Khapre Meenakshi, Sahoo Krushna, Saxena Vartika, Sinha Smita, Luthra Gagandeep, Joshi Anubhuti
All India Institute of Medical Sciences, Rishikesh, India.
Ministry of Health and Family Welfare, New Delhi, India.
Front Public Health. 2024 Dec 4;12:1476938. doi: 10.3389/fpubh.2024.1476938. eCollection 2024.
Transgender (TG) women face violence, discrimination, and stigma, which affect their mental health and hinder their access to targeted intervention (TI) services. This lack of access may increase the risk of human immunodeficiency virus/sexually transmitted infections (HIV/STIs). However, the utilization of TI services among transgender women in Uttarakhand, as well as across the country, remains understudied. The purpose of this study is to explore the utilization of TI services by the transgender community in Uttarakhand.
This qualitative study focused on non-government organizations (NGOs) that implement TI projects in Haridwar and Roorkee, Uttarakhand, India. From September 2023 to January 2024, 5 focus group discussions (FGDs) involving 24 transgender women and 9 in-depth interviews (IDIs) involving NGO staff were conducted. Thematic analysis, guided by the Anderson and Newman healthcare utilization model, was employed.
Several barriers to service utilization were identified, including ritual beliefs, low health literacy, stigma, social isolation, financial insecurity, privacy concerns, and inefficient service delivery. Challenges in the implementation of the STI program and neglect of transgender women in health facilities were also reported. However, enabling factors such as trusted providers, supportive laws, and initiatives by NGOs and government agencies were recognized. Nonetheless, there remains a significant need for information on gender-affirming services and addressing other prevalent health issues within the transgender female community.
The study underscores the interplay of individual, social, and service-related factors affecting healthcare access among transgender women. Inclusive and high-quality healthcare services are necessary to address the complex sociocultural aspects influencing transgender women's healthcare access and utilization.
跨性别女性面临暴力、歧视和污名化，这影响了她们的心理健康，并阻碍她们获得针对性干预（TI）服务。这种服务获取的不足可能会增加感染人类免疫缺陷病毒/性传播感染（HIV/STIs）的风险。然而，北阿坎德邦以及整个印度的跨性别女性对TI服务的利用情况仍未得到充分研究。本研究的目的是探讨北阿坎德邦跨性别群体对TI服务的利用情况。
这项定性研究聚焦于在印度北阿坎德邦哈里瓦和鲁尔基实施TI项目的非政府组织（NGO）。在2023年9月至2024年1月期间，开展了5次涉及24名跨性别女性的焦点小组讨论（FGD）以及9次涉及NGO工作人员的深入访谈（IDI）。采用了以安德森和纽曼医疗保健利用模型为指导的主题分析方法。
确定了几个服务利用的障碍，包括宗教信仰、健康素养低、污名化、社会隔离、经济不安全、隐私担忧以及服务提供效率低下。还报告了性传播感染项目实施中的挑战以及医疗机构对跨性别女性的忽视。然而，也认识到了一些促成因素，如可信赖的提供者、支持性法律以及NGO和政府机构的举措。尽管如此，对于性别肯定服务以及解决跨性别女性群体中其他普遍存在的健康问题的信息仍有很大需求。
该研究强调了影响跨性别女性获得医疗保健的个人、社会和服务相关因素之间的相互作用。需要提供包容且高质量的医疗服务，以应对影响跨性别女性获得和利用医疗保健的复杂社会文化因素。
