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Angelino 2020: barriers to healthcare for AI/AN trans and two-spirit youth…
Angelino 2020: barriers to healthcare for AI/AN trans and two-spirit youth
settler colonialism impact
erased acceptance of two-spirit/ gender diversity in native communities
historical trauma- intergenerational psychosocial distress
US boarding school enforcement of gender binaries leading to increased discrimination
higher rates of mental health issues, suicidality and diseases due to HT and health inequities
provider knowledge and systemic issues
limited understanding of two-spirit identity and AI/AN traditions
Systemic issues like settler colonialism, marginalization, and outdated med systems negativey impact care
medicalization of gender identity had the potential to be stigmatizing, e.g., gender dysphoria diagnosis
patient side barriers
lack of community and family acceptance
limited provider availability, even more limited for gender affirmig care
socioeconomic barriers, e.g., poverty, transportation , health insurance, etc.
discrimination and stigma in schools and society in general
recommendations and solutions
provider training: increasung education on gender affirming and culturally competent care
systemic changes: policy advocacy for healthcare inclsuivity and insurance coverage
community engagement: promoting cultural events, tribal support, get youth more reconnected in culture
ensuring welcoming spaces w/ corrrect pronoums and representation
emphasizing resilience and strengths-based approaches using cultural perspectives
must be community drive, culturally relevant and systemic
provider-side barriers
lack of training on LGBTQ2S health
discomfort/uncertainty when treating trans youth
confusion of provider roles (where the line)
systemic issues e.g, electoric medical records and insurance coverage issues
two-spirit identity
traditional gender diversity in AI/AN communities, celbrated until colonialism
cultural identity beyond western gender binary