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Managing uncertainty: A grounded theory of stigma in transgender health care encounters

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  • Poteat, Tonia
  • German, Danielle
  • Kerrigan, Deanna

Abstract

A growing body of literature supports stigma and discrimination as fundamental causes of health disparities. Stigma and discrimination experienced by transgender people have been associated with increased risk for depression, suicide, and HIV. Transgender stigma and discrimination experienced in health care influence transgender people's health care access and utilization. Thus, understanding how stigma and discrimination manifest and function in health care encounters is critical to addressing health disparities for transgender people. A qualitative, grounded theory approach was taken to this study of stigma in health care interactions. Between January and July 2011, fifty-five transgender people and twelve medical providers participated in one-time in-depth interviews about stigma, discrimination, and health care interactions between providers and transgender patients. Due to the social and institutional stigma against transgender people, their care is excluded from medical training. Therefore, providers approach medical encounters with transgender patients with ambivalence and uncertainty. Transgender people anticipate that providers will not know how to meet their needs. This uncertainty and ambivalence in the medical encounter upsets the normal balance of power in provider–patient relationships. Interpersonal stigma functions to reinforce the power and authority of the medical provider during these interactions. Functional theories of stigma posit that we hold stigmatizing attitudes because they serve specific psychological functions. However, these theories ignore how hierarchies of power in social relationships serve to maintain and reinforce inequalities. The findings of this study suggest that interpersonal stigma also functions to reinforce medical power and authority in the face of provider uncertainty. Within functional theories of stigma, it is important to acknowledge the role of power and to understand how stigmatizing attitudes function to maintain systems of inequality that contribute to health disparities.

Suggested Citation

  • Poteat, Tonia & German, Danielle & Kerrigan, Deanna, 2013. "Managing uncertainty: A grounded theory of stigma in transgender health care encounters," Social Science & Medicine, Elsevier, vol. 84(C), pages 22-29.
  • Handle: RePEc:eee:socmed:v:84:y:2013:i:c:p:22-29
    DOI: 10.1016/j.socscimed.2013.02.019
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    References listed on IDEAS

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    1. Sanchez, N.F. & Sanchez, J.P. & Danoff, A., 2009. "Health care utilization, barriers to care, and hormone usage among male-to-female transgender persons in New York City," American Journal of Public Health, American Public Health Association, vol. 99(4), pages 713-719.
    2. Krieger, N., 2012. "Methods for the scientific study of discrimination and health: An ecosocial approach," American Journal of Public Health, American Public Health Association, vol. 102(5), pages 936-945.
    3. Parker, Richard & Aggleton, Peter, 2003. "HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action," Social Science & Medicine, Elsevier, vol. 57(1), pages 13-24, July.
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