Introduction

Social determinants of health (SDoH) that fuel inequities are well-documented among transgender (trans) people and people of color. Scant literature has explored the experiences of trans women of color, with the exception of HIV-focused studies. There has been a limited focus on how intersecting oppressions (e.g., cisnormativity, racism) shape inequities and community-led strategies for social justice-oriented change. Through an intersectional lens, this study sought to understand the challenges to health and wellbeing faced by trans women of color in Detroit and to identify community-generated strategies for ameliorating these challenges.

Methods

Grounded in a community-university partnership, five focus groups were held with trans women of color from Detroit (n = 33) in 2019 and analyzed utilizing a thematic approach.

Results

Two overarching themes emerged: (1) intersecting stigmas and SDoH that contribute to inequities and (2) intersectional exclusion. Across both themes, community-generated and led strategies emerged. Intersectional exclusion was evidenced by a lack of programs and services designed to address SDoH. Services predominantly focused on HIV, rendering trans women of color only visible in relation to HIV. Participants advocated for intersectionally affirming and holistic services, proposing broad policy, organizational/programmatic, and research solutions that center existing community-led advocacy work.

Conclusions

Addressing intersectional exclusion and SDoH through funding and partnering with trans women of color leaders may contribute to community-led solutions, greater opportunities for trans women of color, and, ultimately, to a thriving community.

Policy Implications.

Broad policy changes led by trans women of color (e.g., access to legal gender affirmation, anti-discrimination laws) may prove most beneficial for ameliorating social conditions and reducing health inequities among trans women of color.

中文翻译：

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“……其他人都享有更高的特权。然后是我们......”：一项定性研究，探索社区对密歇根州底特律有色人种跨性别女性健康不平等和交叉排斥的社会决定因素的反应

介绍

助长不平等的健康社会决定因素 (SDoH) 在跨性别 (trans) 人和有色人种中得到充分证明。除了以 HIV 为重点的研究外，很少有文献探讨有色人种跨性别女性的经历。对交叉压迫（例如，顺从性、种族主义）如何塑造不公平和以社区为导向的社会正义导向变革战略的关注有限。通过交叉视角，本研究试图了解底特律有色人种女性面临的健康和福祉挑战，并确定社区产生的缓解这些挑战的策略。

方法

基于社区与大学的合作关系， 2019 年与底特律的跨性别女性（n = 33）举行了五个焦点小组，并使用主题方法进行了分析。

结果

出现了两个首要主题：(1) 交叉污名和 SDoH 导致不平等；(2) 交叉排斥。在这两个主题中，出现了社区生成和主导的策略。缺乏旨在解决 SDoH 的计划和服务证明了交叉排斥。服务主要集中在 HIV 上，使有色人种女性仅在与 HIV 相关的情况下可见。参与者提倡交叉肯定和整体服务，提出广泛的政策、组织/计划和研究解决方案，这些解决方案以现有社区主导的宣传工作为中心。

结论

通过资助和与跨性别女性领导者合作解决交叉排斥和 SDoH 可能有助于社区主导的解决方案，为跨性别女性提供更多机会，并最终促进社区的繁荣。

政策影响。

由有色人种跨性别女性领导的广泛政策变革（例如，获得合法的性别确认、反歧视法）可能被证明最有利于改善有色人种跨性别女性的社会状况和减少健康不平等。