“Housing Insecurity Seems to Almost Go Hand in Hand with Being Trans”: Housing Stress among Transgender and Gender Non-conforming Individuals in New Orleans

Abstract

Background

Housing insecurity is an established public health problem. The well-documented negative health outcomes associated with housing insecurity include increased stress, sexual and physical victimization, substance use, and exacerbated mental and physical health conditions [^{1, 2}]. Transgender and gender non-conforming individuals (T/GNCI),¹ especially people of color (POC), face differential access to housing-related services, including rental, credit and loan, and shelter support discrimination [^3–6]. T/GNCI also face a wide array of obstacles in attaining quality healthcare and positive health outcomes [⁴]. However, research examining the interconnection of these issues for T/GNCI is limited, particularly in the Deep South. Housing is a particularly salient topic in New Orleans, Louisiana, located in the Deep South, which is characterized by a negative state law and policy environment for T/GNCI [⁷]. New Orleans is known for its high rates of poverty, a history of substandard rental housing quality, rising housing costs, gentrification and mass displacement of native residents, little anti-displacement policy, historically unrestricted short-term rental (STR) policies, and falling under the jurisdiction of extremely permissive statewide eviction statutes [^{8, 9}]. New Orleans also experiences racial segregation, disinvestment in public resources, environmental degradation, cultural heritage loss, unmaintained infrastructure, blighted properties, and other unmitigated remnants of the institutionalized racial and economic segregation from Jim Crow era redlining policies [¹⁰]. Such place-specific structural and financial housing-related obstacles compound the higher discrimination rates T/GNCI experience across the country [⁴] to create a scenario in which New Orleanian T/GNCI are at higher risk of experiencing housing insecurity and associated negative health outcomes than their cisgender counterparts. According to the 2016 US Transgender Survey (USTS), 32% of transgender respondents in Louisiana, compared with 23% nationally, experienced transgender-related housing discrimination in the past year. A higher percentage of Louisiana USTS respondents reported experiencing homelessness in the past year (14% vs. 12%) and lifetime experiences of housing insecurity (32% vs. 30%), compared with national data [¹¹]. In comparison, 1-year and lifetime prevalence of homelessness in the US population was found to be 1.5% and 4.2%, respectively [¹²]. In New Orleans, studies show that African American renters face a disproportionately high rate of discrimination in wealthier neighborhoods [¹³]. Given that race-based housing discrimination is occurring in New Orleans, and gender-based discrimination is documented on the state and national levels [¹⁴], it follows that T/GNC POC in New Orleans would face exacerbated obstacles due to discrimination compounded by race and gender. New Orleans is also characterized by a post-disaster experience with rapid changes in housing infrastructure. Displacement in New Orleans by “urban renewal” projects and residential segregation date back to the Jim Crow Era and still affect thousands of people today [^{15, 16}]. Post-disaster urban planning that does not incorporate sustainable reinvestment strategies can exacerbate inequities in community health by prioritizing higher income neighborhoods [^{17, 18}]. This was true in post-Katrina New Orleans [¹⁹]. Many residents could not return to their desired neighborhoods; those with fewer resources were pushed into areas with poorly functioning or non-existent public transit [²⁰]. In 2017, New Orleans had 95% of its pre-Katrina (2000) overall population, but only 72% of Black residents [²¹]. While empty lots, undeveloped land, and vacant buildings existed in New Orleans before and after Hurricane Katrina, strategies for addressing such underutilized space did not factor into the city’s initial rebuilding plans [⁶]. Such blighted properties impact violence and physical and mental health among residents [^{22, 23}]. More recently, the housing market has been significantly impacted by STR policies [²⁴], which often result in the direct eviction of existing tenants, inflate home values and rents, and reduce the number of available affordable living quarters [²⁴]. T/GNCI living in New Orleans face a unique constellation of discrimination and compromised social services [^{11, 25}], putting them at risk for housing insecurity and associated public health concerns. To the best of our knowledge, no study has investigated these issues in New Orleans, LA, or the Deep South. This study aims to explore housing insecurity experiences, causes, and coping mechanisms among a sample of T/GNCI currently living in New Orleans, LA.

Methods

This study utilized targeted ethnography, a rapid ethnographic method [²⁶], consisting of in-depth interviews with members of the T/GNC communities in New Orleans, collected between March and May 2017. A semi-structured field guide was developed for individual face-to-face interviews. Six pilot interviews were conducted to refine the guide. The final guide consisted of four sections: (1) demographic and socioeconomic information; (2) sexual orientation and gender identities; (3) early and current life stressors; and (4) healthcare seeking stories. Data related to housing was collected in section three and covered (1) personal experiences and community accounts of housing insecurity; (2) connections between housing insecurity and other life aspects; and (3) coping strategies. All T/GNCI 18 and older living in New Orleans, LA, USA, were eligible. Participants (n = 17) were engaged through purposive and snowball sampling, via partner and collaborating organizations, transgender advocacy and support groups, and personal networks of participants and research staff. All respondents consented to participate. Participants received a $30 Walgreens gift card and transportation support (parking pass or $5 gift card to offset public transportation costs). One potential respondent declined to participate, expressing emotional pain related to the interview topics. The research team utilized a hybrid approach to thematic analysis, including inductive and deductive coding and theme development [²⁷]. Two researchers (AL, MP) conducted all interviews. Interviews, lasting 1–2 hours, were audio recorded and transcribed. The interviewers completed debrief forms after each interview, which served to ensure quality assurance, provide preliminary analysis of emergent themes, and guide the a priori codebook development. Upon completion of data collection, transcripts were coded independently by one of four coders using NVIVO Version11. A quarter of transcripts were double coded and reviewed to ensure inter-coder agreement. After the initial coding process was complete, five secondary codes for the housing-related data were developed then applied in vivo collaboratively by two researchers. Housing data was sorted within the secondary coding structure, then reviewed and summarized, and illustrative quotes were pulled to underscore key points. When quotes are offered, along with age, self-ascribed identity labels for gender and race are provided, and therefore will take various nomenclatures. Two community member checks were conducted [²⁸]. The Tulane University Institutional Review Board approved the study. The majority of the research team identifies and exists within the New Orleans lesbian, gay, bisexual, transgender, and queer (LGBTQ) community. One of the interviewers/analysts identifies as T/GNC. This positionality facilitated ease of connection with partner organizations and individual research participants.

Results

The sample (n = 17) ranged in age from 23 to 39 with one 70-year-old participant. Participants identified as white or white/Hispanic (n = 10) or African American, Black, and African Indigenous (n = 7). While all respondents currently resided in the greater New Orleans area, six originated from New Orleans, six from the South, and five from elsewhere in the USA. About half of the sample identified as lower or working class, and half as middle class. Educational status ranged, with more than half having attended some amount of college or trade school. Occupations varied widely, from artist to escort to jobs in the health sector. Sixteen respondents reported a personal experience of homelessness or insecure housing at some point in their lives. All respondents identified as transgender or gender non-conforming; six identified as women, trans women or female; four identified as male, transgender male, or transmasculine; and five as genderqueer, gender non-conforming, non-binary, or bigender/agender. One respondent identified their gender as “child of god”, another as “transsexual.” Based on the secondary coding structure, the results cover general descriptions of housing insecurity, stories of surviving and coping with these experiences, and intersectional obstacles.

Discussion

While there is growing understanding of the unique structural and contextual health constraints faced by communities in the Deep South [²⁹], and most US-based T/GNC studies have occurred in cities such as Los Angeles, New York, and San Francisco [^30–32], research focused in the Deep South on T/GNC populations across gender identity is rare. To our knowledge, this is the first study to look at housing insecurity among T/GNC populations in New Orleans or the Deep South.

Among our sample, we found that an array of circumstances contribute to housing insecurity, including intersectional stigma and discrimination coupled with gentrification and a changing housing landscape. Housing was intricately intertwined with employment and other structural issues; vulnerability in one realm was closely tied to insecurity in the others making survival a delicate balance. Our results corroborate previous findings that connect housing insecurity with increased substance use, physical and sexual vulnerability, difficulty securing employment, and decreased sense of safety, and adherence to medical treatment plans [^{1, 2, 30}].

Housing insecurity is a key social determinant of health. Existing HIV research shows the link between housing and health among vulnerable populations, where transgender women are disproportionately affected [³³]. Persons living with HIV (PLWH) who have stable housing are significantly more likely to have improved care outcomes [^{34, 35}]. This is important, as retention in care among PLWH is low [³⁶] and 30% or less achieve successful viral suppression [^{37, 38}]. Housing research focused on transgender communities has primarily focused on HIV risk among transgender women, finding that homelessness and housing insecurity are associated with higher rates of illicit drug use, illegal hormone injection, exchange sex, and other HIV risk factors among this population [^30–32].

Oppressive structures such as racism, misogyny, capitalism, and transphobia intersect to make certain individuals more vulnerable. While T/GNCI face high rates of housing discrimination [⁴], and Black individuals, irrespective of gender identity, face additional housing discrimination [²⁴], people with both of these identities likely face heightened discrimination and housing obstacles. The Black T/GNCI respondents in our study shared stories highlighting their exacerbated vulnerabilities compared with their white counterparts. White respondents voiced similar observations. It follows that comparable dynamics may hold true for other people of color. Further, respondents noted that transwomen and transfeminine people face intensified housing obstacles, which is compounded at the intersection of race; transfeminine respondents of color reported exacerbated obstacles.

Marginalized groups in search of community, such as LGBTQ people, have a well-established legacy of gentrifying cities [^39–43]. This trend is evident in New Orleans, a liberal haven in the South, which attracts many LGBTQ folks seeking a more accepting environment. In our sample, half of the New Orleanians were not native to the city, and while many had relocated from other parts of the South, they play a role in changing the city. White respondents in our sample reflected on their roles in gentrification processes and how in attempts to find safer spaces, they are displacing others along lines of race and class.

Despite many housing obstacles, respondents discussed factors that buffered these challenges. Social support emerged as a key source of resilience. Queer family structures and looking out for others were stopgaps in crisis and sustained housing solutions. Existing research on T/GNCI also recognizes the resilience of this population, highlighting many forms of resilience, including the role of social support [^44–46]. Alternative family structures and strong community supports are frequent characteristics of queer communities [^{47, 48}], however, not without their shortcomings. In an already vulnerable community where many T/GNCI are struggling for adequate resources, many are supporting those experiencing even greater challenges. This perpetuates financial susceptibility throughout the community. An additional concern was raised through member checks, where exchange of sex or other labor may be expected for shelter.

Findings from this study mirror research and anecdotal reports in other locations, where housing stock is limited and the impacts of gentrification are significant. New Orleans and other cities need a systematic response that can help all residents, coupled with unique interventions for T/GNCI. Current New Orleans effort include the regulation of STRs (e.g., Airbnb) [^{24, 49, 50}] and inclusionary zoning policies requiring affordable units when re-developing public housing [⁵¹]. Responses to the overall gentrification of the city include city land allocation for affordable housing and ensuring that public investments in gentrifying neighborhoods are preceded by significant affordable housing investments, as called for in the City’s Assessment of Fair Housing plan [⁵²]. At the state level, the Greater New Orleans Fair Housing Action Center is working to reform draconian security deposit and eviction laws [⁵³].

Despite important findings, this study is not without its limitations, including the relatively small sample size; however, the sample reflected diversity in gender identity, race, class, income, and education. The limited age diversity may have also concealed unique disparities and coping strategies related to generation, including dis/ability. These points notwithstanding, saturation was reached on an array of themes. The findings are from a specific geographic location, and while trends echo national anecdotal evidence, generalizablity to other geographic locations is uncertain. While New Orleans is its own culturally specific location, trends in urban gentrification and short-term rental policies may be similar in other cities.

Further research is needed to tailor housing initiatives in many US cities, particularly among T/GNCI who may be more vulnerable to housing insecurity. This study did not investigate housing supports such as shelters, housing vouchers, or other potential mechanisms that may alleviate the situation; however, existing research shows that homeless T/GNCI (26%) avoid shelters because they fear gender-related mistreatment, and up to 70% of T/GNCI who did stay in a shelter reported mistreatment [⁴].

In conclusion, while this population faces a wide range of housing insecurity related to gender identity and expression, individuals exist within a larger web of discrimination and structural vulnerabilities and a complex housing landscape. Obstacles faced in accessing housing bi-directionally impact health-related behaviors and outcomes as well as other social determinants of health. Intersecting identities render greater vulnerability or privilege. The interplay of interpersonal and structural obstacles on housing was exacerbated by the New Orleans post-disaster context. The study also demonstrates resilience strategies among T/GNCI, particularly strong social support, which should be built upon in intervention efforts.

Acknowledgments

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