Atención de los profesionales de la salud a personas trans en América Latina y el Caribe / Health professionals care for trans people in Latin America and the Caribbean

Resumen El presente estudio tuvo por objetivo analizar las características de artículos científicos publicados durante el último quindenio respecto a la atención en salud a personas trans en América Latina y el Caribe. Se desarrolló una revisión sistematizada de artículos publicados en cuatro bases de datos, entre los años 2005 y 2020, en la que se encontraron 20 estudios que fueron objeto de análisis. En su mayoría, estos dan cuenta de las percepciones que tienen las comunidades trans y, en menor frecuencia, las experiencias de los profesionales de la salud sobre la atención en salud. Los resultados permiten identificar barreras que influyen en los procesos de atención y los desafíos para mejorarla. Sobresale la formación deficiente e insuficiente en los profesionales sobre identidades trans y los enfoques diferenciales y afirmativos del género, y la necesidad de fortalecer los abordajes integrales entre las comunidades académicas, de la salud y la generación de políticas públicas transformativas.

Abstract Health care is important for the transitions of people with trans life experiences and to strengthen the processes of health and disease. Health professionals are educating and accompanying agents; however, the literature frequently reports that there are barriers perceived by professionals regarding their competencies to accompany such processes, in addition to others related to social representations regarding trans identities, the limited scientific evidence regarding the processes of gender reaffirmation and representing the communities themselves according to their historical and sociocultural characteristics. The aim of this study was to analyze the characteristics of scientific articles published during 15 years regarding health care for trans persons in Latin America and the Caribbean. A systematized review of articles published in four databases between 2005 and 2020 was carried out. 20 studies were analyzed in the research. Most of them report the perceptions of trans communities and, less frequently, the experiences of health professionals on health care. The results allow the identification of barriers that influence the processes of care and the challenges to improve it. The deficient and insufficient training of professionals on trans identities and differential and affirmative gender approaches stand out, as well as the need to strengthen comprehensive approaches among the academic and health communities and the generation of trans affirmative public policies. On the other hand, the results evidence a construction of science with respect to gender that is cisnormative and invisibilizes gender diversities. In addition, many of the studies establish vertical relationships between participants, including researchers, which generates research dynamics in which trans communities are considered more as informants and less as expert peers, community researchers or participants in a collaborative and co-creative research process. These findings support the need and renew the urgency to generate processes of knowledge construction with and for trans communities that allow nurturing educational, social, public policy and health spaces that represent their needs for gender transitions, in case the person considers so, and that welcome in an integral and humanized way the processes of health and disease. Research on health and health care in trans communities both in Colombia and in the rest of Latin America and the Caribbean does not show the implementation of health policies focused on the community and that respond to their health needs. Health professionals, around the world, should accompany from care actions focused on the processes of self-identification and self-determination of gender. Being recognized and made visible based on gender identities and expressions has a positive impact on the mental health of trans people and their well-being. In professional practice, it is important and essential to overcome the barriers of social inequality, promoting a critical social vision and understanding of the reality of this population. It is necessary to expand research from gender diversities and separate from the LGBTIQ+ umbrella given the complex social, cultural, biological, and psychological diversities faced by each community. As for health professionals, it is necessary to deepen the measurement and understanding of attitudes, knowledge, beliefs, skills and gaps identified by all staff, from doctors and nurses to institution managers. This in order to articulate and triangulate information and develop intervention programs aimed at comprehensive and accessible care, especially for their reports about the little information on sexual and gender diversity received during their professional training process and organizational culture. Finally, each country should develop clinical guidelines based on local, national, and international evidence that responds to the psychological and sociocultural needs and experiences of trans communities that include the process of gender transitions from hormone therapy, affirmative surgeries and other non-binary processes of gender expressions, family, psychosocial support, and community accompaniment.

Construindo um ambulatório para a população transgênero: relato de experiência no contexto da Residência de Medicina de Família e Comunidade / Building an ambulatory for the transgender population: experience report in the context of the Residency in Family Practice / Construcción de un ambulatorio para la población transgénero: relato de experiencia en el contexto de la Residencia en Medicina Familiar y Comunitaria

Problema: Este artigo é um relato de experiência da construção de um ambulatório de hormonização para pessoas transgênero no contexto de um Programa de Residência em Medicina de Família e Comunidade no município de Vitória, Espírito Santo. Entende-se como pessoa transgênero aquela que não se identifica com o gênero atribuído ao nascimento, sendo uma das suas necessidades de saúde a hormonização, que é competência da/o médica/o de família e comunidade e não apenas de especialistas focais. No estado do Espírito Santo havia apenas um serviço público que oferecia a hormonização, mas não acolhia novas/os usuárias/os desde o ano de 2020. Método: Neste contexto surgiu a proposta de ofertar acolhimento e o manejo inicial da demanda de pessoas transgênero, voltados à saúde integral, com foco no processo de hormonização, aproveitando a estrutura existente de uma Unidade de Saúde da Família e médicos residentes. A equipe referida buscou se capacitar com o apoio da gerência local e da Secretaria Municipal de Saúde, ofertando atendimento semanal a partir de maio de 2022. Resultados: Tendo mal completado um ano de atividade, o ambulatório atende mais de cem pacientes e recebe encaminhamentos de outros serviços da rede de saúde e assistência. Conclusão: Com base nessa experiência, afirma-se que os programas de residência médica em Medicina de Família e Comunidade se mostram como espaços potenciais de fomento de construção das políticas públicas para esta população, que historicamente possui barreiras de acesso ao cuidado em saúde.

Problem: This article was an experience report of the construction of a hormonization ambulatory for transgender people within the Medical Residency program in Family Practice, located in Vitória, Espírito Santo. A transgender person is understood to be someone who does not identify with the gender assigned at birth, with one of their health needs being hormone therapy, which is a Family Practitioner's responsibility and not just of the focal specialists. In the Brazilian state of Espírito Santo, there was only one public service that offered hormone therapy, but it had not welcomed new users since 2020. Method: In this context, a proposal emerged to offer reception and initial management of transgender's demand, aimed at comprehensive health, focusing on the hormonization process, taking advantage of the existing structure of a Family Health Unit and resident physicians. The aforementioned team sought training with the support of local management and the Municipal Health Department, offering weekly care from May 2022. Results: Having just completed one year of activity, the ambulatory serves more than one hundred patients and receives referrals from other services of the health and assistance systems. Conclusion: From this experience, it is stated that medical residency programs in Family Practice are a potential space for fostering the construction of public policies for this population, which historically has barriers to accessing health care.

Problema: Este artículo fue un relato de experiencia sobre la construcción de un ambulatorio de hormonalización para personas transgénero dentro de un Programa de Residencia en Medicina Familiar y Comunitaria en la ciudad de Vitória, Espírito Santo. Se entiende por persona transgénero a aquella que no se identifica con el género asignado al nacer, siendo una de sus necesidades de salud la hormonalización, la cual es responsabilidad del Médico de Familia y Comunitario y no sólo de los especialistas focales. En el estado de Espírito Santo, solo había un servicio público que ofrecía hormonalización, pero no acogía nuevos usuarios desde 2020. Método: En ese contexto, surgió una propuesta para ofrecer acogida y gestión inicial de la demanda de personas transgénero, orientada a la salud integral, con foco en el proceso hormonal, aprovechando la estructura existente de la Unidad de Salud de la Familia y médicos residentes. El mencionado equipo buscó capacitarse con el apoyo de la gestión local y de la Secretaría Municipal de Salud, ofreciendo atención semanal a partir de mayo de 2022. Resultados: Con apenas un año de actividad, el ambulatorio atiende a más de cien pacientes y recibe derivaciones de otros servicios de la red de salud y asistencia. Conclusión: A partir de esa experiencia, se afirma que los programas de residencia médica en Medicina Familiar y Comunitaria son un espacio potencial para favorecer la construcción de políticas públicas para esta población, que históricamente tiene barreras para acceder a la atención en salud.

Beneficios de la transición social temprana en menores transgénero. Perspectivas de familias: estudio cualitativo / Benefits of early social transition in transgender minors. Family perspectives: qualitative study

FUNDAMENTOS: El término trans aglutina a todas las identidades transgénero. La transición social temprana hacia el género sentido tiene beneficios en el desarrollo del menor. Para las familias, el tránsito es un periodo de grandes incertidumbres, siendo necesario el acompañamiento dirigido a las familias de menores trans. El objetivo del artículo fue explorar, desde una perspectiva paterna y familiar, las necesidades y experiencias sobre el tránsito de menores trans que sirvieran de referente a otros padres/madres que apoyan el tránsito social de sus hijos e hijas.MÉTODOS: Se trabajó con grupos focales de familias funcionales de menores transgénero que habían iniciado la transición (n=14), de nivel educativo medio-alto y que pertenecían a zonas urbanas de Tenerife. Mediante entrevista semiestructurada, comentaron sus experiencias en el proceso de dar soporte al tránsito social de sus hijos e hijas. Los datos fueron registrados en una videograbación y se procesaron mediante análisis de contenido y categorización. RESULTADOS: La transición social temprana tuvo beneficios positivos e inmediatos en el desarrollo del menor, además de en la disminución de la ansiedad. Hubo una mejora general en el humor, la autoestima y las relaciones tanto sociales como familiares. El acompañamiento de especialistas y asociaciones ayudó en las distintas situaciones sociales y favoreció la resiliencia. CONCLUSIONES: El tránsito social temprano es positivo en la esfera personal y sociofamiliar del menor. Para mejorar su resiliencia, las familias demandan acompañamiento en este proceso, así como conocer otras personas trans que les sirvan como referentes transpositivos. Además, señalan la necesidad de formación específica en los profesionales sanitarios.(AU)

BACKGROUND: The term trans brings together all transgender identities. The early social transition towards the affirmed gender has benefits in the child’s development. For families, transit is a period of great uncertainty, requiring support aimed at families of trans minors. The aim of this paper was to explore the needs and experiencies of parents and close-relatives who supported the social transition of their children. METHODS: We worked with focus groups of functional families of transgender minors who had begun the transition (n=14), with a medium-high educational level and who belonged to urban areas of Tenerife. Through a semi-structured interview, they commented on their experiences in the process of supporting the social transition of their children. The data was recorded in a video recording and processed through content analysis and categorization. RESULTS: Early social transition had positive and immediate benefits on child development as well as in the reduction of anxiety. There was a general improvement in mood, self-esteem, and social and family relationships. The accompaniment of specialists and associations helped in the different social situations and favoured resilience.CONCLUSIONS: Early social transition is positive in the personal and socio-family sphere of the minor. To improve their resilience, families demand accompaniment in this process, as well as meeting other trans people who serve as transpositive references. In addition, they point out the need for specific training in health professionals.(AU)

Obstáculos y facilitadores para garantizar el derecho a la salud integral trans en el Gran Buenos Aires y La Plata / Obstacles and facilitators to guarantee the right to integral transgender health in Gran Buenos Aires and La Plata

INTRODUCCIÓN: La Ley 26743/12 de Identidad de Género incorpora al Plan Médico Obligatorio las intervencionesquirúrgicas y los tratamientos integrales hormonales para adecuarel cuerpo a la identidad de género. OBJETIVOS: Indagar en los obstáculos y facilitadores para el cumplimiento de la Ley de Identidad de Género identificados por profesionales de la salud especializados en tratamientos de reafirmación de género del ámbito del Gran Buenos Aires y la ciudad de La Plata en 2012-2015. MÉTODOS: Sedesarrolló una investigación cualitativa basada en entrevistas en profundidad. Se realizaron 12 entrevistas a profesionales de la salud en las especialidades de Cirugía, Endocrinología, Ginecología y SaludMental (Psicología y Psiquiatría) de los tres subsistemas de salud (público, privado y obra social). RESULTADOS: Según lo observado, los profesionales del sistema de salud desarrollaron estrategias locales para garantizar el cumplimiento de la Ley de Identidad de Género y se toparon con obstáculos burocráticos y de disponibilidad de recursos humanos y hospitalarios. Al mismo tiempo, identificaron tensionescon usuarios y usuarias trans del sistema de salud. CONCLUSIONES:Es necesario implementar un programa centralizado, que contemple la formación, asignación y gestión de recursos humanos y hospitalarios que permita afianzar el vínculo entre el sistema de salud y sus profesionales especializados, y que abra canales de diálogo con las organizaciones de usuarios y usuarias.

INTRODUCTION: Argentina’s Gender Identity Law (26743/12) provides coverage within the Mandatory MedicalPlan for surgical procedures and hormonal treatments whose aim is to align body to gender identity. OBJECTIVES: To address obstacles and facilitators to guarantee and applythe Gender Identity Law, developed by health professionals specialized in gender reaffirmation treatments in Gran Buenos Aires and the city of La Plata during 2012-2015. METHODS: A qualitative research based on in-depth interviews was conducted. It included 12 interviews to health professionalsfrom the fields of Surgery, endocrinology, Gynecology and Mental Health, belonging to the three health subsystems (public, private and social security). RESULTS: Health professionals developed local strategies to comply with the Gender Identity Law and had to deal with bureaucratic obstacles and the lack of human and hospital resources. At the same time, they identified tensions with transgender users of the health system. CONCLUSIONS: It is necessaryto implement a centralized program for training, planning and management of human and hospital resources, whichstrengthens the link between health system and its specialized professionals and also opens channels for dialog with user organizations.

Health care: the transvestites of Santa Maria, Rio Grande do Sul, Brazil / Cuidado con la salud: travestis de Santa Maria, Rio Grande do Sul, Brasil / Cuidado com saúde: as travestis de Santa Maria, Rio Grande do Sul

The general purpose of this paper is to present the health care of transvestites from Santa Maria, central region of Rio Grande do Sul, Brazil. Field research was conducted in 2012, between January and November, with transvestites originated from different cities of this State, who were living in Santa Maria at that time. Qualitative methodology was adopted through ethnographic research. The results showed that the interlocutors avoid the institutionalized health services, choosing other forms of care. The interlocutors indicated their choice for "houses of african religion" by identifying them as places that, without questioning the bodily changes and sexual orientation, were able to afford forms of care and protection. Therefore, this article can help to provide some visibility to care transvestites looking for health.

Este trabajo tiene como objetivo general presentar el cuidado a la salud de travestis en el municipio de Santa María, región central de Rio Grande do Sul, Brasil. El trabajo de campo se llevó a cabo en el período de enero a noviembre de 2012, con travestis procedentes de municipios del Rio Grande do Sul, que vivían en Santa María en el momento del estudio. Se trata de un estudio cualitativo a través de investigación etnográfica. Los resultados mostraron que las interlocutoras evitan los servicios de salud institucionales existentes, eligiendo otras formas de atención. Las interlocutoras indicaron su preferencia para asistir a las "casas de religión africana" identificándolas como espacios que, sin cuestionar los cambios corporales y la orientación sexual, ofrecían formas de cuidado y protección. Este artículo puede contribuir con las discusiones de las diversas dimensiones de cuidado, tema central de enfermería.

O objetivo desta pesquisa foi apresentar os cuidados com a saúde de travestis do município de Santa Maria, Rio Grande do Sul, Brasil. A pesquisa de campo realizou-se no período de janeiro a novembro de 2012, com travestis de diversos municípios do Rio Grande do Sul, que residiam em Santa Maria durante a pesquisa. O estudo foi de metodologia qualitativa, por meio de investigação etnográfica. Durante o trabalho de campo, acompanhamos a trajetória de 49 travestis em busca de cuidados com a saúde. As falas foram gravadas e, logo após, transcritas para a reflexão crítica dos dados. Os resultados demonstraram que as interlocutoras evitam os serviços institucionalizados de saúde, optando por outras formas de cuidado. As travestis indicaram sua opção em frequentar as "casas de religião afro", identificando-as como espaços que, sem questionar as modificações corporais e sua orientação sexual, proporcionam formas de cuidado e proteção. Este artigo pode contribuir com as discussões sobre as várias dimensões do cuidado, tema central para enfermagem.