Difficulties experienced by trans people in accessing the Unified Health System

Factor structure and measurement invariance of the Body Appreciation Scale - 2 among Brazilian gender-expansive individuals and transgender men

Among gender-expansive individuals and transgender men, body appreciation can play a protective role against minority stressors and is associated with gender euphoria. The Body Appreciation Scale (BAS-2; Tylka & Wood-Barcalow, 2015) is a leading measure of body appreciation that has been mainly validated in cisgender and mixed-gender samples; however, it has not been validated among Brazilian gender-expansive individuals and transgender men. Therefore, we evaluated the psychometric properties of the BAS-2 among adult Brazilian gender-expansive individuals and transgender men. Participants (158 gender-expansive individuals and 138 transgender men) were recruited through social media in Brazil. Confirmatory Factor Analysis (CFA) supported the original 10-item, unidimensional solution. Multigroup CFA showed configural, metric, and scalar invariance of the BAS-2 between gender-expansive individuals and transgender men. Moreover, the BAS-2 demonstrated significant negative associations, ranging from small to large, with self-objectification, drive for muscularity, and appearance-ideal internalization. We also found good internal consistency and test-retest reliability of the measure. Taken together, our results support the psychometric properties of the BAS-2 among Brazilian gender-expansive individuals and transgender men. The present work offers a valuable contribution towards better understanding facets of positive body image across gender-expansive and transgender populations.

Anticipated Stigma and Social Barriers to Communication Between Transgender Women Newly Diagnosed with HIV and Health Care Providers: A Mediation Analysis

Purpose: We assessed whether anticipated stigma (i.e., fear of public mistreatment due to gender identity) impacts communication between transgender women (TGW) living with HIV and health care providers. Methods: This is a secondary analysis of baseline data from Trans Amigas, a study conducted in Brazil, 2018. The study population consisted of TGW living with HIV, older than 18 years, residing in the São Paulo metropolitan area. We used multivariable logistic regression (α = 0.05), mediation, and bootstrapping for the analysis. Results: One hundred and thirteen participants completed the study. Fear of public mistreatment had an adjusted odds ratio (aOR) of 7.42 (p = 0.003) for difficulty reporting new symptoms to providers. Concerning fear of public mistreatment, we found that unemployment had an aOR of 3.62 (p = 0.036); sex work, an aOR of 2.95 (p = 0.041); and issues related to name change in documents, an aOR of 2.71 (p = 0.033). For the indirect effect on difficulty reporting new symptoms, mediated by fear of public mistreatment, unemployment had an aOR of 1.52 (confidence interval [CI] = 0.88-2.24); sex work, an aOR of 1.48 (CI = 0.81-2.52); and name change issues, an aOR of 1.47 (CI = 0.96-2.43). Conclusions: Anticipated stigma was associated with communication difficulties between TGW living with HIV and providers. Our data suggest that structural factors associated with anticipated stigma could indirectly impact on difficulty reporting new symptoms. These findings indicate the importance of considering social contexts that intersect with individual experiences when analyzing communication barriers between providers and patients, and the need to strengthen social policies for TGW in Brazil. Clinical Trial Registration number: R34MH112177.

Association between in-country migration and HIV infection among transgender women from northeastern Brazil: a respondent-driven sampling survey

BACKGROUND

Migration is common among transgender women (TGW), often driven by the desire to escape stigma, find acceptance, establish new connections, access body modifications, or enter new avenues of sex work. Given the heightened mobility of TGW, they are mostly vulnerable to human immunodeficiency virus (HIV) due to migration. This study aimed to evaluate the association between in-country migration and HIV infection among TGW in Northeast Brazil.

METHODS

The DIVAS was a cross-sectional, multicity study investigating risk behaviors and sexually transmitted infections (STI) among TGW in 2016-2017. A total of 864 TGW were recruited through respondent-driven sampling from three capital cities in Northeast Brazil. Logistic regression estimating odds ratios (OR) and 95% confidence intervals (CI) was used to assess the relationship between in-country migration and HIV infection.

RESULTS

The prevalence of HIV among TGW was 24.5%, 21.4% among those aged 18-34 and 36.1% among those ≥ 35 years old. In-country migration increased the odds of HIV infection among TGW aged 18-34 years (OR = 1.84; 95%CI:1.04-3.27) and even higher among those aged ≥ 35y old (OR = 3.08; 95%CI:1.18-8.04).

CONCLUSIONS

These data reinforce the pressing need for public health policies that provide comprehensive access and strategies for demand creation for HIV/AIDS prevention and care for TGW who are already highly vulnerable to infection.

HIV prevalence among transgender women in Northeast Brazil – Findings from two Respondent Driven Sampling studies

Background

The HIV epidemic still high among key-populations in Brazil, especially among transgender women (TGW). The aim of this study was to investigate the prevalence of HIV infection among TGW and to analyze factors associated with HIV seropositivity across two cross-sectional surveys conducted in Salvador, Bahia, one of the largest urban centers of Brazil.

Methods

The studies were conducted between 2014 and 2016 and 2016-2017 and employed Respondent-Driven Sampling (RDS) sampling, comprising 127 and 161 TGW residents of Salvador, Bahia. The outcome was the positive rapid antigen testing for HIV infection. Odds ratios (OR) and 95% confidence intervals (95%CI) were obtained using binomial logistic regression.

Results

The HIV prevalence was 9.0% (95%CI: 4.2-18.2) and 24.3% (95%CI: 16.2-34.9). In the first study, factors associated with HIV prevalence were experiencing discrimination by the family (OR 8.22; 95%CI: 1.49-45.48) and by neighbors (OR 6.55; 95%CI: 1.12-38.14) as well as having syphilis (OR 6.56; 95%CI:1.11-38.65); in the subsequent study gender-based discrimination (OR 8.65; 95%CI:1.45-51.59) and having syphilis (OR 3.13; 95%CI: 1.45-51.59) were associated with testing positive for HIV.

Conclusion

We found disproportionately high HIV prevalence among TGW, which underscores the context of vulnerability for this population. The data point to the urgency for intensification and expansion of access to HIV prevention and strategies to stop discrimination in health care and services for this population.

The experience of trans or transvestite women in accessing public health services

OBJECTIVE

to understand the meanings of being a trans or transvestite woman in the care provided by Unified Health System health professionals.

METHODS

qualitative research, guided by Heidegger's phenomenology, with 10 trans or transvestitewomen residing and using the Unified Health System in a municipality in Minas Gerais. Fieldwork was carried out by interviews.

RESULTS

trans or transvestitewomen reproduce the social patterns constructed and accepted by the female, with the search for hormonization being common, and, when it is difficult to obtain a prescription, they resort to self-medication. Social name use and acceptance by health professionals promote recognition. Trans or transvestitewomen experience prejudice on a daily basis, not only by professionals, but also because of the assumption of diagnoses by other users.

FINAL CONSIDERATIONS

transphobia promotes withdrawal from health services, due to fear, shame, knowledge about professionals' unpreparedness, triggering illness, social exclusion and violence.

Percepções de LGBTs sobre o Acesso à Atenção Primária de Saúde na Cidade de Guaiúba, CE

O acesso aos serviços de saúde tem se mostrado um desafio constante na trajetória de pessoas LGBT. Considerando isso, este estudo objetivou analisar a percepção de pessoas LGBT sobre o seu acesso às unidades básicas de saúde de Guaiúba, no Ceará. Utilizou-se o método qualitativo, a partir do uso de entrevista semiestruturada e questionário socioeconômico. No total, sete pessoas foram entrevistadas entre os meses de agosto e outubro de 2019. Identificou-se a perpetuação de violações de direitos que reforçavam práticas de iniquidade e invisibilidade das demandas de saúde dessa população. O desrespeito ao nome social e as barreiras atitudinais foram práticas apontadas, criando abismos entre pessoas LGBT e os serviços de saúde. Diante disso, faz-se necessário que profissionais possam investir na capacidade de dialogar, construir e compartilhar cuidados que legitimem a diversidade humana.

(Re)Construction of the body of transgender women: daily search for (in)satisfaction and care?

OBJECTIVE

To analyze the structure and contents of transgender women's social representations of their bodies and body modification practices.

METHODS

Research conducted with 92 women using the Snowball technique. The data were collected using the free evocation of words technique and processed by the Evoc software, which organized the central and peripheral elements.

RESULTS

The representation of the real body includes two structuring aspects: one related to the need to adapt/modify the body conformation according to the self-reported gender, because of the dissatisfaction with the body itself; the second reveals the happiness/satisfaction considering the results obtained through the body modification/adaptation practices adopted in the transition.

FINAL CONSIDERATIONS

The body is constituted as a complex object and was represented by elements that reinforce the understanding of body modifications as needs, with a view to satisfaction, personal fulfillment, and care of one's own body.

PROCESSO TRANSEXUALIZADOR NO SUS: QUESTÕES PARA A PSICOLOGIA A PARTIR DE ITINERÁRIOS TERAPÊUTICOS E DESPATOLOGIZAÇÃO

Trata-se de uma pesquisa qualitativa, des­critiva e exploratória, realizada no Tratamento Fora de Domicílio, na cidade de Cuiabá-MT, Brasil, que objetivou levantar reflexões sobre os itinerários terapêuticos de pessoas trans, na busca pelo Processo Transexualizador. Participaram três homens trans, duas mulheres trans e uma mulher travesti, com faixa etária de 21 a 32 anos. Os da­dos foram coletados por entrevistas semiestruturadas e analisados mediante análise de conteúdo. Os resultados mostram que essas pessoas trans seguem trajetórias diver­sas, procurando serviços institucionalizados ou informais (redes de socialidade trans), para a afirmação de suas identidades de gênero. Destacam-se entraves atinentes à patologização, ao acolhimento, à continuidade do cuidado, à resolutividade e à referência na rede de atenção do processo transexualizador. Observaram-se importantes pontos críticos na assistência social, endocrinológica e para a psicologia, sendo a peregrinação pelos serviços de saúde demarcada por constantes discriminações institucionais, permitindo a compreensão de como o sistema de saúde se organiza em relação ao atendimento dessas pessoas, elencando questões para o trabalho da psicologia, nesse campo, a partir de uma perspectiva da experiência e materialidade do gênero.

Serviços de atendimento integral à saúde de transexuais e travestis no Sistema Único de Saúde

Introdução: É inegável o cenário de marginalização institucional a que está exposta a população travesti e transexual. Isso inclui serviços mesmo no contexto do Sistema Único de Saúde (SUS). Esse fenômeno, como apontam a literatura e os próprios movimentos sociais, apresenta-se principalmente no desrespeito ao nome social, na discriminação, na necessidade de diagnóstico para acesso a serviços e no despreparo das equipes de saúde. Para que se possam reduzir iniquidades históricas na constituição da assistência e da implementação de políticas públicas em saúde, é necessário caracterizar a assistência ofertada a essa população no âmbito do SUS. Objetivo: Analisar como se vêm constituindo os serviços de atendimento integral à saúde de pessoas transexuais e travestis no Brasil com base em uma revisão integrativa da literatura sobre o tema. Métodos: Este é um estudo de natureza qualitativa, do tipo exploratório. Foi realizada revisão integrativa da literatura, buscando explorar o cenário de atenção à saúde trans atual no país. A busca foi conduzida nas bases Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO) e Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) no período de julho a setembro de 2020. Os critérios de inclusão foram ter temática referente a serviços públicos e nacionais de atenção à saúde trans e travesti, independentemente do nível de complexidade. Resultados: Foi realizada a leitura completa de 22 trabalhos. O cenário de atenção à saúde trans e travesti no âmbito do SUS consiste, majoritariamente, em serviços de atenção especializada e concentra-se no Sul do país, em grandes centros urbanos. Os dispositivos de saúde já existentes na rede não se mostram suficientes e capacitados para realizar assistência integral em saúde, com uma ótica que fuja à heterocisnormatividade e ao modelo patologizador biomédico das transidentidades. Modelos de serviços exitosos na Atenção Primária à Saúde (APS), contudo, estão modificando esse cenário. Conclusões: Serviços específicos para a população trans e travesti são necessários, pois operam na lógica de sanar iniquidades históricas sofridas por essa população. A APS é um cenário estratégico nesse cuidado e políticas públicas devem operar nessa perspectiva.

Complementary Recruitment Strategies to Reach Men Who Have Sex with Men and Transgender Women: The Experience of a Large Brazilian HIV Prevention Service

Different strategies have been used to reach men who have sex with men (MSM) and transgender women (TGW) for HIV prevention services. We described the characteristics of MSM and TGW attending a large HIV prevention service in Brazil according to different recruitment strategies or referrals. A total of 2713 individuals (2246[82.8%] MSM and 467[17.2%] TGW) attended the service. Among HIV-negative MSM and TGW, 74.6% and 82.8% were eligible for pre-exposure prophylaxis (PrEP), respectively. PrEP uptake among MSM and TGW was 56.4% and 39.1%, respectively. Participants were mostly referred by peers (43.6%), followed by web-based (24.1%) and venue-based recruitment (16.2%). More young and Black MSM were referred from venue-based recruitment, and web-based strategies more frequently referred MSM with higher education. TGW who were younger and had higher education were more frequently referred from venue-based recruitment. Web-based recruitment failed to reach TGW. Multiple strategies were complementary to reach diverse MSM and TGW populations.

Uso de hormônios não prescritos na modificação corporal de travestis e mulheres transexuais de Salvador/Bahia, Brasil

Resumo O objetivo deste artigo é analisar o uso de hormônios não prescritos entre travestis e mulheres transexuais (TrMT) na cidade de Salvador, Bahia, Brasil. Trata-se de um estudo de corte transversal onde se utilizou a metodologia RDS (respondent driven sampling) para recrutar TrMT entre 2014 e 2016, em Salvador e sua Região Metropolitana. Foi realizada uma análise comparativa entre condições sociodemográficas, comportamentais e de afirmação de gênero com o uso de hormônios. Os dados ponderados pelo estimador RDS-II. Utilizou-se o programa Stata, versão 14, para análises estatísticas. Foram recrutadas 127 TrMT. Da amostra estudada, 69,1% das participantes fizeram uso de hormônios não prescritos, o que esteve associado ao uso de silicone líquido industrial e ao relato de satisfação corporal. As TrMT que estavam confortáveis com o pênis e que sentiam prazer com o mesmo apresentaram menor probabilidade de uso de hormônio. As participantes soropositivas para HIV reportaram maior proporção de uso de hormônio. O uso não prescrito de hormônios foi utilizado pela maioria das TrMT. É provável que esse uso esteja associado a uma melhor satisfação com a autoimagem e com o corpo entre as TrMT. Verificou-se o uso em elevadas quantidades desses medicamentos e de maneira exacerbada, provavelmente devido ao pouco acesso aos serviços de saúde pública.

O vivido de mulheres trans ou travestis no acesso aos serviços públicos de saúde

RESUMO Objetivo: compreender os sentidos de ser mulher trans ou travesti nos atendimentos realizados por profissionais de saúde do Sistema Único de Saúde. Métodos: pesquisa qualitativa, norteada pela fenomenologia de Heidegger, com 10 mulheres trans ou travestis residentes e usuárias do Sistema Único de Saúde de um município mineiro. Trabalho de campo foi realizado por entrevistas. Resultados: mulheres trans ou travestis reproduzem os padrões sociais construídos e aceitos ao feminino, sendo comum a busca pela hormonização e, havendo dificuldade em obterem a prescrição, recorrem à automedicação. A utilização e a aceitação do nome social pelos profissionais de saúde promovem seu reconhecimento. Mulheres trans ou travestis vivenciam cotidianamente o preconceito, não somente por profissionais, mas também pela suposição de diagnósticos por outros usuários. Considerações finais: a transfobia promove o afastamento dos serviços de saúde, por medo, vergonha, conhecimento sobre o despreparo dos profissionais, desencadeando adoecimento, exclusão social e violência.

Association between gender-based discrimination and medical visits and HIV testing in a large sample of transgender women in northeast Brazil

Background

Gender-based discrimination remains a substantial barrier to health care access and HIV prevention among transgender women in Brazil. The aim of this study was to investigate the association between gender-based discrimination and medical visits, as well as with HIV testing among transgender women in the last 12 months in northeast Brazil.

Methods

This is a cross-sectional study of 864 transgender women recruited using Respondent-Driven Sampling in three cities in northeastern Brazil in 2016. A socio-behavioral questionnaire was applied. Multivariate analyses were performed using logistic regression, with odds ratio and respective 95% confidence intervals estimation, to estimate the effect of gender-based discrimination on two outcomes: i) medical visits and ii) HIV testing in the last 12 months.

Results

547 transgender women (67·0%) had medical visits, and 385 (45·8%) underwent HIV testing in the last 12 months. In the multivariate analysis, gender-based discrimination was associated with a reduced likelihood of medical visits (OR: 0·29; 95%CI: 0·14–0·63) and HIV testing (OR: 0·41; 95%CI: 0·22–0·78) in the last 12 months.

Conclusion

Gender-based discrimination played an essential role in reducing the access of TGW to medical visits and HIV testing services. Furthermore, by confirming the association between gender-based discrimination and medical visits and HIV testing in the multivariate analysis, we have demonstrated how this predictive variable can affect by reducing access to health services. The findings point to the need for non-discriminatory policies based on the defense and promotion of human rights that may foster the access of transgender women to Brazilian health services.

Therapeutic itinerary of transsexual people in light of human rights

BACKGROUND

The therapeutic itinerary is not limited to the identification and availability of health services offered, but relates to the different individual searches and sociocultural and economic possibilities of each patient. In this study, we discuss the therapeutic itinerary of transsexual people seeking healthcare, from the user's perspective.

OBJECTIVE

The aim of this study was to discuss the therapeutic itinerary of transsexual people seeking healthcare, from the user's perspective.

DESIGN AND PARTICIPANTS

Individual interviews were performed with 10 transsexuals at the Trans Space of a University Hospital of Pernambuco, using the Universal Declaration of Human Rights as the theoretical reference and the Bardin's thematic content analysis as the reference methodological framework.

ETHICAL CONSIDERATIONS

This study was approved by the Human Research Ethics Committee at the Federal University of Pernambuco under protocol no. 91284218.5.0000.5208.

FINDINGS

The comprehensive care for transsexual people was evidenced through four categories analyzed: low demand of transsexuals in health services; use of social name in health services; care permeated by prejudiced and discriminatory attitudes; and health system and professionals who are not able to meet transgender health issues.

DISCUSSION

Transsexual people are stigmatized and experience prejudice in their daily health, in a way they do not enjoy fundamental rights, as if they had fewer rights, or infringe the principle of universality of access to health. Thus, for effective and comprehensive care, the health team must keep up to date on the public policies existing in the healthcare of transsexual people and reconstruct what they understand by gender.

CONCLUSION

Knowledge about the therapeutic itinerary of transgender people may support evaluation processes of health service networks to ensure the access to and reorganization of these services. Understanding this dynamic allows fostering discussions about the structure of health services at all care levels for the care of this population.

Nonprescribed Sex Hormone Use Among Trans Women: The Complex Interplay of Public Policies, Social Context, and Discrimination

Purpose: Trans women are systematically excluded from basic human rights, possibly due to social contexts of transphobia. In health care, such barriers may result in nonprescribed sex hormone use and lead to significant health complications. As few studies investigated this phenomenon, we analyzed factors associated with nonprescribed sex hormone use by trans women in seven municipalities of São Paulo, Brazil. Methods: Muriel was a cross-sectional study (2014/2015), in which 673 transgender people answered a face-to-face survey. This analysis focused on trans women (n=616). Poisson regression models were used to assess factors associated with nonprescribed sex hormone use. A direct acyclic graph was built with a priori knowledge on the matter and was used for covariate selection. Results: A total of 90.7% of participants reported ever taking sex hormones. Most of those detailed nonprescribed use, which was associated with sex work, starting to use hormones before 18, identifying as travesti and lower education. Having the chosen name honored in public health services was found to be protective against this outcome. Conclusion: A high proportion of nonprescribed sex hormone use was observed in our sample. Our findings suggest barriers to health care and the need for trans women to resort to medically unsupervised transition procedures. Among sex workers, this may also be due to higher economic and access needs than other groups. Ensuring social rights and providing adequate health care services may lessen nonprescribed sex hormone use, preventing subsequent risks and resulting in better health outcomes for trans women.

Health of transgender men in low-income and middle-income countries: a scoping review

INTRODUCTION

Despite the rapid growth of research on transgender (trans) health globally, the extent of research on trans men and other transmasculine persons assigned the female sex at birth remains unclear. We, therefore, conducted a scoping review on trans men's health in low-income and middle-income countries (LMICs).

METHODS

The review included peer-reviewed articles and conference abstracts, and grey literature published from 1 January 1999 to 5 July 2019 in English, French, Hindi or Spanish and reporting original quantitative and/or qualitative data on the health of trans men or transmasculine persons living in LMIC. Studies were excluded if they did not disaggregate data for trans men or if they only described surgical techniques or laboratory values.

RESULTS

We included 53 studies (42 peer-reviewed and 11 grey literature) from 19 LMIC. Most were conducted in higher-middle-income countries (n=12) and in Latin America (n=16, 30.2%), the Middle East (n=14, 26.4%) or Sub-Saharan Africa (n=12, 22.6%) and published in 2014 or later (n=44, 83.0%). Approximately half of studies used quantitative methods (52.8%, n=28), of which 64.3% (n=18) had fewer than 50 participants and 14.2% (n=4) had over 150. Across study designs, social determinants of health and gender-affirming care were the most commonly represented domains (49.1% and 47.1% of studies respectively), with common themes including gender-based violence, coercion and discrimination as well as unprescribed hormone use. Other domains represented included mental health (32.1%), sexual and reproductive health (24.5%), general healthcare access (18.9%), physical health (9.4%) and substance use (9.4%).

CONCLUSION

Greater inclusion and disaggregation of trans men and transmasculine persons in global health research is needed to support sex- and gender-based analyses of trans health. Community-based research approaches and theoretically driven research may help to increase the relevance and rigour of such research. Funders should invest in research on trans men's health in LMIC.

Voice And Gender Incongruence: Relationship Between Vocal Self-Perception And Mental Health Of Trans Women

OBJECTIVE

To verify the association between vocal perception and Common Mental Disorders (CMD) suspicion in trans women.

METHODS

Cross-sectional observational study including 24 adult trans women with a minimum time of presentation as a woman of six months. The sampling of the subjects was supported by the "Snowball" technique. Three questionnaires were applied for data collection: sociodemographic and health data, Self-Reporting Questionnaire (SRQ-20) and Trans Woman Voice Questionnaire (TWVQ). The sociodemographic and health data collected were: age, marital status, education, smoking habits, speech therapy, use of hormones, and whether they had undergone Sex Reassignment Surgery (SRG). SRQ-20 was used for suspicion of CMD evaluation, such as depressive and anxiety symptoms. TWVQ is a vocal self-report questionnaire for trans women living the full-time gender role in which they self-identify. TWVQ has a minimum score of 30 points and a maximum of 120 points. Higher scores are associated with perceptions of a higher frequency of voice-related difficulties and psychosocial impacts. For statistical analysis, data were analyzed descriptively and statistically using Fisher's and Mann-Whitney's exact tests, both with a significance level of 5%.

RESULTS

The average participants' age in this study was 28.2 years old (SD = 6.5 / minimum = 21 and maximum = 48); 83.3% were single; most (41.7%) were high school graduates; and most (95.83%) had not undergone Sex Reassignment Surgery. All subjects reported using hormones; 37.5% were smokers; 4.2% had undergone speech therapy; and the average number of years of experience in the female role was 8.8 years (SD = 7.2). The average TWVQ score was 55.4 points (SD = 4.3). Through SRQ-20, it was verified the prevalence of suspected CMD in 58.3% of the participants. The study results indicated that communicative dissatisfaction in trans women due to inconsistent voice with the recognized gender is associated with probable CMD such as depression and anxiety (P= 0.001).

CONCLUSION

Trans women who reported greater difficulties and voice-related effects in their lives had more symptoms of anxiety and depression. Although more research is needed, results indicate the need for inter-professional preventive and therapeutic actions directed towards assisting trans women. This fact encourages reflection on the care of this population and the role of health professionals, enhancing scientific production, clinical practice and the inclusion of the "transsexuality" theme in Speech Language and Hearing Sciences.

[Life after sexual reassignment surgery: significance for gender and transsexuality]

The Transsexualization Process is the main service directed to trans-specific health in Brazil, which provides services such as hormone therapy and sexual reassignment surgeries to the trans population. In this article, the significance surrounding the surgical procedure, the new genitalia, gender and transsexuality among women who underwent sexual reassignment surgery at the Cassiano Antônio de Moraes University Hospital (HUCAM), located in Vitória, Espírito Santo State, Brazil, was analyzed. Qualitative research was carried out, narrative interviews were recorded, and thematic content analysis was performed. The sample was composed of 9 participants selected by snowball sampling. The conclusion drawn is that the surgeries are related to the search for the humanization of bodies. The comprehension about being a woman was not limited to a biological status for gender. Transsexuality was presented as a transitional experience between genders. The sexual reassignment surgery was seen as a strategy of corporal correction in line with expectations about social relationships in gender by participants, the success of which is evaluated from the standpoint of beauty, pleasure and passability.

Abrindo os armários do acesso e da qualidade: uma revisão integrativa sobre assistência à saúde das populações LGBTT

Resumo A pesquisa buscou estudar as situações que condicionam o acesso e a qualidade da assistência à saúde de lésbicas, gays, bissexuais, travestis e transexuais (LGBTT) nos serviços de saúde, a partir de uma revisão integrativa da literatura nacional e internacional, cuja amostra de 41 artigos foi selecionada nas bases PubMed, Lilacs e SciELO, no período entre 2007 e 2018. O acesso e a assistência à saúde das populações LGBTT foram discutidos em três dimensões: relacional, que diz respeito às relações intersubjetivas entre usuários e profissionais; organizacional, que se refere aos modos de organizar os serviços e os processos de trabalho; e contextual, que engloba como situações de vulnerabilidades imbricadas com os determinantes sociais afetam as condições de satisfação das necessidades de saúde. Os dados mostraram que as populações LGBTT são alvo de preconceitos, violências e discriminações, que, somados a diferentes marcadores sociais, engendram um contexto de vulnerabilidades no acesso e na assistência à saúde. É necessário transformar as práticas e as relações sociais que se dão no interior das instituições de saúde, do contrário, corre-se o risco de afastar cada vez mais parte dessas populações dos serviços de saúde.

Self-perception of voice in transgender people

ABSTRACT Purpose: to describe the transgender people’s self-perception of voice. Methods: a total of 60 people participated in this cross-sectional study. They attended a reference outpatient center for the health of lesbians, gays, bisexuals, and transgender people. The data collection consisted of self-administered questionnaires, a participant’s profile questionnaire, and a voice self-assessment questionnaire. Results: most of the interviewees were young people who had never visited a speech-language-hearing therapist with the Public Health System (Sistema Único de Saúde); in general, they expressed interest in having such attention. The answers revealed an impact in the axes assessed, namely: “use of the voice in social life”, “mischaracterization of gender, due to the voice”, and “indication of dysphonia". Voice symptom characteristic of dysphonia was also identified in some people. Conclusion: transgender people are unsatisfied with their voices, which is an element that hinders the perception of the identified gender. It also has repercussions in their social, emotional, labor, and interpersonal lives. Hence, it is important to include speech-language-hearing therapy in the transgendering process, which is desired by most of the transgender people.

ACESSO À SAÚDE PELA POPULAÇÃO TRANS NO BRASIL: NAS ENTRELINHAS DA REVISÃO INTEGRATIVA

Resumo Neste artigo, é realizado um mapeamento da produção científica sobre o acesso à saúde pela população transexual pós-2008, ano importante para a saúde trans no Brasil, no qual foi criado o Processo Transexualizador do Sistema Único de Saúde. O objetivo desse trabalho foi realizar uma revisão integrativa da literatura sobre acesso à saúde da população transexual e travesti brasileira, empregando as bases de dados MEDLINE, LILACS e SciELO, empregando-se os seguintes descritores: ‘transexualidade’, ‘transexualismo’, ‘travestismo’, ‘travesti’ e ‘transgênero’, foram selecionados 22 artigos. Considerando a produção científica analisada, constatamos inúmeros desafios ao acesso da população trans no Sistema Único de Saúde, como a discriminação, a patologização da transexualidade, a falta de qualificação dos profissionais, o acolhimento inadequado, a escassez de recursos para o financiamento de políticas e programas voltados ao combate à discriminação de origem homofóbica e trans-travestifóbica, bem como a ausência da garantia de serviços específicos – como o processo transexualizador.

Factors associated with self-reported non-completion of the hepatitis B vaccine series in men who have sex with men in Brazil

Background

The objective of the present study was to analyze the factors associated with non-completion of the hepatitis B vaccine series among men who have sex with men and use geosocial dating apps in Brazil.

Methods

This was a cross-sectional, population survey-based, analytical study, conducted exclusively online in all the regions of Brazil, with a sample of 1855 men who have sex with men. The data was collected between November 2016 and February 2017, using the social networking website Facebook.

Results

Univariate, bivariate and multivariate analyses showed that 4.7% of the participants reported receiving one dose of the vaccine, 12.5% two doses, 19.4% three doses, and 45.8% did not know. Multivariate analysis showed that level of education (OR = 0.31; CI 95% 0.14–0.72; p = 0.007), identification as bisexual (OR = 0.6; CI 95% 0.38–0.95; p = 0.030), HIV serological status (OR:2.3; CI 95% 1.58–3.34; p = < 0.001) and frequency of access to health services (OR = 2.38; CI 95% 1.53–3.72; p = < 0.001) were associated with not completing the vaccine series. Low completion of the hepatitis B vaccine series was detected in the population studied.

Conclusion

Completion of the hepatitis B vaccine series was low among men who have sex with men and use geosocial dating apps in Brazil. The factors associated with non-completion were related to social, individual and healthcare (programmatic) vulnerabilities.

Experiences of transgender women/transvestites with access to health services: progress, limits, and tensions

Given both the changes in sexual customs, norms and policies and the persistent patterns in Brazil, the article analyzes the experiences of transgender women/transvestites with access to health services and discusses sexual/gender discrimination and their demands for gender transition and AIDS prevention services. The study involved interviews with nine transgender women/transvestites 23-45 years of age from low-income strata in the Baixada Fluminense region of Greater Metropolitan Rio de Janeiro, Brazil, in 2016 and observation of contexts of prostitution and sociability. Compared to the violence experienced years previously, the narratives of transgender women/transvestites highlight important social strides. They report that health professionals do not discriminate against them based on their condition, although they resist calling them by their social names. This embarrassment and the structural problems of the Brazilian Unified National Health System (SUS) are minimized by the agency of trans women/transvestites in obtaining care, such as recourse to contact networks and awareness of their civil rights. The narratives on their search for body changes for transitioning often reveal a tense combination of the technologies offered by health services and those managed by transvestites themselves. Although AIDS policies focus on measures for trans women/transvestites, HIV prevention is not among their main demands on health services. There are subjective barriers for accessing services, resulting from internalized stigma and the association of HIV infection with their living conditions. Improvement in healthcare for the trans/travestite population requires a debate on structural problems in the SUS, the defense of its expanded view of care, and investments in professional training.

Body construction and health itineraries: a survey among travestis and trans people in Rio de Janeiro, Brazil

The article examines health itineraries followed by Brazilian travestis, trans men and trans women in the affirmation of their gender, based on the survey Trans Uerj: Health and Citizenship of Trans People in Brazil. The survey's main objectives were to gauge the trans/travesti population's diversity and sociodemographic profile; and to map the various ways they access their rights as citizens, especially to healthcare services and body modification technologies. Interviewers, mainly trans people and travestis, applied 391 questionnaires in the city of Rio de Janeiro and its metropolitan region to interviewees of different social classes, schooling levels and gender identity configurations, contacted through the interviewers' social networks. For defining respondents' gender identities the survey used an original method based on self-definitions, which were then aggregated into 6 categories for data analysis purposes. This article discusses the multiple strategies used by this trans population in gender affirmation processes to gain access to regulated and/or unregulated use of hormones and surgical procedures.

[Psychological well-being among transvestites and trans women in the state of São Paulo, Brazil]

This article sought to estimate factors associated with the psychological well-being of transvestites and trans women. It is a cross-sectional study with 602 transvestites and trans individuals in seven cities in the state of São Paulo, Brazil from 2014 to 2015. We carried out a sample selection through a consecutive approach and using the snowball technique. The dependent variable was psychological well-being (WHOQOL-BREF) and the independent variables were: sociodemographic characteristics, body modifications, health conditions, violence and incarceration. We used a multiple variance analysis to identify associated factors. Most were black or brown and were aged between 25 and 39 years, had up to complete secondary education, individual income of up to two times the minimum wage and worked, and 42.3% were sex workers. Around one-quarter had been incarcerated. Around one-quarter were in treatment for HIV. Mean psychological well-being score was 63.2 (95%CI: 61.8-64.6). In the multiple analysis, the factors associated with lower psychological well-being were: not having a fixed address, having lower educational levels, being dissatisfied with personal relationships, friend support or the gender-affirming procedures they had undergone and having suffered verbal or sexual violence. While worse living conditions and exposure to violence harm the psychological well-being of transvestites and trans women, the possibility of undergoing desired body transformations and having their social name respected interfere positively in their evaluations of their lives.

Psicologia e Políticas de Saúde da População Trans: Encruzilhadas, Disputas e Porosidades

Resumo Este texto se propõe a compor uma reflexão sobre algumas fronteiras que atravessam a Psicologia quando posta em contato com as demandas dos segmentos trans e com a operacionalização de políticas de saúde para este segmento. Um rápido levantamento das políticas de saúde nos possibilita entender como suas construções apontam diferentes entendimentos tanto sobre a própria experiência trans quanto sobre as dinâmicas de poder que instituem a norma cisgênera como centralidade e régua a partir da qual são medidas as experiências. A ambiguidade posta é atentar que na medida em que garantir o acesso universalizado aos serviços, bem como amplificar sua oferta, é necessidade a ser pautada com urgências, as práticas cotidianas dos profissionais destes espaços vai produzir o tom de toda a política, marcando esta como emancipatória e acolhedora ou como apenas mais um reforço das normas da cisgeneridade naturalizada e compulsória. A Psicologia, aqui cremos, ocupa um lugar estratégico dada a sua produção enquanto campo que afirma as autodeterminações de gênero e se capilariza nos mais diversos nichos do sistema de saúde, inclusive na atenção básica. Por fim, atentar para as normas que atravessam a proposição e efetivação das políticas de saúde para a população trans é exercício fundamental para que possamos estabelecer práticas despatologizantes e finalmente abdicar da produção constante de “especialistas” imbuídos por um conjunto de relações de poder, de dizer sobre o outro suas supostas verdades, produzindo exclusões das vivências que não caibam nos restritos manuais biomédicos.

Política de saúde LGBT e sua invisibilidade nas publicações em saúde coletiva

RESUMO Trata-se de uma revisão de literatura que tem por objetivo identificar o que expressaram as publicações dos principais periódicos nacionais da área da saúde coletiva, sobre gestão, políticas e práticas em saúde direcionadas à população LGBT, no período compreendido entre 2004 e 2018. A busca de documentos se deu por meio da ferramenta ‘busca integrada’, sendo selecionados artigos disponíveis na íntegra que estavam indexados na base de dados Scientific Electronic Library Online (SciELO). Foram analisadas as publicações de dez periódicos nacionais, e selecionadas 27 publicações que discutiam políticas públicas de saúde para a população LGBT. Observou-se pouca expressão de temas relacionados com a população LGBT, nos 14 anos do recorte temporal proposto por este artigo, uma vez que, dos 14.700 artigos encontrados, somente 92 faziam referência à população LGBT, e apenas 27 discutiam as políticas de saúde. Desse modo, verifica-se a necessidade de realização de pesquisas direcionadas à análise de implantação das políticas públicas de saúde LGBT, que subsidiem a construção de dados epidemiológicos e informações que traduzam as necessidades em saúde dessa população.

Caminhos percorridos por transexuais: em busca pela transição de gênero

RESUMO Este estudo teve como objetivo descrever os caminhos percorridos por transexuais, visando conhecer seus itinerários na busca por atendimento às suas necessidades e demandas em saúde. Como percurso metodológico, realizou-se um estudo exploratório com abordagem qualitativa, tendo por referência teórica os Itinerários Terapêuticos (IT). Foram realizadas entrevistas com sete transexuais. A partir dessas, foi possível identificar alguns marcos nos IT dos(as) entrevistados(as), tais como o ‘reconhecimento como trans’ e a ‘rede de cuidados em saúde: em busca da modificação corporal’. Acredita-se que este estudo permitiu dar visibilidade à trajetória de pessoas transexuais, considerando suas vivências, seus conflitos e dificuldades para conseguirem alcançar sua identidade de gênero. Além disso, foi possível perceber como a transexualidade é, ainda, uma condição não vista por profissionais de saúde e gestores da Rede de Atenção à Saúde, como também por parte de pessoas do convívio social. Isso sinaliza para a importância deste estudo em pelo menos três aspectos: social, político e de saúde.

Desafios enfrentados por pessoas trans para acessar o processo transexualizador do Sistema Único de Saúde

A transformação do corpo pode se constituir em determinante social à saúde da população trans. Neste artigo, são analisados três desafios à universalização do acesso ao processo transexualizador do Sistema Único de Saúde (SUS), serviço de saúde específico às demandas por transformação do corpo da população trans. Foi realizada pesquisa qualitativa com dados produzidos a partir de entrevistas narrativas gravadas em áudio. Os atuais desafios são: 1. A distribuição geográfica dos programas com concentração de seis das dez unidades habilitadas para a oferta do processo transexualizador do SUS na região Sudeste, bem como ausência de unidades na região Norte. 2. A realidade de discriminação e desrespeito ao nome social que impedem o acesso aos serviços de saúde. 3 O diagnóstico de transexualismo, que, ao se orientar por normas socialmente construídas para o gênero, impede o acesso aos serviços transexualizadores.

Barriers and facilitators to PrEP for transwomen in Brazil

Pre-exposure prophylaxis (PrEP) is an important biomedical intervention that may help reduce the risk of HIV transmission among transwomen. To date, little research is available to inform interventions to increase uptake and adherence to PrEP among transwomen, especially in places outside the U.S. We conducted a qualitative study in 2015 with 34 adult transwomen in Rio de Janeiro, Brazil and assessed awareness, interest, barriers and facilitators to PrEP uptake and adherence for transwomen. Almost one third of participants had heard of PrEP, and most were interested and thought it would be beneficial for transwomen in their community. Barriers to PrEP included fear of being HIV positive resulting in low HIV testing and concerns about the ability to adhere to a daily PrEP regimen. The most prominent barrier to uptake was past experiences of transgender-identity related discrimination in the universal health care system that reduced willingness to seek PrEP or health care in general. Participants recommended technological solutions to PrEP health education information that could address uptake and adherence. This study informs efforts to increase PrEP use among transwomen in Brazil.

O que esperam pessoas trans do Sistema Único de Saúde?

Este artigo discute as críticas e sugestões apresentadas por pessoas trans para garantia de seu acesso e da promoção de ações para cuidado integral de sua saúde no Sistema Único de Saúde (SUS). Foram realizadas entrevistas semiestruturadas, gravadas em áudio, transcritas e realizada análise de conteúdo. Apontou-se a formação continuada para trabalhadores da saúde, com o objetivo de reverter a realidade de discriminação, desrespeito ao nome social e dificuldade de diálogo entre profissionais e usuários trans, condições que limitam o acesso à saúde. Considerou-se a necessidade de universalizar a hormonioterapia e o implante de silicone e a reivindicação por atendimento multiprofissional na saúde trans como formas de garantir o cuidado e a segurança necessários aos processos de transformação do corpo.

(Trans)formações corporais: reflexões sobre saúde e beleza

Resumo Este artigo discute interpretações sobre saúde, adoecimento e beleza engendradas nos processos de transformação do corpo vivenciados por pessoas trans. A partir de uma abordagem qualitativa, foram realizadas 15 entrevistas semiestruturadas, gravadas em áudio, com pessoas trans residentes na Região Metropolitana de Vitória, Espírito Santo (ES). Foram realizadas transcrição e análise de conteúdo. Observa-se que a beleza aparece diretamente relacionada às percepções sobre saúde e adoecimento entre as participantes da pesquisa. Evidencia-se importante divergência entre as compreensões de saúde e doença produzidas pelos poderes e saberes biomédicos sobre os corpos trans e aquelas que as pessoas trans produzem sobre si mesmas, sobretudo em programas de atenção à saúde específica, como os processos transexualizadores. Conclui-se que o respeito à autonomia das pessoas trans na transformação de seus corpos, sendo consideradas as suas interpretações sobre a produção de saúde ou adoecimento, afirma-se como fundamental para a promoção da saúde da população trans.