" horizontal ellipsis Everybody Else Is More Privileged. Then It's Us horizontal ellipsis ": a Qualitative Study Exploring Community Responses to Social Determinants of Health Inequities and Intersectional Exclusion Among Trans Women of Color in Detroit, Michigan

Introduction Social determinants of health (SDoH) that fuel inequities are well-documented among transgender (trans) people and people of color. Scant literature has explored the experiences of trans women of color, with the exception of HIV-focused studies. There has been a limited focus on how intersecting oppressions (e.g., cisnormativity, racism) shape inequities and community-led strategies for social justice-oriented change. Through an intersectional lens, this study sought to understand the challenges to health and wellbeing faced by trans women of color in Detroit and to identify community-generated strategies for ameliorating these challenges. Methods Grounded in a community-university partnership, five focus groups were held with trans women of color from Detroit (n = 33) in 2019 and analyzed utilizing a thematic approach. Results Two overarching themes emerged: (1) intersecting stigmas and SDoH that contribute to inequities and (2) intersectional exclusion. Across both themes, community-generated and led strategies emerged. Intersectional exclusion was evidenced by a lack of programs and services designed to address SDoH. Services predominantly focused on HIV, rendering trans women of color only visible in relation to HIV. Participants advocated for intersectionally affirming and holistic services, proposing broad policy, organizational/programmatic, and research solutions that center existing community-led advocacy work. Conclusions Addressing intersectional exclusion and SDoH through funding and partnering with trans women of color leaders may contribute to community-led solutions, greater opportunities for trans women of color, and, ultimately, to a thriving community. Policy Implications. Broad policy changes led by trans women of color (e.g., access to legal gender affirmation, anti-discrimination laws) may prove most beneficial for ameliorating social conditions and reducing health inequities among trans women of color.