About This Guide

For most people, it is normal to be excited or curious when meeting someone with an identity or experience significantly different from their own. This can often spark a desire to ask personal questions with the intention of learning more. While this is an understandable interest, it is important to remember that transgender individuals are asked these questions frequently. Even if well-intentioned, some questions can feel invasive, inappropriate, or even hostile. This is especially true when the person is trying to access care.

A common concern voiced by transgender individuals is that they have to describe what it means to identify as transgender in order to receive sensitive care and services. For example, 50 percent of transgender individuals who participated in the National Transgender Discrimination Survey (NTDS) reported having to provide basic information about their transgender identities, experiences, or bodies before they were given medical services.¹ As a result, many transgender individuals avoid accessing routine and emergency care out of fear or because they don't want to have to educate their providers. If you demonstrate preexisting knowledge of transgender identities and experiences, transgender individuals may feel more comfortable when accessing care, which may increase the success of your services.

Another all-too-common complaint relates to having experienced prejudice, discrimination, or violence, even when accessing medical and social services. According to several studies and surveys, for example—

• Fifty-three percent of transgender respondents to NTDS have been verbally harassed or treated disrespectfully in places of public accommodation, and 44 percent have been denied service because of their transgender identity. Twenty-two percent of respondents who have interacted with law enforcement officers have been harassed by them, 20 percent have been refused assistance, 6 percent have been physically attacked by an officer, and 2 percent have been sexually assaulted by an officer. Transgender people of color faced higher rates of prejudice and violence, with up to 38 percent reporting harassment by officers.²
• Seventy-seven percent of transgender people have felt physically unsafe in public.³
• Twenty percent of transgender people have experienced discrimination in a social service agency, from both clients and staff.⁴

On top of these high rates of discrimination and prejudice, transgender individuals also experience high rates of sexual violence. According to several studies, more than 50 percent have been sexually assaulted at some point in their lives.⁵

Because transgender people make up a relatively small portion of the population (approximately 0.3 to 3 percent),⁶ service providers may wonder about the cost-benefit ratio of providing additional training or modifying practices to meet transgender victims' needs. We believe that the concept of universal design—borrowed from the disability rights movement—applies. If the physical world is designed in accessible ways, the structures will better serve all individuals, whether they have disabilities or not. Likewise, if you construct service delivery systems to serve the most marginalized individuals effectively (e.g., transgender clients), these systems better serve all clients. A little effort devoted to increasing your cultural competency regarding transgender victims of sexual assault will have positive, unanticipated results for non-transgender victims as well.

Most professionals already possess what is required to provide victims of sexual assault with respectful and appropriate care:

• Knowledge: Knowledge about what is required to provide the service the victim is seeking or needs.
• Skills: Ability to ask appropriate questions, listen to the victim's responses, and have those responses shape the services being provided.
• Attitudes: Belief that being a professional means serving all victims with respect and fairness, even if that requires (temporarily) ignoring personal beliefs, judgments, and emotions.

With an enhanced understanding of transgender-related issues, professionals and providers who serve victims of sexual assault can be sources of support and care for all victims, including individuals in this high-risk population.