This paper draws on ethnographic, qualitative and survey data with transwomen in Puerto Rico to examine the social and political-economic context of lay injection with hormone and silicone - common practices within this community. We describe specific practices of hormone and silicone injection, the actors that govern them, the market for the sale and distribution of syringes and the networks of lay specialists who provide services to a population that is neglected by and largely excluded from biomedical settings. Our data derive from ethnographic observations, sociodemographic questionnaires, surveys and semi-structured interviews conducted with a diverse group of transwomen in metropolitan San Juan, Puerto Rico. Our analysis focuses on four overlapping social domains or processes that shape the practices of lay silicone and hormone injection among transwomen: (1) the circulation of gender transitioning technologies within local and global markets; (2) the tension between the social exclusion of transwomen and their resilient sub-cultural responses; (3) the cultural meanings that shape transwomen's attitudes about injection; and (4) the perceived consequences of injection. We conclude with a discussion of the kinds of intervention and policy changes that would respond to the factors that most endanger transwomen's health.
ALÍXIDA RAMOS-PIBERNUS; ELIUT RIVERA-SEGARRA; JOSÉ COLÓN-BURGOS; OSVALDO GONZÁLEZ-SEPÚLVEDA; CARLOS E. RODRÍGUEZ-DÍAZ; SHEILLA RODRÍGUEZ-MADERA (UNIVERSIDAD DE PUERTO RICO, Recinto de Ciencias Médicas, Puerto Rico) RESUMEN Introducción: Los Determinantes Sociales de la Salud (DSS) son una prioridad para la reducción de las inequidades en salud. La Psicología y la Educación para la Salud son disciplinas cuyo enfoque principal es el mejoramiento de la salud de las personas. No obstante su quehacer tradicionalmente se ha enfocado en el trabajo con los individuos, obviando la atención a los aspectos estructurales. Objetivos: documentar la percepción sobre los DSS en las profesiones de Psicología y en Educación para la Salud en Puerto Rico e identificar experiencias en sus respectivas prácticas con los DSS. Método: Se administró la Encuesta de Percepción sobre Factores Socio-estructurales a 124 profesionales y estudiantes de Psicología y Educación para la salud en Puerto Rico. Para el análisis se utilizaron estadísticas descriptivas. Resultados: se observa un mayor desconocimiento sobre los efectos de DSS como la pobreza, el estigma, el apoyo social y la clase social. Asimismo, la mayor parte de los/as encuestados/as manifestaron que su rol como promotores de la salud se ha centrado a nivel individual fomentando el cambio conductual. Conclusiones: Estos resultados resaltan la importancia de reflexionar críticamente sobre nuestro quehacer y los discursos dominantes en los que nos hemos formado como profesionales de la salud. Se incluyen recomendaciones para trabajar con algunos hallazgos del estudio. PALABRAS CLAVE: Eventos no-epilépticos, disociación somatoforme, inducción de convulsiones, experiencias de abuso infantil, epilepsia. Determinantes Sociales de la Salud, Psicología, Educación para la Salud, formación. ABSTRACT Social Determinants of Health (SDH) have been identified as a priority in the reduction of health inequities. Psychology and Health Education are disciplines that aim to improve the health of people. However, their work has traditionally focused at an individual level, neglecting structural aspects that impact health. The objectives of this study where: (1) document the perception about SDH among Psychology and Health Education professionals in Puerto Rico and (2) identify their experiences in their practices with SDH. The Survey on the Perception about Socio-structural Factors was administered to 124 participants. Descriptive statistics were used for the analysis. Results reflect a greater lack of knowledge on the effects of DSS as poverty, stigma, social support and social class. Also, most of the participants manifested that their role as health professionals has focused at an individual level promoting people to change their behaviors. This results emphasize the importance of critically reflect on our practices and the dominant discourses embedded in us as health professionals. Recommendations for working with the study findings are included and discussed.
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