Trans-Specific Health Care: Challenges in the Context of New Policies for Transgender People

Abstract

This study aims to understand transgender peoples' access to the Brazilian public healthcare system in light of the new public policies for this group in Brazil. Our ethnographic study involved interviews with transgender women at a non-governmental organization and a direct participant-observation study conducted 2 years later to observe how a new specialized service was providing healthcare for transgender people. Transgender people reported difficult personal life trajectories, marked by discrimination and binary standards, in their struggle to become recognized as women/men. At the specialized service, gender norms and stereotyping were observed being put into operation by untrained service providers. This dominance of pathologizing models ended up not decreasing transgender patients' access to unsafe care outside of the public sector. The promotion and protection of the right to health thus depends upon cultural changes. This may well include changes in technical-scientific discourse regarding the transgender experience in order to account for the depathologization and gender fluidity recognition.

Experiências de acesso de mulheres trans/travestis aos serviços de saúde: avanços, limites e tensões

“…Nevertheless, in relation to the difficulties experienced in the context of the medical appointments, they were unanimous in reporting experiences of embarrassment due to lack of the use of their social name by the health professionals. As already shown in the literature 6,7,8 , conjugation in the feminine was an extremely sensitive topic in their reports. The majority know the legislation that guarantees recognition of their social name and gender identity in the public administration.…”

“…According to various studies, discrimination prevents or hinders access to health services by trans persons/transvestites 5,6,7,8,9 . Still, in the narratives here, discrimination based on their condition as trans woman/transvestite appears not to have prevented their access to services.…”

“…Although specialized services now appear to be better qualified, there are still frequent reports of discrimination. Studies have highlighted the need to train the health teams to provide more humane care and respect for different sexual and gender identities 5,6,7,8,9 . International studies on barriers to healthcare for the trans population have shown similar results 10,11,12,13,14 .…”

Prejudice Against Gender and Sexual Diversity among Medical Students from the 1st to the 8th Semesters of a Medical Course in Southern Brazil

“…Transsexual individuals meet important theoretical and practical professional unpreparedness that directly influences health care, including the difficulty of access to care among this population outside the public health system -demonstrating that the SUS may not be the base factor of prejudice in the search of a professional who can properly acknowledge and treat this population. [24][25][26] According to White et al 1 , the level of preparation and comfort of medical students in the care of LGBT patients is unknown, and the curriculum related to the LGBT topic is poor or reasonable. The topic they feel better prepared to deal with…”

A nationwide cross-sectional study of 15,611 lesbian, gay and bisexual people in China: disclosure of sexual orientation and experiences of negative treatment in health care

“…Based on previous studies [36,37], transgender people face unique stresses and challenges related to their gender identity and expression, which are clearly different from the experiences of LGB people. For instance, their gender identities are often not properly acknowledged and recognized in the health care settings, resulting in postponement and denial of care.…”