Trans and gender diverse people in the UK expect sexual health services are 'not set up' for them, reinforced by poor healthcare experiences and lack of information, and participants' suggestions for inclusive care align with and reinforce BASHH expert recommendations.
Trans and gender diverse people commonly anticipated that sexual health services were not set up to meet their needs before even accessing them.
Participants actively looked for visible hallmarks of inclusivity as signals that a service had engaged with trans and gender diverse needs.
Preferences for service type were divided, with some participants wanting specialist trans and gender diverse services while others preferred to access general sexual health services.
Staff attitudes were identified as a key factor underpinning inclusivity in sexual health services.
Participants emphasised that the skills needed to deliver trans and gender diverse-inclusive care are already present in sexual health service staff.
The study used a community-informed qualitative design with semistructured interviews and focus groups involving 59 trans and gender diverse participants aged 17–71 years.
Participants' suggestions for trans and gender diverse-inclusive sexual health services align with and reinforce existing BASHH expert recommendations.
This research explored how trans and gender diverse (T/GD) people in the UK experience sexual health services and what would make those services more inclusive. The researchers conducted in-depth interviews with 33 participants and held focus groups with 26 more, recruiting people aged 17 to 71 through community organisations and social media. The study was co-designed with T/GD people and an advisory group including charities and sexual health clinicians. The study found that many T/GD people expected sexual health services would not be equipped to meet their needs even before they tried to access them. These expectations were shaped by negative experiences in other healthcare settings and a lack of relevant information on NHS websites. Some participants had actually been turned away from care for being considered 'too complex.' When people did consider accessing services, they looked for visible signs of welcome — such as Trans Pride flags in waiting rooms — as signals that the service had made an effort to be inclusive. Staff attitudes emerged as particularly important: participants wanted kindness and openness, and feared having their gender identity questioned or their health needs dismissed. Opinions were split on whether specialist T/GD services or inclusive general services were preferable, reflecting the diversity of needs within the T/GD community. Importantly, participants felt that sexual health service staff already possessed the skills needed to provide respectful, person-centred care — the issue was not a lack of capability but a lack of consistent application of those skills for T/GD patients. This research suggests that improving trans-inclusive care does not require entirely new systems, but rather ongoing engagement with T/GD communities, visible signals of welcome, and staff commitment to applying already-existing person-centred care skills to all patients regardless of gender identity.
Witney T, Rait G, Saunders J, Hobbs L, Mitchell L, Stewart J, et al.. (2025). One way or another, you are not going to fit: trans and gender diverse people's perspectives on sexual health services in the United Kingdom.. Sexually transmitted infections. https://doi.org/10.1136/sextrans-2024-056231