Gender-Affirming identification documents are associated with positive health-related outcomes for transgender people in Bolivia.

Purpose: Legislation has improved access to gender-affirming identification documents (IDs) in many countries but few studies address the laws' effects. We document the relationship between gender-affirming IDs and four measures of health-related outcomes for a nonprobability sample of transgender people in Bolivia, where a 2016 gender identity law improved access to gender-affirming IDs. Methods: We interviewed 18 transgender advocates in three Bolivian cities about the law and its effects. We then developed a survey with the Organization of Transgender, Transsexual, and Transfeminine People of Bolivia (OTRAF) and surveyed 93 transgender people from across Bolivia about their demographics, work, health, discrimination experiences, and political engagement in June 2023. Results: Interviews emphasize the importance of gender-affirming IDs to transgender Bolivians. Survey respondents who had changed their names and gender data on their IDs were significantly more likely to report taking a human immunodeficiency virus (HIV) test in the last six months, to have taken hormone replacement therapy (HRT), and to be taking HRT under doctor supervision than those who have not, in logistic regression and propensity score matching analyses. The analyses include variables that could influence health-related outcomes such as income, education, employment, gender identity, location, and age. Conclusion: We suggest that access to gender-affirming IDs can improve health-related outcomes and that gender identity laws have important public health impacts for transgender communities.