Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de de Janeiro, Brasil.
Cad Saude Publica. 2019;35(4):e00111318. doi: 10.1590/0102-311X00111318. Epub 2019 Apr 8.
Given both the changes in sexual customs, norms and policies and the persistent patterns in Brazil, the article analyzes the experiences of transgender women/transvestites with access to health services and discusses sexual/gender discrimination and their demands for gender transition and AIDS prevention services. The study involved interviews with nine transgender women/transvestites 23-45 years of age from low-income strata in the Baixada Fluminense region of Greater Metropolitan Rio de Janeiro, Brazil, in 2016 and observation of contexts of prostitution and sociability. Compared to the violence experienced years previously, the narratives of transgender women/transvestites highlight important social strides. They report that health professionals do not discriminate against them based on their condition, although they resist calling them by their social names. This embarrassment and the structural problems of the Brazilian Unified National Health System (SUS) are minimized by the agency of trans women/transvestites in obtaining care, such as recourse to contact networks and awareness of their civil rights. The narratives on their search for body changes for transitioning often reveal a tense combination of the technologies offered by health services and those managed by transvestites themselves. Although AIDS policies focus on measures for trans women/transvestites, HIV prevention is not among their main demands on health services. There are subjective barriers for accessing services, resulting from internalized stigma and the association of HIV infection with their living conditions. Improvement in healthcare for the trans/travestite population requires a debate on structural problems in the SUS, the defense of its expanded view of care, and investments in professional training.
鉴于性习俗、规范和政策的变化以及巴西持续存在的模式，本文分析了跨性别女性/异装癖者获得医疗服务的经历，并讨论了性/性别歧视以及他们对性别过渡和艾滋病预防服务的需求。该研究于 2016 年在巴西里约热内卢大都市区沿海低地地区采访了 9 名年龄在 23-45 岁之间的跨性别女性/异装癖者，并观察了卖淫和社交的背景。与多年前经历的暴力相比，跨性别女性/异装癖者的叙述强调了重要的社会进步。他们报告说，医疗保健专业人员不会因其状况而歧视他们，尽管他们抵制用他们的社会名字称呼他们。这种尴尬和巴西统一国家卫生系统（SUS）的结构性问题，通过跨性别女性/异装癖者在获得护理方面的代理行为得到了最小化，例如求助于联络网络和意识到他们的公民权利。他们对过渡时期身体变化的寻求叙述常常揭示了卫生服务提供的技术和异装癖者自己管理的技术之间紧张的结合。尽管艾滋病政策侧重于针对跨性别女性/异装癖者的措施，但艾滋病毒预防并不是他们对医疗服务的主要需求之一。由于内在的耻辱感和艾滋病毒感染与他们的生活条件之间的关联，他们在获得服务方面存在主观障碍。改善跨性别/易装癖者群体的医疗保健需要就 SUS 的结构性问题进行辩论，捍卫其扩大的护理观点，并投资于专业培训。
