title: Factors associated with healthcare avoidance among transgender women in Argentina.
abstract: BACKGROUND
  Transgender (TG) women in many settings continue to contend with barriers to healthcare, including experiences of stigma and discrimination. Argentina has a universal health care system and laws designed to promote healthcare access among TG women. However, little is known about barriers to healthcare access among TG women in this setting. The aim of this study was to explore individual, social-structural and environmental factors associated with healthcare avoidance among TG women in Argentina.
  
  
  METHODS
  Data were derived from a 2013 nation-wide, cross-sectional study involving TG women in Argentina. We assessed the prevalence and factors associated with avoiding healthcare using multivariable logistic regression.
  
  
  RESULTS
  Among 452 TG women included in the study, 184 (40.7%) reported that they avoided seeking healthcare because of their transgender identity. In multivariable analysis, factors positively associated with avoiding seeking healthcare were: having been exposed to police violence (adjusted odd ratio [aOR] = 2.20; 95% CI: 1.26 - 3.83), internalized stigma (aOR = 1.60, 95% CI: 1.02-2.51), having experienced discrimination by healthcare workers (aOR = 3.36: 95% CI: 1.25 - 5.70) or patients (aOR = 2.57; 95% CI: 1.58 - 4.17), and currently living in the Buenos Aires metropolitan area (aOR = 2.32; 95% CI: 1.44 - 3.76). In contrast, TG women with extended health insurance were less likely to report avoiding healthcare (aOR = 0.49; 95% CI: 0.26 - 0.93).
  
  
  CONCLUSIONS
  A high proportion of TG women in our sample reported avoiding healthcare. Avoiding healthcare was associated with stigma and discrimination in healthcare settings, as well as police violence experiences. Although further research is warranted, these finding suggests that socio-structural interventions tailored TG women needs are needed to improve access to healthcare among this population.
authors.forename: María Eugenia
authors.initials: ME
authors.lastname: Socías
authors.forename: Brandon D L
authors.initials: BD
authors.lastname: Marshall
authors.forename: Inés
authors.initials: I
authors.lastname: Arístegui
authors.forename: Marcela
authors.initials: M
authors.lastname: Romero
authors.forename: Pedro
authors.initials: P
authors.lastname: Cahn
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.forename: Omar
authors.initials: O
authors.lastname: Sued
mesh_terms: D000328:Adult; D001118:Argentina; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D057545:Social Stigma; D011795:Surveys and Questionnaires; D063106:Transgender Persons / Q000523:psychology*; D014754:Violence; D008297:Male