One way or another, you’re not going to fit: Trans and gender diverse people’s perspectives on sexual health services in the United Kingdom

Objectives Trans and/or gender diverse (T/GD) people in the UK are less likely to access sexual health services (SHS) than cisgender people but are more likely to report negative experiences. The British Association for Sexual Health and HIV (BASHH) developed expert recommendations for T/GD-inclusive SHS, but these lack service user perspectives. This study addressed this gap by asking T/GD people how SHS could be T/GD-inclusive. Methods Semi-structured interviews (n=31) and focus groups (n=21) were conducted with T/GD people aged 17-71 years old recruited through community organisations and social media, exploring experiences of SHS and inclusivity. Study design, materials, and analysis were informed by T/GD people and an advisory committee of charities and sexual health clinicians. Data were analysed using thematic analysis, managed using NVivo. Results Participants often expected that SHS were not set up for T/GD people. This was reinforced by poor experiences in other healthcare settings and the lack of information on NHS websites. Some participants had been denied care because they were ‘too complex.’ Participants wanted to know that SHS had engaged with the needs of T/GD people and looked for hallmarks of inclusivity, such as Trans Pride flags in reception areas. Some participants wanted specialist T/GD services, but others preferred to access general SHS. Staff attitudes were a key factor underpinning inclusivity. Anticipating having their identity questioned or needs dismissed, participants sought kindness and openness. Although the needs of T/GD people are diverse and different from cisgender service users, participants stressed that SHS staff already had the skills to deliver sensitive person-centred care and emphasised the value of inclusive SHS. Conclusion These findings provide insight into what a sample of T/GD people in the UK consider important for T/GD-inclusive SHS. Participants’ suggestions aligned with and reinforce BASHH expert recommendations. Importantly, they highlight the need for ongoing engagement to deliver T/GD-inclusive SHS. Key messages What is already known on this topic Trans and/or gender diverse people are less likely to engage with sexual health services than cis-gender people The British Association for Sexual Health and HIV (BASHH) Gender and Sexual Minority Special Interest Group (GSM SIG) has developed expert recommendations for trans-inclusive sexual health services, but user perspectives are missing What this study adds Participant suggestions and preferences for inclusive services support BASHH GSM recommendations Participants looked for inclusive SHS that recognise, understand and affirm their needs How this study might affect research, practice or policy Enhancing T/GD inclusivity involves active engagement with clinical spaces, processes and delivery