Health equity for trans and gender-diverse Australians: addressing the inverse care law through the provision of gender-affirming health care in the primary healthcare setting

Abstract

Background Equitable access to gender-affirming hormone treatment (GAHT) for trans and gender-diverse people has been identified as a key factor in addressing rates of poor health outcomes in the trans and gender-diverse community. In Australia, GAHT is largely delivered via a medical model, and within acute care facilities. Medicalisation and pathologisation of gender-affirming care acts as a significant barrier to access for many trans and gender-diverse individuals. Methods This project incorporated a case study approach using multiple methods to investigate a recent community sponsored, co-designed program providing GAHT that included a peer navigator (PN) model of care in a primary healthcare (community health) setting. Results Service activity in Year 1 and Year 2 demonstrated acceptability of the model, with over 1000 appointments delivered. This was supported by client feedback survey data collected at their initial (n = 110) and then 6-months post visit (n = 78) with the PN, and 31 interviews with clients, staff and stakeholders. Conclusion Findings highlight the integral nature of the PN to the sustainability of the program, with some key insights into potential barriers. Basing service design on an Informed Consent model recognises the agency of the individual and their right to equitable access to health care of their choosing.