What are the main barriers to healthcare for transgender and nonbinary communities?

    • The main barriers include institutional biases, systemic transphobia, lack of trans-competent medical providers, and challenges with insurance coverage for routine and preventative care.
  2. How does limited access to healthcare impact the transgender community?

    • Limited access increases susceptibility to HIV/STIs due to restricted availability of testing and preventative measures like PrEP.
  3. What methodology did Dr. Tordoff use in her research?

    • Dr. Tordoff used quantitative intersectionality methods to analyze the impact of racialized and genderized experiences on HIV/STI prevalence and healthcare access.
  4. What were the key findings of the study?

    • Key findings include a higher prevalence of HIV/STIs among transgender women of color due to intersectional synergism and significant disparities in access to PrEP.
  5. How can healthcare access for transgender and nonbinary individuals be improved?

    • Improvements can be made by expanding trans-inclusive healthcare models, addressing cissexism and structural racism, and ensuring transgender representation in clinical trials.


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