Trans and gender-diverse people’s experiences of primary care in Sweden – a qualitative study

Abstract Background Trans and gender-diverse people experience a high burden of health issues and face barriers to accessing care. Primary care has a large responsibility in providing equitable access to care and thus improving the health of the population. We, therefore, explored trans and gender-diverse people’s experiences of primary care in Sweden. Method Semi-structured interviews were conducted with 12 self-identified trans or gender-diverse persons living in Sweden, aged over 15, and with experience of primary care. Participants were recruited via trans organizations. The interviews were analysed using reflexive thematic analysis. Results Five themes were identified: “Preparations and low expectations”, “Attempts at trans-competent care”, “When trans experiences are not present – from smooth to excluded”, “When being trans becomes a problem – from friction to overt violations”, and “Effects of healthcare encounters – from discomfort to shifted responsibility”. Conclusion Findings show that participants’ experiences with primary care in Sweden were influenced by cisnormativity, leading to invisibility, exclusion, misgendering, and a lack of knowledge. Experiences of discomfort on the part of care providers, ridicule, disrespect, and denial of care imply the presence of transphobia. These barriers result in trans and gender-diverse people experiencing low levels of trust, having to navigate their care without support, and not having their healthcare needs met. There is an urgent need for increased trans competence and allyship with trans communities to ensure equitable access to healthcare. Training and further research should be developed in close consultation with trans organisations to address these disparities.