Reisner Sari L, Poteat Tonia, Keatley JoAnne, Cabral Mauro, Mothopeng Tampose, Dunham Emilia, Holland Claire E, Max Ryan, Baral Stefan D
Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Fenway Institute, Fenway Health, Boston, MA, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Lancet. 2016 Jul 23;388(10042):412-436. doi: 10.1016/S0140-6736(16)00684-X. Epub 2016 Jun 17.
Transgender people are a diverse population affected by a range of negative health indicators across high-income, middle-income, and low-income settings. Studies consistently document a high prevalence of adverse health outcomes in this population, including HIV and other sexually transmitted infections, mental health distress, and substance use and abuse. However, many other health areas remain understudied, population-based representative samples and longitudinal studies are few, and routine surveillance efforts for transgender population health are scarce. The absence of survey items with which to identify transgender respondents in general surveys often restricts the availability of data with which to estimate the magnitude of health inequities and characterise the population-level health of transgender people globally. Despite the limitations, there are sufficient data highlighting the unique biological, behavioural, social, and structural contextual factors surrounding health risks and resiliencies for transgender people. To mitigate these risks and foster resilience, a comprehensive approach is needed that includes gender affirmation as a public health framework, improved health systems and access to health care informed by high quality data, and effective partnerships with local transgender communities to ensure responsiveness of and cultural specificity in programming. Consideration of transgender health underscores the need to explicitly consider sex and gender pathways in epidemiological research and public health surveillance more broadly.
跨性别者是一个多样化的群体，在高收入、中等收入和低收入环境中受到一系列负面健康指标的影响。研究一致表明，这一群体中不良健康结果的患病率很高，包括艾滋病毒和其他性传播感染、心理健康困扰以及药物使用和滥用。然而，许多其他健康领域仍未得到充分研究，基于人群的代表性样本和纵向研究很少，针对跨性别者群体健康的常规监测工作也很匮乏。在一般调查中缺乏用于识别跨性别受访者的调查项目，这往往限制了用于估计健康不平等程度和描述全球跨性别者群体健康状况的数据的可得性。尽管存在这些限制，但仍有足够的数据突出了围绕跨性别者健康风险和复原力的独特生物学、行为、社会和结构背景因素。为了降低这些风险并增强复原力，需要一种全面的方法，包括将性别肯定作为一个公共卫生框架，改善卫生系统并根据高质量数据提供医疗服务，以及与当地跨性别者社区建立有效的伙伴关系，以确保项目的响应性和文化特异性。对跨性别者健康的考虑凸显了在更广泛的流行病学研究和公共卫生监测中明确考虑性别和性别的途径的必要性。
