School of Public Health, All India Institute of Medical Sciences, Jodhpur, India.
Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India.
BMC Health Serv Res. 2024 Aug 26;24(1):989. doi: 10.1186/s12913-024-11010-2.
Transgender people comprise an estimated 0.3-0.5% (25 million) of the global population. The public health agenda focuses on understanding and improving the health and well-being of gender minorities. Transgender (TG) persons often have complex healthcare needs and suffer significant health disparities in multiple arenas. The international literature suggests that this community is at a higher risk of depression, and other mental health problems, including HIV. Many transgender people experience gender dysphoria and seek specific medical needs such as sex reassignment surgeries, implants, hormonal therapies, etc., but are unable to access these services due to financial or social reasons. The objective of this study was to assess the healthcare needs and associated barriers experienced by transgender people in Western Rajasthan.
A qualitative study was carried out in which multilevel stakeholder interviews were conducted using interview and focus group discussion guides. Data was analyzed using the qualitative thematic analysis technique.
Findings reveal that transgender people have expressed their need to access health services for general health needs, including but not limited to mental health, non-communicable diseases, and infectious diseases. Barriers to healthcare services were identified on 3 levels: health system, social and personal. Health system barriers include policy, accessibility, affordability, and acceptability issues. Social factors such as inadequate housing, education, and job opportunities also play an important role in affecting the individual's health-seeking behavior. The knowledge of healthcare providers in this context was also limited in context of health insurance schemes, package of services available for transgenders and the importance of gender sensitive healthcare.
Transgender people expressed the need for mental health services, programs targeting nutritional improvement, gender-affirmation procedures besides regular screening of non-communicable diseases as operational for males and females. Levels of barriers have been identified at various levels ranging from absence of targeted policies to individual behavior.
据估计，全球人口中有 0.3-0.5%（2500 万）是跨性别者。公共卫生议程的重点是了解和改善性别少数群体的健康和福祉。跨性别者（TG）通常有复杂的医疗需求，并在多个领域遭受严重的健康差距。国际文献表明，该群体患抑郁症和其他心理健康问题（包括 HIV）的风险较高。许多跨性别者经历性别焦虑，并寻求特定的医疗需求，如性别重置手术、植入物、激素治疗等，但由于财务或社会原因无法获得这些服务。本研究的目的是评估西拉贾斯坦邦跨性别者的医疗需求和相关障碍。
进行了一项定性研究，使用访谈和焦点小组讨论指南对多层次利益相关者进行了多层次利益相关者访谈。使用定性主题分析技术对数据进行分析。
研究结果表明，跨性别者表示需要获得一般健康需求的医疗服务，包括但不限于心理健康、非传染性疾病和传染病。医疗服务障碍在三个层面上被确定：卫生系统、社会和个人。卫生系统障碍包括政策、可及性、可负担性和可接受性问题。社会因素，如住房、教育和就业机会不足，也在影响个人寻求医疗服务的行为方面发挥了重要作用。在这种情况下，医疗保健提供者的知识也有限，包括医疗保险计划、为跨性别者提供的服务包以及性别敏感医疗保健的重要性。
跨性别者表示需要心理健康服务、针对营养改善的计划、性别确认程序以及除了针对男性和女性的常规非传染性疾病筛查外。障碍的程度已在不同层面上确定，从缺乏有针对性的政策到个人行为。
