Knowledge, attitudes and practices regarding tuberculosis among transgender individuals in the city of São Paulo, Brazil

Ferreira, Sérgio; Francisco, Priscila Maria Stolses Bergamo; Nogueira, Péricles Alves

doi:10.1590/1413-81232018248.25212017

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FREE THEMES • Ciênc. saúde coletiva 24 (8) • Aug 2019 • https://doi.org/10.1590/1413-81232018248.25212017 copy

Knowledge, attitudes and practices regarding tuberculosis among transgender individuals in the city of São Paulo, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The aim of the present study was to evaluate knowledge, attitudes and practices regarding tuberculosis (TB) among transvestites and transsexual women. A cross-sectional study was conducted with a convenience sample (n = 124; 58 transvestites and 66 transsexuals) in the city of São Paulo, Brazil, in 2014 and involved the administration of the Knowledge, Attitudes and Practices questionnaire. Absolute and relative frequencies were calculated for all variables and the comparisons of percentage distributions between groups were performed using Pearson’s Chi-square test, Fisher’s exact test or its generalization, with a 5% significance level. Most participants were young and non-white. Transvestites had lower levels of schooling, reported more passages through the prison system and declared themselves to be sex workers more frequently. Little more than half of the participants were aware that treatment for TB was free of charge. Knowledge on TB was modest, permeated with misunderstandings regarding signs/symptoms, transmission and prevention, which influence attitudes and practices in relation to the disease. The findings demonstrate that health education actions do not achieve their goals in the control of tuberculosis.

Key words
Tuberculosis; Health; Knowledge; Attitudes; Practice; Transgender persons; Health education

Variable/categories	Total		Transvestites (n=58)		Transsexuals (n = 66)		p
Variable/categories	n	%	n	%	n	%	p
Age (years)							0.269^* * Generalization of Fisher's exact test.
18 to 29	61	49.2	30	51.7	31	47.0
30 to 39	37	29.8	20	34.5	17	25.8
40 to 49	21	17.0	6	10.3	15	22.7
≥ 50	5	4.0	2	3.4	3	4.5
Skin color							0.462
White	47	37.9	20	34.5	27	40.9
Non-white	77	62.1	38	65.5	39	59.1
Schooling (years of study)							*0.008^ * Generalization of Fisher's exact test.**
0 to 4	12	9.7	10	17.2	2	3.0
5 to 8	39	31.4	21	36.2	18	27.3
9 to 11	44	35.5	19	32.8	25	37.9
≥ 12	29	23.4	8	13.8	21	31.8
Passage through prison system							< 0.001
Yes	31	25.0	23	39.7	8	12.1
No	93	75.0	35	60.3	58	87.9
Sex worker							< 0.001
Yes	89	71.8	51	87.9	38	57.6
No	35	28.2	7	12.1	28	42.4
Time in prostitution							0.183^* * Generalization of Fisher's exact test.
< 1 year	5	5.6	3	5.9	2	5.3
1 to 10 years	43	48.3	22	43.2	21	55.3
11 to 20 years	29	32.6	21	41.1	8	21.1
≥ 21 year	12	13.5	5	9.8	7	18.4

Variables/categories	Total		Transvestites (n = 58)		Transsexuals (n = 66)		p
Variables/categories	n	%	n	%	n	%	p
Received information on TB							0.169
Yes	68	54.8	28	48.3	40	60.6
No	56	45.2	30	51.7	26	39.4
Sources of information accessed¹ 1 Multiple-choice question;							0.874^* * Generalization of Fisher's exact test;
Pamphlets/posters	17	20.7	6	18.8	11	22.0
TV/Radio/Internet	8	9.8	4	12.5	4	8.0
Lectures/classes/health professional	57	69.5	22	68.8	35	70.0
Opinion about TB							0.866
Very serious	54	43.5	27	46.6	27	40.9
Serious	56	45.2	25	43.1	31	47.0
Not serious	8	6.5	4	6.9	4	6.1
Does not know	6	4.8	2	3.4	4	6.1
TB curable							0.183^ Fisher's exact test.
Yes	115	95.8	52	89.6	63	95.4
No	5	4.2	4	6.9	1	1.6
Cure for TB							0.140
Medical treatment ² 2 Through treatment at primary care service/medication with medical supervision;	97	84.3	41	78.8	56	88.8
Rest without medication	18	15.7	11	21.2	7	11.2
Cost of treatment for TB							0.077
Free of charge	66	53.2	26	44.8	40	60.6
Expensive ³ 3 Combination of responses of very expensive, reasonably expensive and expensive.	21	16.9	15	19.0	6	4.5
Does not know	37	29.8	17	29.3	20	30.3
How TB is transmitted							0.884^* * Generalization of Fisher's exact test;
Correct forms	46	37.1	21	36.2	25	37.9
In correct forms	43	34.7	21	36.2	22	33.3
Does not know	35	28.2	16	27.6	19	28.8
How TB is prevented							0.321^* * Generalization of Fisher's exact test;
Correct forms	1	0.8	1	1.5	-	-
In correct forms	62	50.0	32	55.2	30	45.5
Does not know	61	49.2	25	38.5	36	54.5
Who can get TB?							0.310^* * Generalization of Fisher's exact test;
Anyone	94	75.8	41	70.7	53	80.3
Others	18	14.5	9	8.6	9	7.6
Does not know	12	9.7	8	13.8	4	6.1

Variables/categories	Total		Transvestites (n = 58)		Transsexuals (n = 66)		p
Variables/categories	n	%	n	%	n	%	p
Would feel if had TB							0.317^* * Generalization of Fisher's exact test;
Fear	30	26.6	14	20.1	19	28.8
Sadness	40	32.3	24	41.4	16	24.2
Others	15	12.1	7	12.1	8	12.1
No feeling	25	20.2	8	13.8	17	25.8
Does not know	11	8.9	5	8.6	6	9.1
Would talk about disease							0.039^ Fisher's exact test.
Yes	89	73.6	36	64.3	53	81.5
No	32	26.4	20	35.7	12	18.5
To whom respondent would talk about disease¹ 1 Multiple-choice question;							0.153^* * Generalization of Fisher's exact test;
Doctor	12	13.3	7	12.1	5	7.6
Steady partner	11	12.2	5	8.6	6	9.1
Parents/relatives	39	43.8	15	25.9	25	37.9
Close friend/work mate	27	30.0	10	25.0	17	25.8
Action to take it symptoms of TB were suspected							0.256
Seek primary care service	108	88.5	49	84.5	59	92.2
Others	14	11.5	9	15.5	5	7.8
When respondent would seek primary care service							0.610^* * Generalization of Fisher's exact test;
Self-medication failed	23	19.2	8	13.8	15	22.7
Symptoms for more than 2 weeks	7	5.8	4	6.9	3	4.5
As soon as perceiving symptoms	84	70.0	40	69.0	44	66.7
Does not know	6	5.0	4	6.9	2	3.0
Know someone who had TB							0.321^* * Generalization of Fisher's exact test;
Yes	86	70.5	43	74.1	43	65.2
No	36	29.5	14	24.1	22	33.3
Feelings toward individuals with TB							0.661^* * Generalization of Fisher's exact test;
Supportive and wish to help	72	58.1	31	53.4	41	62.1
Supportive, but distant	31	25.0	17	29.3	14	21.2
Indifferent	9	7.3	3	5.2	6	9.1
Fear of infection	7	5.6	4	6.9	3	4.5
Others	5	4.0	3	5.2	2	3.0
How other people consider someone with TB							0.651^* * Generalization of Fisher's exact test;
Many reject person	85	68.5	42	72.4	43	65.2
Supportive, but avoid contact	14	11.3	6	10.3	8	12.1
Many help	13	10.5	4	6.9	9	13.6
Does not know/others	12	9.7	6	9.1	6	9.1
Greatest concern about TB² 2 Open-ended question with response categories based on first thing mentioned by respondents.							0.667^* * Generalization of Fisher's exact test;
Death	22	17.7	9	15.5	13	19.7
Transmission	24	19.4	12	20.7	12	18.2
Treatment/Internment/Cure	21	16.9	13	22.4	8	12.1
Becoming ill	11	8.9	5	8.6	6	9.1
None	22	17.7	9	15.5	13	19.7
Others	24	19.4	10	17.2	14	21.2
Feels well-informed about TB							0.063
Yes	33	26.6	20	34.5	13	19.7
No	91	73.4	38	65.5	53	80.3
Would like more information about TB							0.416
Yes	108	87.1	49	84.5	59	89.4
No	16	12.9	9	15.5	7	10.6
Desired sources of information¹ 1 Multiple-choice question;							0.380^* * Generalization of Fisher's exact test;
Newspapers/magazines	4	2.8	1	1.6	3	3.9
Radio/TV/Internet	33	23.2	11	17.5	22	28.9
Lectures/Conversations/Health professional	38	26.8	21	33.3	17	22.4
Pamphlets	21	14.8	10	17.5	11	14.5
Others	46	32.4	20	40.8	26	44.1

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[1] Collaborations

S Ferreira Júnior worked on the conception, realization of the research and the final writing; PMSB Francisco in the statistical analyzes and in the final writing; PA Nogueira in the orientation of the research and in the final writing.