HIV-related care for transgender people: A systematic review of studies from around the world.

RATIONALE: Transgender people face unique challenges, such as structural, interpersonal, and individual vulnerabilities to chronic diseases. Stigma and prejudice may hamper their access to health care and prevent their inclusion in the labor market, as well as cause exposition to violence. Labor market exclusion contributes to engagement in survival sex work, which increases HIV infection vulnerability. HIV continuum of care combines HIV prevention (including antiretroviral pre-exposure prophylaxis (PrEP), antiretroviral post-exposure prophylaxis (PEP) and HIV testing) with linkage to care (that is, initiating, maintaining and monitoring antiretroviral therapy). Currently, many studies evaluate the access barriers and facilitators to HIV care for transgender people. OBJECTIVE: The present systematic review aimed to provide a clear summary of the current literature on HIV-related care for transgender men, transgender women and gender diverse people. METHOD: Inclusion criteria were peer-reviewed quantitative studies, published through April 04, 2018, concerning transgender women, transgender men and gender diverse people and HIV-related care, which was any intervention aiming to prevent, treat or alleviate the impact of HIV on these populations. RESULTS: From 6,585 references, 62 articles were included: Three articles had results on PEP, 18 on PrEP, 29 on HIV-testing, 17 on access to health care, and 13 on adherence to treatment. CONCLUSIONS: The present study is the first systematic review evaluating HIV-related care for transgender people. Data collection is still scarce regarding transgender men and gender diverse people. Worldwide, testing for HIV infection does not necessarily enable access to the HIV continuum of care for transgender populations or even guarantee awareness of HIV seropositivity.

Relações de gênero no trabalho em saúde em um estabelecimento prisional feminino / Gender relations in health care in a female prison / Relaciones de género en la atención de salud en una prisión femenina

O objetivo do artigo é discutir sobre as relações de gênero na perspectiva de profissionais de uma Equipe de Atenção Básica Prisional (EABp) de uma penitenciária feminina. Os dados foram produzidos a partir da fala de profissionais da saúde em cinco encontros de apoio matricial, sendo o gênero utilizado como categoria de análise. Como resultados, foi possível organizar três subtemas como desdobramentos do tema principal: gestação e permanência dos bebês na prisão; normas corporais e saúde; e nome social de pessoas trans. A discussão segue referenciais dos estudos de diversidade sexual e de gênero e saúde coletiva, além de abordar a necessidade do direito à saúde integral da população encarcerada, especificamente de mulheres e população LGBTI. A centralidade do cuidado relativo à gestação e o papel da educação permanente para a redução do preconceito e qualificação no atendimento também aparecem como campos de trabalho a ser explorados.

The objective of this article is to discuss gender relations from the perspective of professionals of a Prison Basic Health Staff at a female prison. The speeches of health professionals were analyzed in five matrix support meetings and gender was used as category of analysis. Results were possible to be organized in three subthemes from the main theme: pregnancy and babies staying in prison; body norms and health; and transgender people social names. The discussion of these results follows theoretical aspects of gender and sexual diversity studies and collective health and mainly addresses the right to integral health care in prison, specifically to women and LGBTI population. The central role of health attention directed to motherhood in prison and the role of health education in order to reduce prejudice and to qualify health attention also appear as important fields of work to be explored.

El objetivo de este artículo es discutir las relaciones de género desde la perspectiva de los profesionales que componen un equipo de atención básica de salud en una prisión femenina. Los datos fueron producidos a partir de cinco encuentros de soporte matricial y el género fue utilizado como categoría de análisis. Los resultados fueron organizados en tres subtemas del tema principal: embarazo y bebés que permanecen en prisión; normas corporales y salud y nombres sociales de personas transgénero. La discusión toma en cuenta aspectos teóricos de la diversidad sexual y de género y la salud colectiva y aborda la necesidad del derecho a la atención integral a la salud en la prisión, específicamente dirigido a las mujeres y a la población LGBTI. La centralidad de la atención a la salud dirigida a la maternidad y la educación permanente para la reducción del prejuicios y calificación en la atención, también surgieron como campos de trabajo a explorar.