Chakrapani Venkatesan, Santos Heather, Battala Madhusudana, Gupta Shaman, Sharma Satvik, Batavia Aditya, Siddiqui Sahil Jamal, Courts Kelly A, Scheim Ayden I
Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India.
National Institute of Advanced Studies, Bengaluru, India.
PLOS Glob Public Health. 2024 Oct 29;4(10):e0003506. doi: 10.1371/journal.pgph.0003506. eCollection 2024.
Little research has examined the health care experiences of transmasculine people in India, where government initiatives to improve access to transition-related (also called gender-affirmative) care have recently been announced. We draw on data from 'Our Health Matters', a mixed-methods community-based participatory research project, to characterize the transition-related care experiences of transmasculine people in India. Peer researchers conducted 40 virtual qualitative interviews in Hindi or Marathi from July to September 2021. Between November 2022 and January 2023, 377 transmasculine people participated in a multi-mode survey available in five languages. Qualitative data were analysed with a combination of framework analysis and grounded theory techniques. Data were mixed using a convergent parallel approach. Transmasculine persons' care journeys began with information-seeking, relying on peers and internet searches. In choosing between the public and private healthcare systems, they weighed issues of quality and affordability: the public system was perceived as lower-quality and difficult to access but most could not afford private care, leading to delays in care. Indeed, unmet need was common; 36.4% of survey participants were planning but had not begun to receive transition-related care and 80.2% wanted at least one transition-related surgery. Although some participants encountered stigma and refusal of care when seeking hormones, survey participants reported largely positive experiences with their hormone prescribers, which may reflect the influence of peer referrals. Participants underwent psychological assessments prior to transition-related care, which some experienced as disempowering and a barrier to disclosing mental health challenges. Finally, participants who were able to access care reported improved well-being, although surgical dissatisfaction was not uncommon (26.2%). Trans-inclusive medical training and continuing education are critical to enhancing access to high-quality transition-related care. Transmasculine people generally relied on peers and grassroots organizations for information, system navigation, and financial assistance. Strengthening these existing community resources may improve access to care.
在印度，政府最近宣布了旨在改善获得与过渡相关（也称为性别肯定）护理机会的举措，但针对跨性别男性群体医疗保健经历的研究却很少。我们利用“我们的健康至关重要”这一基于社区的混合方法参与式研究项目的数据，来描述印度跨性别男性群体与过渡相关的护理经历。同伴研究人员在2021年7月至9月期间用印地语或马拉地语进行了40次虚拟定性访谈。在2022年11月至2023年1月期间，377名跨性别男性参与了一项有五种语言版本的多模式调查。定性数据采用框架分析和扎根理论技术相结合的方法进行分析。数据采用收敛平行方法进行整合。跨性别男性群体的护理历程始于信息寻求，依赖同伴和网络搜索。在公共和私营医疗系统之间做出选择时，他们权衡了质量和可承受性问题：公共系统被认为质量较低且难以获得，但大多数人负担不起私营医疗服务，导致护理延迟。事实上，未满足的需求很常见；36.4%的调查参与者正在计划但尚未开始接受与过渡相关的护理，80.2%的人希望至少进行一次与过渡相关的手术。尽管一些参与者在寻求激素治疗时遇到了耻辱感和护理拒绝，但调查参与者报告称，他们与激素开处方者的经历总体上是积极的，这可能反映了同伴推荐的影响。参与者在接受与过渡相关的护理之前接受了心理评估，有些人认为这是一种剥夺权力的行为，也是披露心理健康挑战的障碍。最后，能够获得护理的参与者报告称幸福感有所改善，尽管手术不满意的情况并不少见（26.2%）。跨性别包容的医学培训和继续教育对于增加获得高质量与过渡相关护理的机会至关重要。跨性别男性群体通常依靠同伴和基层组织获取信息、系统导航和经济援助。加强这些现有的社区资源可能会改善护理的可及性。
