Bioethical reflections on the access of transgender individuals to public health

Silva, Renato Canevari Dutra da; Silva, Ana Bárbara de Brito; Alves, Fernanda Cunha; Ferreira, Kemilly Gonçalves; Nascimento, Lizza Dalla Valle; Alves, Maryanna Freitas; Canevari, Carlabianca Cabral de Jesus

doi:10.1590/1983-80422022301519EN

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Research • Rev. Bioét. 30 (1) • Jan-Apr 2022 • https://doi.org/10.1590/1983-80422022301519EN copy

Bioethical reflections on the access of transgender individuals to public health

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

In Brazil, transgender individuals, those whose gender identity differs from the assigned biological sex, are marginalized by society and face difficulties in accessing the Unified Health System. This study sought to identify these difficulties by carrying out an integrative review of papers published in the SciELO, LILACS, MEDLINE, Virtual Campus for Public Health, Base de Dados de Enfermagem, and ColecionaSUS databases, in the last five years. Of the 26 articles found, only nine met the inclusion criteria. Based on their references other nine papers were included, thus totaling 18. Results point to the following difficulties encountered: hostility in care; disrespect for the social name; technical and scientific unpreparedness of professionals; difficulty of access to gender reassignment procedures; and prejudice. It is therefore of paramount importance to implement interventions to minimize segregation, and invest in further research on this topic.

Unified Health System; Transgender persons; Delivery of health care

Title	Authors	Type of study	Objective
“Experiências de acesso de mulheres trans/travestis aos serviços de saúde: avanços, limites e tensões”⁴	Monteiro and Brigeiro	Qualitative study	Discuss the discrimination of access of trans women /travestis to the health system and their difficulties
“Dificuldades vividas por pessoas trans no acesso ao Sistema Único de Saúde”¹¹	Rocon and collaborators	Qualitative study	Discuss the difficulties of trans people living in the metropolitan region of Vitória, Espírito Santo to access health services in SUS
“A Política Nacional de Saúde Integral de Lésbicas, Gays, Bissexuais e Transgêneros (LGBT) e o acesso ao processo transexualizador no Sistema Único de Saúde (SUS): avanços e desafios”¹²	Popadiuk, Oliveira and Signorelli	Qualitative and quantitative study	Qualitatively and quantitatively study SUS and the ways of implementing the transition process in the health system
“O que esperam pessoas trans do Sistema Único de Saúde”¹³	Rocon and collaborators	Qualitative research	Address interviews by trans individuals about the need for body transformations and access to the health system
“Implicações bioéticas no atendimento de saúde ao público LGBTT”¹⁴	Santos and collaborators	Study design	Analyze academic publications regarding LGBTT health care actions by focusing on principialist bioethics
“Outness, stigma, and primary health care utilization among rural LGBT populations”¹⁵	Whitehead, Shaver, and Stephenson	Qualitative and quantitative study	Analyze the impact of stigma specifically for rural LGBT populations
“Addressing gaps in physician knowledge regarding transgender health and healthcare through medical education”¹⁶	McPhail, Rountree-James and Wheltter	Qualitative study	Analyze the denial of care to trans individuals due to lack of medical knowledge and transphobia
“Perceived barriers and facilitators to health care utilization in the United States for transgender people: a review of recent literature”¹⁷	Lerner and Robles	Literature review	Identify barriers to health care for trans individuals: negative experiences in the health system; lack of knowledge of the provider on identity issues and transgender health issues
Percepções de usuários transexuais sobre o cuidado na Estratégia de Saúde da Família: o desafio do reconhecimento e do rompimento da invisibilidade ¹⁸	Gomes	Master’s thesis: qualitative, descriptive, and exploratory study.	Understand the reality experienced by transgender individuals from their perceptions about the care provided to them in the family health strategy
O processo transexualizador no SUS e a saúde mental de travestis e transexuais ¹⁹	Ferreira	Term paper: exploratory research of qualitative approach.	Analyze the perception of trans patients regarding the care they receive considering the promotion of their mental health in the transition process offered by SUS
“Removing transgender identity from the classification of mental disorders: a Mexican field study for ICD-11”²⁰	Robles and collaborators	Qualitative study	Compare the diagnostic elements proposed for gender incongruity of ICD-11, gender dysphoria of DSM-5 and transsexualism of the ICD-10 category with the self-reported experience by trans individuals
“Uso do nome social no Sistema Único de Saúde: elementos para o debate sobre a assistência prestada a travestis e transexuais”²¹	Silva and collaborators	Essay	Analyze the use of the social name in SUS as a way of access and integrality of travestis and transgender people
“Factors impacting transgender patients’ discomfort with their family physicians: a respondent-driven sampling survey”²²	Bauer and collaborators	Qualitative study	Analyze how trans patients feel uncomfortable and may avoid health care in primary care
“I am your trans patient”²³	Lewis and collaborators	Case report	Share the experiences of the transgender population in health care and an important message that doctors would like to know
“Barriers to care among transgender and gender nonconforming adults”²⁴	Gonzales and Henning-Smith	–	Examine trans individual’s health and access to health
“Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people”²⁵	Deutsch	Manual	Empower the health services and system with instruments and knowledge to achieve the health needs of the transgender population and patients with gender dysphoria
“How should physicians refer when referral options are limited for transgender patients?”²⁶	Dietz and Halem	Case report	Examine the care scenario from the perspective of a patient whose experiences with specialists were negative
“O acesso das pessoas transexuais e travestis à atenção primária à saúde: uma revisão integrativa”²⁷	Pereira and Chazan	Literature review	Present the results of an integrative review on the access of trans individuals to primary health care services

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[1] Correspondence: Renato Canevari Dutra da Silva – Rua RC11, s/n, quadra 9, lote C, Residencial Canaã CEP 75909-690. Rio Verde/GO, Brasil.