Authors analyze data from the San Francisco site of the National HIV Behavioral Surveillance Transgender (NHBS-Trans) Study (2019–2020) to explore how disability status among transgender women influences mental health. Chi-squared and Fisher's exact tests to assess associations between disability status and psychological distress. Multivariable logistic regression models assessed the magnitude of these associations adjusted for potential confounders.

Findings: 71.14 % of the sample (N = 201) reported living with one or more disabilities. Participants with 1+ disabilities had more than 10 times the odds of reporting high levels of psychological distress and more than five times the odds of reporting suicidal ideation compared to those with no disabilities. Participants with 2+ disabilities had 10+ times the odds of reporting suicidal ideation compared to participants with no disabilities. Authors conclude that transgender women living with disabilities face multiple intersecting inequities likely attributable to living in a world that is not built for them on the basis of gender identity and disability status. The resulting psychological distress, alongside transphobia and ableism, can exacerbate mental health issues.