title: Experiences of Trans Women and Two-Spirit Persons Accessing Women-Specific Health and Housing Services in a Downtown Neighborhood of Vancouver, Canada.
abstract: Little is known about trans womens' experiences accessing gender-segregated health and housing services, particularly services for marginalized individuals living in poverty. As such, we conducted a qualitative investigation into experiences of accessing women-specific health and housing services among trans women and two-spirit persons in a downtown neighborhood of Vancouver, Canada.
  
  
  
  Between June 2012 and May 2013 interviews were conducted with 32 trans women and two-spirit individuals who had accessed women-specific health and/or housing services. Participants were recruited from four open prospective cohorts of sex workers and individuals who use drugs. Interview data were analyzed using a participatory analysis approach with two participants who were hired as research assistants.
  
  
  
  Participants were generally able to access women-specific services in the neighborhood. However, there were reports of discrimination related to gender identity, discrimination based on gender expression (e.g., requirement of a feminine gender expression), and lack of staff intervention in harassment from other service users.
  
  
  
  Trans women and two-spirit persons in our study relied upon services for their health and safety and, therefore, exclusion from women-specific services had potentially severe adverse consequences such as homelessness and sexual violence. Recommendations to improve accessibility, including policy development and procedural recommendations, are put forth.
authors: 1 Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver, Canada .|2 Department of Criminology, Kwantlen Polytechnic University , Surrey, Canada .
authors: Tara
authors: T
authors: Lyons
authors: 1 Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver, Canada .|3 School of Population and Public Health, University of British Columbia , Vancouver, Canada .
authors: Andrea
authors: A
authors: Krüsi
authors: 4 Providing Alternatives Counselling & Education Society (PACE) , Vancouver, Canada .
authors: Leslie
authors: L
authors: Pierre
authors: 5 Pivot Legal Society , Vancouver, Canada .
authors: Adrienne
authors: A
authors: Smith
authors: 1 Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver, Canada .|6 Faculty of Health Sciences, Simon Fraser University , Burnaby, Canada .
authors: Will
authors: W
authors: Small
authors: 1 Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver, Canada .|3 School of Population and Public Health, University of British Columbia , Vancouver, Canada .
authors: Kate
authors: K
authors: Shannon
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001955:British Columbia; D002947:Cities; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006703:Ill-Housed Persons / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011203:Poverty; D011446:Prospective Studies; D036301:Qualitative Research; D012112:Residential Facilities; D011477:Sex Work; D063508:Social Discrimination; D019966:Substance-Related Disorders; D063106:Transgender Persons / Q000523:psychology*; D055815:Young Adult
keywords: access to care; gender identity; health disparities; homelessness; substance use; transgender