Intersectional structural oppression as a fundamental cause: Reflections on implementing a medical-legal partnership project.

Abstract

Objective: Intersectional and structural intervention approaches are critical to addressing health inequities experienced by transgender and gender diverse (trans) populations. In this commentary, we reflect on the implementation of a community-led, medical-legal partnership project designed to address barriers to legal gender affirmation and improve health outcomes for trans women of color with criminal records in Detroit.

Method: We initiated a partnership between a community health center and legal advocacy organization to address the health-harming legal needs of five trans women of color with criminal records via attorney support and financial assistance.

Results: We enrolled four participants, and two received legal name changes. Our low success rate was largely because of legal costs that far exceeded our expectations and resources. These costs stemmed from compounding monetary sanctions participants received for low-level vehicular civil infractions.

Conclusions: Our implementation of this intervention revealed structural intersectional oppression in action. Monetary sanctions interact with Michigan name change policies requiring court appearances for applicants with criminal records, creating nearly insurmountable barriers to legal gender affirmation for economically vulnerable communities subjected to racism and cissexism. Building intersectional structural competency inclusive of legal literacy via multisectoral collaborations between diverse legal and policy experts, community members, and academic researchers is critical to developing interventions to address structural determinants of trans health. (PsycInfo Database Record (c) 2025 APA, all rights reserved).