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Regarding barriers to access to care, most participants reported long wait times, difficulty <br />getting an appointment, and lack of follow through with referrals (by the referring provider). <br />Several individuals felt they were treated differently based on their immigration status. <br />Participants discussed the overall lack of understanding medical professionals have ofthe TGNC <br />community and would like to see additional transgender-specific training facilitated by people <br />from the TGNC community. The issue of lack of healthcare insurance and cost of healthcare <br />continued to surface during the discussions, along with the lack of awareness by some <br />community members on sliding fee scales. The need for mental health care was a recurring <br />theme. Participants expressed that most mental health support comes from their peers. <br />Participants also identified a need to address social determinants of health, such as housing, <br />economic resources, education (technology classes), and support services (legal and <br />transportation services). <br />A limitation of the focus groups is that the majority of individuals who participated in the focus <br />groups were the same individuals who completed the survey, thus the results may not be <br />applicable to the general TGNC population in Orange County. <br />The following recommendations (see Figure 2) are based on the survey and focus group findings <br />detailed in this summary of findings and are intended to provide some general guidance on next <br />steps to improve the quality of and access to HIV/STD healthcare services for the TGNC <br />community of Orange County. OCHCA and Alianza Translatinx developed these <br />recommendations jointly with support from Facente Consulting. These recommendations will <br />be shared with key stakeholders throughout Orange County as we work to make progress to <br />improve healthcare access and outcomes for the TGNC community, and will take a concerted <br />and ongoing effort. <br />(Continued on next page.) <br />23 <br />