Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Int J Equity Health. 2024 May 24;23(1):107. doi: 10.1186/s12939-024-02167-7.
Non-communicable diseases (NCDs) are high on the priority list of the Kerala government, and exploring the extent to which transgender and gender diverse (TGD) community members benefit from the services of national programmes for NCDs can provide valuable insights on improving the inclusivity of the health system as it moves towards Universal Health Coverage. This study was conducted to explore the prevalence of NCD risk factors as well as facilitators and barriers to NCD management among the TGD population in Kerala.
A multiple methods study, including a cross-sectional survey of 120 self-identifying TGD people that included an adaptation of the WHO STEPS questionnaire, as well as in-depth interviews with thirteen individuals, was conducted in three districts of Kerala to explore the barriers and facilitators to NCD prevention and management.
The results are presented using the key dimensions emerging out of the Diederichsen framework. A range of discrimination faced by TGD people in Kerala traps them in situations of low educational outcomes with consequent disadvantages in the job market when they search for livelihoods. This results in a large proportion of our sample living away from families (69 percent), and finding themselves in precarious jobs including sex work (only 33 percent had a regular job), with all these aforementioned factors converging to marginalise their social position. This social position leads to differential risk exposures such as increased exposure to modifiable risk factors like alcohol (40 percent were current alcohol users) and tobacco use (40.8 percent currently used tobacco) and ultimately metabolic risk factors too (30 and 18 percent were hypertensive and diabetic respectively). Due to their differential vulnerabilities such as the discrimination that TGD people are subjected to (41.7 percent had faced discrimination at a healthcare centre in the past one year), those with higher exposure to risk factors often find it hard to bring about behavioural modifications and are often not able to access the services they require.
The disadvantaged social position of TGD people and associated structural issues result in exacerbated biological risks, including those for NCDs. Ignoring these social determinants while designing health programmes is likely to lead to sub-optimal outcomes.
非传染性疾病（NCDs）是喀拉拉邦政府的首要任务之一，探索跨性别和性别多样化（TGD）社区成员从 NCD 国家计划服务中受益的程度，可以为改善卫生系统的包容性提供有价值的见解，因为卫生系统正在朝着全民健康覆盖的方向发展。本研究旨在探讨喀拉拉邦 TGD 人群中 NCD 风险因素的流行程度，以及 NCD 管理的促进因素和障碍。
采用多方法研究，包括对 120 名自我认同的 TGD 人群进行横断面调查，其中包括对世界卫生组织 STEPS 问卷的改编，以及对 13 名个体进行深入访谈，在喀拉拉邦的三个地区进行，以探讨 NCD 预防和管理的障碍和促进因素。
使用 Diederichsen 框架中出现的关键维度呈现结果。TGD 人群在喀拉拉邦面临的一系列歧视使他们陷入低教育成果的境地，从而在寻找生计时在就业市场上处于不利地位。这导致我们的样本中有很大一部分人远离家庭（69%），从事不稳定的工作，包括性工作（只有 33%有固定工作），所有上述因素都导致他们的社会地位边缘化。这种社会地位导致了不同的风险暴露，例如增加了对可改变的风险因素的暴露，如酒精（40%的人是当前的酒精使用者）和烟草使用（40.8%的人目前使用烟草），最终也导致了代谢风险因素（30%和 18%分别患有高血压和糖尿病）。由于 TGD 人群面临的歧视等差异化脆弱性（在过去一年中，41.7%的人在医疗中心受到歧视），那些面临更高风险因素暴露的人往往难以进行行为改变，并且往往无法获得所需的服务。
TGD 人群的不利社会地位和相关的结构性问题导致了生物风险的加剧，包括 NCD 风险。在设计卫生计划时忽略这些社会决定因素可能导致结果不理想。
