Muhammad Azwar, Lilis Widiastuty, Wirawan Setialaksana

Social Stigma, Family Support, and Healthcare Access as Determinants of Substance Use Among Transgender Populations

Introduction

Social stigma, family support, and healthcare access as determinants of substance use among transgender populations. Analyzes social stigma, family support, and healthcare access as determinants of substance use among transgender individuals, revealing barriers in South Sulawesi.

Abstract

Substance abuse among transgender individuals remains underexplored, particularly in the context of how intersecting social determinants contribute to its prevalence. Existing studies often overlook the paradox wherein increased healthcare access does not equate to effective support due to systemic bias and exclusion in service provision. This study aims to analyze the influence of social stigma, family support, and healthcare access on drug abuse among transgender individuals in South Sulawesi. A cross-sectional quantitative study was conducted involving 230 transgender individuals in South Sulawesi, including 178 residing in Makassar. Data were collected through structured interviews and validated questionnaires, and then analyzed using descriptive statistics and logistic regression. The findings indicate that social stigma is a significant risk factor linked to an increased likelihood of substance use (p < 0.05), whereas family support shows a protective association, potentially mitigating the risk of substance use within this population. However, greater access to healthcare services is associated with higher chances of substance use, indicating challenges in the effectiveness of rehabilitation services for transgender individuals, particularly due to persistent stigma, lack of provider training in gender-sensitive care, and limited inclusivity within existing healthcare systems.These findings highlight the need for a holistic intervention framework that prioritizes stigma reduction, social support, and inclusive healthcare access, particularly within marginalized and rural health systems. The evidence may guide policies aimed at enhancing equity and responsiveness in service delivery for underserved populations.

Review

This study makes a timely and important contribution to understanding the complex determinants of substance use among transgender populations, a group often marginalized and under-researched, particularly within the context of South Sulawesi. By investigating the roles of social stigma, family support, and healthcare access, the authors tackle a critical public health issue with significant implications for policy and intervention development. The cross-sectional quantitative design with a substantial sample size of 230 transgender individuals provides valuable empirical insights into these associations, and the focus on an under-explored geographic region further enhances the study's relevance. The findings illuminate several key insights. Social stigma is robustly identified as a significant risk factor, while family support emerges as a protective factor, validating intuitive hypotheses with empirical data. Crucially, the study uncovers a paradoxical association where greater access to healthcare services is linked to higher chances of substance use. While the abstract attributes this to systemic issues such as persistent stigma, lack of provider training in gender-sensitive care, and limited inclusivity, the full paper would benefit from a more detailed exploration of how 'access' was measured and the specific pathways through which it becomes counterproductive. Further clarity on the specific validated questionnaires used would also strengthen the methodological transparency. Despite these considerations, the study's implications are profound and actionable. It underscores the urgent need for a paradigm shift in healthcare delivery, advocating for a holistic intervention framework that prioritizes active stigma reduction, robust social support systems, and the creation of truly inclusive, gender-affirming healthcare environments. This research provides a crucial evidence base that can inform policymakers and healthcare providers in developing equitable and responsive services for transgender individuals in South Sulawesi and other similar marginalized communities globally, ultimately aiming to transform healthcare from merely accessible to genuinely supportive and effective.

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