2 - (IOP 24) Trans and Nonbinary Community Support to Promote Access to Gender Affirmation and Reduce Suicide Risk: Findings from a World Café

Trans and nonbinary (TNB) populations face alarming disparities in suicidal thoughts and behaviors, including death. Despite strong evidence for the mitigating effect of medical, social and legal gender affirmation on suicide risk, a number of barriers limit access to gender affirming care (GAC), leaving community members to bridge gaps in GAC access and suicide risk management. As part of a larger project to formalize community support for GAC navigation and TNB suicide prevention, the current study collected formative data to characterize community practices and needs in navigating GAC and managing suicide risk within the local setting, a Black trans-led community organization. A highly diverse sample (N = 32; 84% Black, Indigenous, or people of color; 53% trans feminine, 28% trans masculine, 34% nonbinary) attended a 2.5-hour World Cafe event involving simultaneous rotating group discussions and note-taking to capture consensus on participant expertise navigating social, medical, and legal GAC domains. Four peer facilitators (100% Black, trans women) lead group discussions on eight GAC domains (1. social affirmation; 2. hormone therapy; 3. ‘top’ surgery to alter chest or breast tissue; 4. ‘bottom’ surgery to alter genitalia; 5. changes in gender presentation; 6. legal affirmation; 7. gender affirming mental health care; 8. suicide-related risk management). Social affirmation was the most accessed area of GAC (100%), while surgery to alter genitalia was the least (30%). Consensus-based, rapid, directed content analysis of group discussion transcripts, group notes, and group facilitator field notes identified themes characterizing GAC processes and within-community interpersonal functions. GAC processes described by participants included: structural, medical/institutional, and relational/individual gaps and barriers to care; decision-making processes; and impacts/lessons learned. Interpersonal-functional processes that emerged within group discussions included: sharing lived experiences, offering advice or support, community affirmation, and community gatekeeping. The most common themes involved participants sharing positive or negative impacts and lessons learned from personal lived experiences navigating various domains of GAC. Limited time afforded to each group discussions limited thematic saturation for content, but not process themes. Findings from community discussions build on the current literature regarding GAC access, suicide risk, and community support by identifying areas to target when developing interventions to promote GAC access and prevent TNB suicide (e.g., patient navigation to mitigate barriers, tools for decision-making, peer facilitation). Findings also highlight key interpersonal functions that may be leveraged to maximize the acceptability and feasibility of future interventions (e.g., touchpoints for peer facilitator training).