Freitas Francisca Lidiane Sampaio, Bermúdez Ximena Pamela Claudia Díaz, Merchán-Hamann Edgar, Dias Dos Santos Adriano Santiago, Vieira Victor Fonseca
Public Health Postgraduate Program, University of Brasilia, Brasilia, DF, Brazil.
Int J Equity Health. 2024 Dec 25;23(1):272. doi: 10.1186/s12939-024-02359-1.
Most transgender people face different conditions of health vulnerability on a daily basis. In the Brazilian context, no research review has been found on such situations in the light of the theoretical conceptualization of multidimensional vulnerability. This research aimed to identify and analyze components of social and/or programmatic vulnerability that interfere with access to health care for trans people in Brazil.
The scoping review followed the JBI Manual and the PRISMA-ScR list. Brazilian studies published in any language, in the period 2019-April 2023, in the NCBI/PubMed, Web of Science, EMBASE, Scopus, SciELO, and LILACS databases were selected. The inclusion criteria included: original research with a sample of transgender people aged 18 years and over; and research contemplating conditions of social and/or programmatic vulnerability. Three reviewers independently selected the articles. The extracted and mapped data included components of these dimensions, according to the theoretical framework, as well as characteristics of the studies, for the synthesis of the descriptive analysis.
A total of 46 studies were included. Social and programmatic vulnerability components were present in 67% of the studies. Among the main findings, the social dimension included discrimination, situations of violence in different contexts and social exclusion; prejudice and school dropout, homelessness, informal work and precarious income; and harmful use of alcohol and/or other drugs. The programmatic dimension encompassed disrespect for the use of the social name and institutional discrimination; hormone therapy without professional monitoring and scarcity of specialized services; lack of integration between Primary Health Care (PHC) and specialized care and insufficient PHC involvement; distortions between what is contained in public health policies and the practice in the services. A higher percentage (61%) of studies with trans women and 7% with trans men were observed; inequalities in regional distribution; predominance of HIV and AIDS and mental health themes; and similar percentages in the various methodological approaches and publications in national and foreign journals.
The identified situations of vulnerability contribute mainly to supporting the formulation and implementation of new public policies in comprehensive health that are more comprehensive and inclusive, which mitigate the current social and health inequities.
大多数跨性别者每天都面临着不同的健康脆弱状况。在巴西的背景下，尚未发现有研究从多维脆弱性的理论概念角度对这种情况进行综述。本研究旨在识别和分析影响巴西跨性别者获得医疗保健的社会和/或项目脆弱性的组成部分。
范围综述遵循JBI手册和PRISMA-ScR清单。选取2019年至2023年4月期间在NCBI/PubMed、科学网、EMBASE、Scopus、SciELO和LILACS数据库中以任何语言发表的巴西研究。纳入标准包括：以18岁及以上跨性别者为样本的原创研究；以及考虑社会和/或项目脆弱性状况的研究。三名评审员独立筛选文章。根据理论框架，提取和映射的数据包括这些维度的组成部分以及研究的特征，用于描述性分析的综合。
共纳入46项研究。67%的研究中存在社会和项目脆弱性组成部分。主要研究结果中，社会维度包括歧视、不同背景下的暴力情况和社会排斥；偏见和辍学、无家可归、非正规工作和不稳定收入；以及酒精和/或其他药物的有害使用。项目维度包括不尊重使用社会名称和机构歧视；无专业监测的激素治疗和专业服务匮乏；初级卫生保健（PHC）与专科护理之间缺乏整合以及PHC参与不足；公共卫生政策所包含内容与服务实践之间的偏差。观察到跨性别女性的研究比例较高（61%），跨性别男性的研究比例为7%；区域分布不平等；艾滋病毒和艾滋病以及心理健康主题占主导；以及在各种方法学方法以及国内外期刊发表的文章中比例相似。
所确定的脆弱状况主要有助于支持制定和实施更全面、更具包容性的综合健康新公共政策，以减轻当前的社会和健康不平等。
