{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T16:47:37Z","timestamp":1794502057190,"version":"4.9.1"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T00:00:00Z","timestamp":1658188800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T00:00:00Z","timestamp":1658188800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Little is known about the barriers to mental health and substance use services for trans women living with HIV. We conducted a qualitative study with trans women living with HIV and providers to explore barriers to mental health and substance use services in San Francisco.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We conducted focus group discussions and key informant interviews with a total of 15 medical, mental health, substance use, and social service providers and trans women living with HIV. We identified, analyzed, and reported themes using thematic analysis and derived themes directly from the data.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Our study participants identified two main themes and three subthemes. One main theme is that trans women and providers have lost trust in the system due to (a) lack of a linkage system between referrals and services, (b) structural barriers such as service location, language capacity, clinic hours, and (c) constant changes in services available. Another main\u00a0theme is anti-trans and mental health stigma.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Interventions to coordinate linkage from medical to mental health and substance use (MHSU) services are urgently needed to facilitate the utilization of MHSU services. Other interventions to improve quality monitoring and system improvement, and to address multiple stigmas broadly in society are needed to improve unmet MHSU service needs among trans women living with HIV in San Francisco.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12913-022-08315-5","type":"journal-article","created":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T16:09:59Z","timestamp":1658246999000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["\u201cLost trust in the system\u201d: system barriers to publicly available mental health and substance use services for transgender women in San Francisco"],"prefix":"10.1186","volume":"22","author":[{"given":"Glenda N.","family":"Baguso","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Aguilar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Sicro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malaya","family":"Ma\u00f1acop","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerry","family":"Quintana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin C.","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,7,19]]},"reference":[{"key":"8315_CR1","unstructured":"Center for Disease Control and Prevention. HIV Infection, Risk, Prevention, and Testing Behaviors Among Transgender Women\u2014National HIV Behavioral Surveillance, 7 U.S. Cities, 2019\u20132020. HIV Surveillance Special Report 27. 2021. Available from: https:\/\/www.cdc.gov\/hiv\/pdf\/library\/reports\/surveillance\/cdc-hiv-surveillance-special-report-number-27.pdf"},{"key":"8315_CR2","unstructured":"San Francisco Department of Public Health, Population Health Division. HIV Epidemiology Annual Report 2020. Retrieved from https:\/\/www.sfdph.org\/dph\/files\/reports\/RptsHIVAIDS\/AnnualReport2020-Purple_20210817Web.pdf"},{"issue":"3","key":"8315_CR3","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1089\/lgbt.2014.0099","volume":"2","author":"Y Mizuno","year":"2015","unstructured":"Mizuno Y, Frazier EL, Huang P, Skarbinski J. Characteristics of transgender women living with HIV receiving medical care in the United States. LGBT Health. 2015; 2(3): 228\u2013234. doi: https:\/\/doi.org\/10.1089\/lgbt.2014.0099","journal-title":"LGBT Health"},{"key":"8315_CR4","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1136\/sextrans-2013-051342","volume":"90","author":"GM Santos","year":"2014","unstructured":"Santos GM, Wilson EC, Rapues J, Macias O, Packer T, Raymond HF. HIV treatment cascade among transgender women in a San Francisco respondent driven sampling study. Sex Transm Infect. 2014;90:430\u20133. https:\/\/doi.org\/10.1136\/sextrans-2013-051342.","journal-title":"Sex Transm Infect."},{"issue":"1","key":"8315_CR5","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1007\/s11524-014-9921-4","volume":"92","author":"EC Wilson","year":"2015","unstructured":"Wilson EC, Chen YH, Arayasirikul S, Wenzel C, Raymond HF. Connecting the dots: Examining transgender women\u2019s utilization of transition-related medical care and associations with mental health, substance use, and HIV. J Urban Health. 2015; 92(1):182\u2013192.","journal-title":"J Urban Health"},{"issue":"5","key":"8315_CR6","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1037\/cou0000143","volume":"63","author":"SL Reisner","year":"2016","unstructured":"Reisner SL, Hughto JMW, Gamarel KE, Keuroghlian AS, Mizock L, Pachankis J. Discriminatory experiences associated with posttraumatic stress disorder symptoms among transgender adults. J Couns Psychol. 2016;63(5):509\u201319. https:\/\/doi.org\/10.1037\/cou0000143.","journal-title":"J Couns Psychol."},{"issue":"147","key":"8315_CR7","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.drugalcdep.2014.11.023","volume":"1","author":"C Rowe","year":"2015","unstructured":"Rowe C, Santos GM, McFarland W, Wilson EC. Prevalence and correlates of substance use among trans*female youth ages 16\u201324 years in the San Francisco Bay Area. Drug Alcohol Depend, 2015;1(147): 160\u2013166. doi: https:\/\/doi.org\/10.1016\/j.drugalcdep.2014.11.023","journal-title":"Drug Alcohol Depend"},{"key":"8315_CR8","doi-asserted-by":"publisher","DOI":"10.4324\/9780203070628","volume-title":"Treating the trauma survivor: an essential guide to trauma-informed care.","author":"C Clark","year":"2014","unstructured":"Clark C, Classen CC, Fourt A, Shetty M. Treating the trauma survivor: an essential guide to trauma-informed care. New York, NY: Routledge\/Taylor & Francis Group; 2014."},{"issue":"11","key":"8315_CR9","doi-asserted-by":"publisher","first-page":"1010","DOI":"10.1097\/MLR.0000000000000583","volume":"54","author":"KD Jaffee","year":"2016","unstructured":"Jaffee KD, Shires DA, Stroumsa D. Discrimination and delayed health care among transgender women and men: Implications for improving medical education and health care delivery. Med Care. 2016; 54(11):1010\u20131016.","journal-title":"Med Care"},{"issue":"3","key":"8315_CR10","first-page":"67","volume":"68","author":"MM Johns","year":"2019","unstructured":"Johns MM, Lowry R, Andrzejewski,J, Barrios LC, Demissie Z, McManus T, et al. Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students \u2013 19 states and large urban school districts, 2017. MMWR Surveill Summ. 2019; 68(3):67\u201371.","journal-title":"MMWR Surveill Summ"},{"issue":"2","key":"8315_CR11","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1097\/MED.0000000000000227","volume":"23","author":"JD Safer","year":"2016","unstructured":"Safer JD, Coleman E, Feldman J, Garofalo R, Hembree W, Radix A, Sevelius J. Barriers to healthcare for transgender individuals. Curr Opin Endocrinol Diabetes Obes. 2016; 23(2): 168\u2013171. doi: https:\/\/doi.org\/10.1097\/MED.0000000000000227","journal-title":"Curr Opin Endocrinol Diabetes Obes."},{"issue":"4","key":"8315_CR12","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1097\/QAI.0000000000001831","volume":"79","author":"LA Bukowski","year":"2018","unstructured":"Bukowski LA, Chandler CJ, Creasy SL, Matthews DD, Friedman MR, Stall RD. Characterizing the HIV care continuum and identifying barriers and facilitators to HIV diagnosis and viral suppression among black transgender women in the United States. J Acquir Immune Defic Syndr. 2018; 79(4):413\u2013420.","journal-title":"J Acquir Immune Defic Syndr."},{"issue":"6","key":"8315_CR13","doi-asserted-by":"publisher","first-page":"1048","DOI":"10.1007\/s11606-018-4783-1","volume":"34","author":"S Chaudhri","year":"2019","unstructured":"Chaudhri S, Zweig KC, Hebbar P, Angell S, Vasan A. Trauma-informed care: A strategy to improve primary healthcare engagement for persons with criminal justice system involvement. J Gen Intern Med. 2019; 34(6): 1048\u20131052.","journal-title":"J Gen Intern Med"},{"issue":"1","key":"8315_CR14","doi-asserted-by":"publisher","first-page":"e0253444","DOI":"10.1371\/journal.pone.0253444","volume":"16","author":"JA Thomas","year":"2021","unstructured":"Thomas JA, Irvine MK, Xia Q, Harriman GA. Service utilization and HIV outcomes among transgender women receiving Ryan White Part A services in New York City. PLoS ONE. 2021; 16(1): e0253444. https:\/\/doi.org\/10.1371\/journal.pone.0253444","journal-title":"PLoS ONE"},{"key":"8315_CR15","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1111\/nhs.12048","volume":"15","author":"M Vaismoradi","year":"2013","unstructured":"Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013;15:398\u2013405. doi: 10.111\/nhs.12048","journal-title":"Nurs Health Sci"},{"issue":"5","key":"8315_CR16","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1016\/j.jana.2017.06.001","volume":"28","author":"L Munro","year":"2017","unstructured":"Munro L, Marshall Z, Bauer G, Hammond R, Nault C, Travers R. (Dis)integrated care: Barriers to health care utilization for trans women living with HIV. J Assoc Nurses AIDS Care, 2017; 28(5): 708\u2013722. https:\/\/doi.org\/10.1016\/j.jana.2017.06.001","journal-title":"J Assoc Nurses AIDS Care"},{"key":"8315_CR17","unstructured":"Substance Abuse and Mental Health Services Administration. SAMHSA\u2019s Working Definition of Recovery. [Brochure]. 2012. Accessed at: https:\/\/store.samhsa.gov\/sites\/default\/files\/d7\/priv\/pep12-recdef.pdf"},{"issue":"1","key":"8315_CR18","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1089\/apc.2019.0067","volume":"34","author":"W Bocking","year":"2020","unstructured":"Bocking W, MacCrate C, Israel H, Mantell JE, Remien RH. Engagement and retention in HIV care for transgender women: perspectives of medical and social service providers in New York City. AIDS Patient Care STDS. 2020; 34(1):16\u201326. doi: https:\/\/doi.org\/10.1089\/apc.2019.0067","journal-title":"AIDS Patient Care STDS."},{"key":"8315_CR19","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1002\/pmh.1381","volume":"11","author":"DL Bales","year":"2017","unstructured":"Bales DL, Timman R, Luyten P, Busschbach J, Verheul R, Hutsebaut J. Implementation of evidence-based treatment for borderline personality disorder: the impact of organizational changes on treatment outcome of mentalization-based treatment. Personal and Ment Health. 2017;11:266\u2013277. doi: https:\/\/doi.org\/10.1002\/pmh.1381","journal-title":"Personal and Ment Health"},{"key":"8315_CR20","unstructured":"Freeman G, Hughes J. Continuity of care and the patient experience. The King\u2019s Fund; 2010. Accessed March 22, 2022. https:\/\/www.kingsfund.org.uk\/sites\/default\/files\/field\/field_document\/continuity-care-patient-experience-gp-inquiry-research-paper-mar11.pdf"},{"key":"8315_CR21","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1186\/s12913-020-4999-8","volume":"20","author":"P Nilsen","year":"2020","unstructured":"Nilsen P, Seing I, Ericsson C, Birken SA, Schildmeijer K. Characteristics of successful changes in health care organizations: an interview study with physicians, registered nurses and assistant nurses. BMC Health Serv Res. 2020; 20, 147. https:\/\/doi.org\/10.1186\/s12913-020-4999-8","journal-title":"BMC Health Serv Res"},{"key":"8315_CR22","doi-asserted-by":"publisher","unstructured":"Memon A, Taylor K, Mohebati LM, Sundin J, Cooper M, Scanlon T, et al. Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England. BMJ Open. 2016;(6): e012337. doi: https:\/\/doi.org\/10.1136\/bmjopen-2016-012337","DOI":"10.1136\/bmjopen-2016-012337"},{"issue":"6","key":"8315_CR23","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1176\/appi.ps.201900399","volume":"71","author":"KL Moore","year":"2010","unstructured":"Moore KL, Lopez L., Camacho D, Munson MR. A qualitative investigation of engagement in mental health services among Black and Hispanic LGB young adults. Psychiatr Serv. 2010; 71(6): 555\u2013561. doi: https:\/\/doi.org\/10.1176\/appi.ps.201900399","journal-title":"Psychiatr Serv"},{"issue":"2","key":"8315_CR24","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1080\/19359701003622875","volume":"14","author":"JC Shipherd","year":"2010","unstructured":"Shipherd JC, Green KE, Abramovitz S. Transgender clients: Identifying and minimizing barriers to mental health treatment. J Gay Lesbian Ment Health. 2010;14(2):94\u2013108. https:\/\/doi.org\/10.1080\/19359701003622875.","journal-title":"J Gay Lesbian Ment Health."},{"key":"8315_CR25","unstructured":"KFF. Mental health and substance use state fact sheets. 2021, December 13. Accessed April 5, 2022: https:\/\/www.kff.org\/statedata\/mental-health-and-substance-use-state-fact-sheets\/"},{"key":"8315_CR26","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1007\/s10461-018-2328-6","volume":"23","author":"MI Loya-Montiel","year":"2019","unstructured":"Loya-Montiel MI, AIDS and Behavior Davis DA, Aguilar-Martinez JM, Bailey OAP, Morales-Miranda S, Alvis-Estrada JP, et al. Making the link: A pilot health navigation intervention to improve timely linkage to care for men who have sex with men and transgender women recently diagnosed with HIV in Guatemala City. AIDS Behav. 2019;23:900\u20137.","journal-title":"AIDS Behav"},{"issue":"4","key":"8315_CR27","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1176\/appi.ps.201700241","volume":"69","author":"P Corrigan","year":"2018","unstructured":"Corrigan P, Sheehan L, Morris S, Larson JE, Torres A, Lara JL, et al. The impact of peer navigator program in addressing the health needs of Latinos with serious mental illness. Psychiatr Serv. 2018; 69(4):456\u2013461.","journal-title":"Psychiatr Serv"},{"issue":"3","key":"8315_CR28","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1007\/s10488-017-0839-5","volume":"45","author":"L Sheehan","year":"2018","unstructured":"Sheehan L, Torres A, Lara JL, Paniagua D, Larson JE, Mayes J, et al. Qualitative evaluation of a peer navigator program for Latinos with serious mental illness. Admin Policy Ment Health. 2018; 45(3): 495\u2013504. doi: https:\/\/doi.org\/10.1007\/s10488-017-0839-5","journal-title":"Admin Policy Ment Health"},{"issue":"suppl 1","key":"8315_CR29","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1007\/s10461-019-02697-0","volume":"15","author":"EC Wilson","year":"2021","unstructured":"Wilson EC, Turner C, Arayasirikul S, Woods T, Tryon J, Franza K, Lin, R. HIV care engagement among trans women of color in San Francisco Bay Area demonstration projects: Findings from the Brandy Martell Project and TransAccess. AIDS Behav. 2021; 15(suppl 1): 31\u201339. doi: https:\/\/doi.org\/10.1007\/s10461-019-02697-0","journal-title":"AIDS Behav"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-022-08315-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-022-08315-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-022-08315-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T16:10:05Z","timestamp":1658247005000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-022-08315-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,19]]},"references-count":29,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["8315"],"URL":"https:\/\/doi.org\/10.1186\/s12913-022-08315-5","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,19]]},"assertion":[{"value":"14 April 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 June 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 July 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Interviews were conducted over Zoom due to COVID safety protocols. All interviews were recorded and transcribed verbatim. Participants provided verbal informed consent.  All methods were carried out in accordance to relevant guidelines and regulations. The study was approved by the Institutional Review Board at University of California, San Francisco (IRB#20-32166).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors report no real or perceived vested interest related to this article that could be construed as a conflict of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"930"}}