Racism, Transphobia, and RApe Myths
This project is borne out of the recognition that whiteness is often centered in psychological research. While previous research supports the idea that oppressive attitudes are positively related (e.g., racism, ageism, homophobia, sexism; Aosved & Long, 2006), there has been little work examining the racism that is foundational to anti-trans prejudice and rape myths. The purpose of this line of research is provide correlational, then experimental, evidence of how racist and transphobic attitudes relate to rape myths (i.e., inaccurate and pervasive beliefs about rape, rape victims, and rapists, such as “men can’t help themselves” and “women who dress in tight clothes are asking for it”).
Data from a preliminary correlational study indicate that people who report greater racist beliefs are also likely to report greater anti-trans prejudice and to endorse more rape myths (Klement & Grimm, 2021; presented at the Midwestern Psychological Association conference in April 2021). These findings offer conceptual support and confirm our expectation that people who endorse more anti-Black beliefs will also endorse more rape myths and anti-trans beliefs.
The next study planned is an experimental one which manipulates a female sexual assault victim’s gender identity (i.e., cisgender vs. transgender) and racial identity (i.e., white vs. Black). My hypothesis is that anti-Black beliefs and anti-trans beliefs will moderate victim blame for rape victims, such that Black rape victims and Black trans rape victims will receive more blame from people who score higher on racism and transphobia scales.
After that, I plan to examine the role that critical consciousness might play in perceptions of a victim who is varied by racial identity and trans identity. This study is conceptually based on Parent and Silva’s (2018) work focused on anti-trans bathroom bill endorsement and Miller’s (2019) investigation of racial bias in perceptions of sexual assault victims and perpetrators.
Racist and transphobic assumptions in rape myth scales
The majority of research investigating the role that rape myths play in our perceptions of sexual victimization uses a small number of rape myth scales. While these scales, such as the Updated Illinois Rape Myth Acceptance Scale, have been shown to have high validity and reliability, it is worth examining the possibility that the items make assumptions about rape, rape victims, and rapists, based on cultural understandings of gender and race.
For example, the item, “When men rape, it is because of their strong desire for sex,” could be answered differently depending on whether a person is thinking about a Black male target or a white male target. Due to racialized and sexualized gender stereotypes (in this case, specifically stereotypes that Black men are hypersexual and aggressive), participants could more readily endorse this myth if it were about a Black man than about a white man or an Asian man (whose racialized and sexualized gender stereotypes would desexualize and feminize him).
This project is a thematic content analysis of existing rape myth scales (as well as other attitudinal scales focused on rape, rapists, and rape victims) with the goal of determining to what extent there is overlap in the items with common racialized and sexualized gender stereotypes.
Assessing Healthcare Providers’ Knowledge and Attitudes about Transgender Health Issues
Estimates from a Williams Institute survey in 2016 indicate that in the U.S., 0.6% of adults are transgender (i.e., having a gender identity different than the gender they were assigned at birth), an estimate that doubled from a survey five-years prior (Flores et al., 2016). As more people come out as transgender, it is critical that healthcare providers (HCPs) are trained in addressing transgender-specific health issues in a culturally competent manner. While HCPs may be open to and motivated to learn about these unique healthcare concerns, training in nursing programs and medical schools is lacking (Chan, Skocylas, & Safer, 2016; Rowan et al., 2019). Recent research has identified several barriers transgender patients can experience in accessing healthcare, including perceptions that HCPs will not be competent regarding transgender health issues and previous negative experiences with HCPs (Harb et al., 2019; Hughto, Pachankis, & Reisner, 2018). However, there remains minimal research addressing HCPs in training and current HCPs’ knowledge of transgender health issues.
Access to and outcomes of healthcare for transgender individuals is relatively poor compared to cisgender individuals. In a study of Irish adults, Howell and Maguire (2019) found that cisgender individuals were more likely than transgender individuals to seek physical healthcare. Similarly, Rider, McMorris, Gower, Coleman, and Eisenberg (2018) found that transgender and gender nonconforming (TGNC) high school students reported poorer health outcomes than cisgender students. Specifically, TGNC students reported fewer preventive health checkups, more frequent nurse visits, and poorer general and long-term physical and mental health self-assessments (Rider et al., 2018). These differences between cisgender and transgender patients’ healthcare seeking behaviors and outcomes indicate that transgender patients are experiencing barriers to healthcare.
Barriers to Transgender Healthcare
One possible reason for this disparity is healthcare providers’ (HCPs) lack of transgender-related medical knowledge coupled with anti-transgender attitudes. When assessing transgender patients’ barriers to healthcare, Hughto, Rose, Pachankis, and Reisner (2017) found previous healthcare discrimination was a contributing factor to accessing transition-related care. Thus, transgender patients might be less likely to seek healthcare due to previous HCP mistreatment (Hughto et al., 2018). This mistreatment can vary widely, from using the wrong pronouns (i.e., misgendering) to outright discrimination (e.g., refusing treatment). When transgender patients are expecting to be stigmatized by their providers, they might be unwilling to seek healthcare at all, particularly if they know their HCP does not practice gender affirmation (Goldenberg et al., 2019). In an interview study with transgender patients assigned female at birth, Harb et al. (2019) found that the main themes participants described as barriers to seeking and obtaining healthcare included a lack of access to competent care; distress about seeking that care; and characteristics of the setting (such as feminine -coded decorations and design).
Transgender patients are also explicitly concerned about their HCPs’ lack of education around transgender healthcare (Marshall et al., 2018). Relatedly, Bauer et al. (2009) discuss “informational erasure,” effectively a lack of information, training, and education about transgender-related healthcare issues, which can lead to the assumption that there isn’t any information available which reinforces the lack of knowledge. Each of these problems indicates a greater trend for transgender patients seeking healthcare: their providers do not know enough about treating transgender patients, and those providers might not care to learn more.
Healthcare Providers’ Knowledge and Attitudes about Transgender Healthcare
Given that many studies indicate a major barrier for transgender patients seeking and obtaining healthcare is a lack of provider knowledge about their care, it’s important to investigate what knowledge HCPs do have. Unfortunately, like other areas of transgender healthcare and medicine, the literature is limited. In assessing knowledge for specific care, Chen et al. (2019) found varying levels of different knowledge domains and between provider types. For example, while knowledge of the World Professional Association for Transgender Health (WPATH) recommendations on fertility counseling was high overall, there was a lot of variance in knowledge about the effects of puberty blockers on later fertility (Chen et al., 2019) and physicians reported greater knowledge overall than did masters-level mental health providers.
Other studies also indicate that there is a wide variance in how much HCPs are trained and knowledgeable about transgender healthcare. As HCPs often have little time to dedicate to continuing education once they begin working, formal instruction can be critical to provide HCPs with the knowledge needed to treat transgender patients. Unfortunately, many students do not receive this instruction, or if they do, they do not rate it as adequate (Chan et al., 2016). Moreover, even if HCPs are willing to learn about treating transgender patients, they do not presently have the training or high enough level of comfort with transgender patients to treat them competently (Chan et al., 2016; Rowan et al., 2019). In an interview study with both transgender patients and HCPs, McPhail, Rountree-James, and Whetter (2016) identified that a lack of providers’ knowledge about transgender health concerns was contributing to a gap of service for transgender patients. Some patients reported that they felt they needed to educate their own providers about their healthcare needs; at the same time, a few providers indicated that any stigma or discrimination against transgender patients was only perceived, not reality (McPhail et al., 2016). These studies all represent a disconnect between the desire of HCPs to serve their patients competently and their ability to do so for transgender patients.
Scope of Project
There are three major parts in this line of research: (1) an archival study of current formal education on transgender healthcare at medical schools and nursing programs; (2) a set of studies exploring rural healthcare providers’ (HCP) knowledge about and attitudes toward transgender patients and their healthcare; and (3) an interview study of transgender patients focusing on their rural healthcare experiences, particularly those at the Indian Health Service.