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Through the lens of intersectionality, this chapter illustrates how racism, transphobia, classism, and other social processes of privilege and oppression shape experiences of health care engagement among transgender and gender diverse (TGD) people who are Black, indigenous, and People of Color (BIPOC). This chapter also explores how addressing social determinants of health outside of mainstream health care engagement, such as education and economic development, can complement mainstream health care engagement practices to be inclusive and improve overall health outcomes for BIPOC TGD communities. Outside of the context of the United States, there is significant diversity in concepts, definitions, and understandings of what constitutes health care, what are prioritized as social determinants of health, as well as sociocultural beliefs about gender. For the purpose of this chapter, we will focus on these elements within a North American context.


A vast array of gender identities and expressions exist within BIPOC TGD communities, situated within their own sociocultural and sociohistorical contexts. These terms can be highly specific, change over time and across generations, and carry different social, cultural, and political implications. Shared identities and language help community members develop a sense of belonging and strengthen relational ties. However, even within groups, there often exist many different ways that individuals choose to identify and describe themselves, and for many different reasons. For example, the term “queen” (also “femme queen,” and “reyna” in Spanish) has been used by communities of Black and Latina transgender women to identify themselves and was widely used in the “ballroom scene” of the 1960s, although its use likely traces back much further. “Queen” has been commonly used to identify transgender women who participate in pageants and ballroom competitions. Contemporary adaptations of the term “queen” among some communities of Black transgender women (and “king” among Black transgender men) have expanded the use of the term in cultural alignment with Black empowerment movements as a means to increase social solidarity and elevate the experiences of its members amid the ongoing fight against racial injustice in the United States.

In addition, some Black transgender people identify as a “woman (or man) of transgender experience,” emphasizing that some TGD people identify with the gender binary and regard their transgender experience as part of their history rather than their present identity. Individuals of transgender experience often do not identify with the terms “transgender man” (or “trans man”) or “transgender woman” (or “trans woman”) as others in the same community might and may reject medicalized or research-oriented categorizations of their experience. Two-step methodologies to collect demographic information about individuals from TGD communities that permit individuals to indicate their gender identity followed by a question about sex assigned at birth may prove more acceptable by some, but not all members of BIPOC TGD communities.

Within Latinx communities, the term “travesti” is commonly used throughout South America and has been ...

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