Mayfaire A, Mayfaire M, Glynn T. The vital role of trans-led CBOs in public health research and efforts: an example from TransSocial, Inc. HPHR. 2021;43.10.54111/0001/QQ3
Transgender and gender diverse individuals experience high rates of economic marginalization, mental health concerns, substance use, and health issues.1 These disparities do not occur in a siloed manner, but rather, are interconnected and are driven by oppression, discrimination, and stigma. In other words, health equity for this community relies on multi-level intervention with heavy focus on sociostructural factors (e.g., housing, access to services, education, economic stability). These factors both produce and exacerbate health disparities.2 Public health programs and policy to address such drivers of health depend on data, and specifically, from samples that accurately represent the community and reflect their needs. Additionally, implementation of programs and services depend on community knowledge, reach, and uptake. Community based organizations (CBOs) specifically led by Trans and gender diverse community members are in a unique position to fulfill both data collection and implementation needs for public health programs to be most successful.
For example, we, at TransSOCIAL Inc. (transsocial.org) have continuously provided resources/services (e.g., food assistance, utility payments, access to affirming health care, legal name changes on identity documents) to our community of Trans and gender diverse individuals in South Florida. Further, we have initiated a needs assessment data collection project. Many of our clients would not otherwise be reporting their needs to, or accessing similar aid from, government- or academic-led programs. This is likely due to various factors including mistrust of non-Trans-led outreach efforts and historical micro-aggressive and discriminatory experiences. Indeed, the limited work that has been published that speaks to this issue is clear: Trans individuals want peer-led services and resources/outreach via Trans organizations and leaders.3-6 By allowing the community to be the leaders in conducting the research for service/program development and be the vehicle for implementation, this facilitates a shift that has been continuously called for – working for communities and not on them. Below, we present our initial and ongoing efforts, as a Trans-led CBO, of data collection for a needs assessment and discuss our ongoing service implementation work.
We were able to collect cross-sectional survey data from a sample of our transgender and non-binary clients in South Florida (N=99) to assess needs. Of note, given they were our clients, individuals had a history of being connected to our resources and services. Written and verbal explanation were provided that anonymous data would be used for reporting purposes before participants chose to complete survey. Demographics and sociostructural factors were collected via self-report (see Table 1 for details). To assess differences in who may need certain services, we examined the bivariate associations between each demographic variable and each sociostructural factor (Cramér’s V). Significant associations were followed-up with logistic regressions to determine specific differences. To explore the complex web of sociostructural determinants of health for Trans and non-binary individuals, we examined correlations between all the sociostructural factors (phi coefficient
Table 1. Sample demographics and sociostructural characteristics N = 99
25 and under
Did not complete high school
26 – 35
High school diploma or equivalent
Has some college
Has college degree or higher
Race & Ethnicity
Identity documents all match
Current housing status3
e.g., non-binary, genderqueer, Two-Spirit, genderfluid, agender, or combination
Utilities are affordable to me
e.g., female, transwoman, non-binary, genderqueer, genderfluid, or combination
Utilities are a financial burden
I have enough food
e.g., male, transman, non-binary, genderqueer, genderfluid, third gender, agender, or combination of listed
I sometimes do not have enough food
Has health insurance
Has access to primary care physician
Has access to mental health resources
Another not listed
Law enforcement discrimination
Violence due to gender
BIPOC = Black, Indigenous, People of Color; 1For analysis purposes, combined last two age categories; 2For analysis purposes, collapsed into binary representing less than high school education vs high school education or greater; 3For analysis purposes, collapsed unstable and houseless to make binary variable
Race/ethnicity was associated with ability to afford utilities (V = 0.30, p = .029). Non-Hispanic BIPOC were 4 times more likely compared to White non-Hispanic counterparts (OR=4.02, 95% CI 1.37, 11.76) and almost 3.5 times more likely compared to White Hispanic counterparts (OR=3.39, 95% 1.02, 11.19) to not be able to afford utilities. Gender was associated with having a lifetime history of being houseless (V = 0.32, p = .008) and with health insurance status (V = 0.26, p = .033). Those with a feminine gender were over 4 times more likely to have been houseless (OR=4.38, 95% CI 1.52, 12.63) and less likely to have health insurance (OR=0.23, 95% 0.06, 0.84) compared to those with a masculine gender. Age and sexual orientation were not significantly associated with any sociostructural factor. Findings reflect the need to focus specific efforts on reaching Trans and non-binary BIPOC and those with a feminine gender with services.
Overall, correlations between sociostructural factors show associations between unstable housing, not being able to afford utilities, food insecurity, being uninsured, not having access to a primary care doctor, and gender-based discrimination and violence (see Table 2 for details). Notably, not having all identity documents match (i.e., name, gender) was associated with gender-based discrimination and violence. Findings indicate the complex associations between economic marginalization, social oppression, and access to health care reflecting the importance of providing social services and resources to mitigate health disparities. Further, there is a clear need to provide funding and facilitation to identity document changes.
Table 2. Bivariate correlations between sociostructural factors (N=99)
Current unstable housing
Lifetime unstable housing
Cannot afford utilities
< High school education
Access to PCP
Access to mental health care
Identity documents match
Law enforcement discrimination
Notes. *<.05; **<.01; phi coefficient was used; PCP = primary care physician
We are continuing our efforts to collect our own data from our community. We have also started to collect a needs assessment survey from individuals that have not received services with us or who are just initiating connection with us. We will be able to compare data from these new clients to the data we presented here from established clients. This will aid in determining who we need to reach better, what services need expansion, and what new resources would benefit the community that may not be provided elsewhere. Further, we continue our implementation of public health services including providing utility payments, food packages, transportation, sexual health packages, funding and facilitation of identity document changes, and funding and referrals for gender affirming healthcare. To do this, it has required securing funding, applying to local and federal government and agency grants, collecting materials, finding staffing for efforts, community outreach, marketing, and establishing dissemination plans.
We have done our needs assessment and service provision independently and have shown the feasibility and acceptability of having a Trans-led CBO lead public health efforts; imagine what we could do with the support of public health professionals and researchers. Thus, we request researchers and other public health professionals reconsider their role when engaging with Trans and gender diverse communities. The best way to help us is to use the strengths you have that many Trans-led CBOs may not have access to for many reasons (e.g., sociostructural barriers and discrimination) and let us use our unique strengths that you do not have access to like lived experiences, trust, and networks within the community. For example, providing CBOs with methodology training/mentorship, grant and manuscript writing training/consultation, and infrastructure for outreach/implementation efforts. In this way, public health professionals can leverage community strengths and aid in capacity building for the community.
If we think of working towards health equity for the Trans and gender diverse community as a potluck, if public health professionals and researchers can bring their best dish of systems and method knowledge sprinkled with training, mentorship, and facilitation, we can bring our best dish of our expertise – us.
We thank all of our clients and participants in this survey.
The authors have no relevant financial disclosures or conflicts of interest.
Ashley Mayfaire (pronouns: she/her & they/them) is the Co-Founder and Director of Operations of TransSOCIAL, Inc. After experiencing firsthand the barriers that their husband, Morgan, faced during his gender transition from female to male, Ashley and Morgan co-founded TransSOCIAL, Inc. to build a network of resources and support for the Trans community. Ashley frequently speaks on educational panels and is always creating new curriculum for TransSOCIAL’s TLGBQ+ Cultural Sensitivity Training for businesses, healthcare providers and universities, creating more safe and affirming spaces for Trans people to access care and public accommodations. They utilize their platform to educate and engage the community in HIV prevention and treatment efforts through their participation in the South Florida AIDS Network as the Broward ARCH Committee Chair, and have consulted for multiple research projects and reports on HIV in the Trans community.
Morgan Mayfaire (pronouns: he/him/his) is the Co-Founder and Executive Director of TransSOCIAL, Inc. His passion for building acceptance and equality for Trans people in society guides his work in the community, linking Trans people to resources he found difficult to access during his own gender transition from female to male. Morgan is a passionate advocate for HIV prevention and treatment programs in South Florida, participating in the South Florida AIDS Network, as well as being named the At-Large Transgender Prevention Alternate for the 2017-2019 term of the Florida Comprehensive HIV/AIDS Planning Network, Prevention Planning Group. He has received numerous awards for his service and advocacy work from Latinos en Acción, the National Trans Visibility March, the Trans Equality Awards and other organizations.
Tiffany R. Glynn (pronouns: she/her/hers) is currently a Clinical Fellow in Behavioral Medicine and the Gender Identity Program at Harvard Medical School/Massachusetts General Hospital/Fenway Health. Further, she is completing her Ph.D. in Clinical Health Psychology at the University of Miami. Prior to this, she completed her M.S. at the Brown University School of Public Health. Her research focuses on health equity and the biopsychosocial-structural factors driving health disparities among sexual and gender minorities and other marginalized communites.