Chilean Trans Men: Healthcare Needs and Experiences at the Public Health
Main Article Content
Abstract
Introduction: Research shows high rates of discrimination against the transgender population in healthcare centers, which has negative consequences for their quality of life. There are few studies in this area that focus upon the experiences of trans men, although, they tend to experience higher levels of violence and stigmati-
zation in healthcare settings.
Method: We explored the perceptions of 14 Chilean trans men regarding discrimination in healthcare centers from an ethnographic approach, with the aim of analyzing their experiences in these facilities, and identifying their needs in relation to healthcare.
Results: The majority of trans men perceived health centers as a source of discrimination. The most important expressions of discrimination involve questioning their gender identity, and disregarding their social names and pronouns. In view of this, interviewees placed fear of discrimination as the main factor preventing them from being attended at healthcare centers. On the other hand, having access to health workers who are trained in providing care to the transgender population, being provided with information, and the possibility of receiving psychosocial support are the main factors promoting their attendance at these facilities.
Discussion: The study has implications both for health professionals and public policies focused on the transmasculine community. Recommendations are made for professionals and administrative staff to provide respectful and sympathetic care in order to generate spaces free of discrimination that encourage attendance at healthcare centers, improving the welfare of trans men.
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Gonzalez, S., & Bernales, M. (2022). Chilean Trans Men: Healthcare Needs and Experiences at the Public Health . International Journal of Mens Social and Community Health, 5(3), e1-e14. https://doi.org/10.22374/ijmsch.v5i3.93
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11. Shires DA, Jaffee K. Factors associated with health care discrimination experiences among a national sample of female-to-male transgender individuals. Health Soc Work. 2015;40(2):134–41. http://dx.doi.org/10.1093/hsw/hlv025
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15. Peitzmeier S, Reisner L, Harigopal P, Potter J. Female-to-male patients have high prevalence of unsatisfactory Paps compared to non-transgender females: Implications for cervical cancer screening. J Gen Intern Med. 2014;29:778–84. http://dx.doi.org/10.1007/s11606-013-2753-1
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17. Peitzmeier SM, Agénor M, Bernstein IM, McDowell M, Alizaga NM, Reisner SL, et al. “It can promote an existential crisis”: Factors influencing Pap test acceptability and utilization among transmasculine individuals. Qual Health Res. 2017;27(14):2138–49. http://dx.doi.org/10.1177/1049732317725513
18. Adauy A, Sandoval J, Ríos R, Cartes A, Salinas H. Terapia hormonal en la transición femenino a masculino (ftm) androgénica, para trans masculino o para hombre transgénero. Rev Chil Obstet Ginecol. 2018;83(3):318–28. http://dx.doi.org/10.4067/s0717-75262018000300319
19. González V, Catalán M, Pantoja de Prada V. Evaluación con enfoque de salud de la situación de personas trans en Chile: Una realidad invisibilizada. Cuadernos Méd Soc. 2018;58(2):49–55.
20. Aylagas M, García Ó, Rodríguez B. Barreras en la asistencia sociosanitaria en personas transexuales: Revisión sistemática de estudios cualitativos. Enferm Clín. 2018;28(4):247–59. http://dx.doi.org/10.1016/j.enfcli.2017.09.004
21. Valenzuela A, Cartes R. Salud comunitaria, la experiencia de salud trans en el Servicio de Salud Talcahuano, Chile. Psicoperspectivas. 2020;19(2):142–53. http://dx.doi.org/10.5027/psicoperspectivas-vol19-issue2-fulltext-1789
22. Tomicic A, Gálvez C, Quiroz C, Martínez C, Fontbona J, Rodríguez J, et al. Suicide in lesbian, gay, bisexual and trans populations: Systematic review of a decade of research (2004–2014). Rev Méd Chil. 2016;144(6):723–33. http://dx.doi.org/10.4067/S0034-98872016000600006
23. Romanelli L, Lu W, Lindsey M. Examining mechanisms and moderators of the relationship between discriminatory health care encounters and attempted suicide among US transgender help-seekers. Adm Policy Ment Health. 2018;45(6):831–49. http://dx.doi.org/10.1007/s10488-018-0868-8
24. Movimiento de Integración y Liberación Homosexual. Informe Anual de Derechos Humanos (HECHOS, 2020) 2020.
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26. Lewis S. Qualitative inquiry and research design: Choosing among five approaches. Health Promot Pract. 2015;16(4):473–75. http://dx.doi.org/10.1177/1524839915580941
27.Troncoso-Pantoja C, Amaya-Placencia A. Entrevista: Guía práctica para la recolección de datos cualitativos en investigación de salud. Rev Fac Med. 2017;65(2):329–32. http://dx.doi.org/10.15446/revfacmed.v65n2.60235
28. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. http://dx.doi.org/10.1191/1478088706qp063oa
29. Braun V, Clarke V. Can I use TA? Should I use TA? Should I not use TA? Comparing reflexive thematic analysis and other pattern‐based qualitative analytic approaches. Couns Psychother Res. 2021;21(1):3747. http://dx.doi.org/10.1002/capr.12360
30. Quattrucci C. Los límites del dispositivo médico en la atención de la salud sexual de hombres trans. [Presentación de congreso]. XXX1 Congreso ALAS Uruguay 2017. Montevideo, Uruguay; 2017. pp. 1–12.
31. Dowshen N, Lee S, Franklin J, Castillo M, Barg F. Access to medical and mental health services across the HIV care continuum among young transgender women: A qualitative study. Transgend Health 2017;2,81–90. http://dx.doi.org/10.1089/trgh.2016.0046
32. Denson DJ, Padgett P, Pitts N, Paz-Bailey G, Bingham T, Carlos JA, et al. Health care use and HIV-related behaviors of black and latina transgender women in 3 US metropolitan areas: Results from the transgender HIV behavioral survey. J Acquir Immune Defic Syndr. 2017;7(5):268–75. http://dx.doi.org/10.1097/QAI.0000000000001402
33. Oberheim ST, DePue MK, Hagedorn WB. Substance use disorders (SUDs) in transgender communities: The need for trans-competent SUD counselors and facilities. J Addict Offender Couns. 2017;38,33–47. http://dx.doi.org/10.1002/jaoc.12027
34. Puckett JA, Cleary P, Rossman K, Newcomb ME, Mustanski B. Barriers to gender-affirming care for transgender and gender nonconforming individuals. Sex Res Soc Policy. 2018;15:48–59. http://dx.doi.org/10.1007/s13178-017-0295-8
35. Madera SLR, Díaz NV, Padilla M, Pibernus XR, Neilands TB, Segarra ER, et al. Just like any other patient: Transgender stigma among physicians in Puerto Rico. J Health Care Poor Underserved. 2019;30:1518–42. http://dx.doi.org/10.1353/hpu.2019.0089
36. Abelson M. ‘You aren’t from around here’: Race, masculinity, and rural transgender men. Gender Place Culture. 2016;23(11):1535–46. http://dx.doi.org/10.1080/0966369X.2016.1219324
37. Anderson A, Irwin J, Brown A, Grala C. “Your picture looks the same as my picture”: An examination of passing in transgender communities. Gender Issues. 2020;37(1):44–60. http://dx.doi.org/10.1007/s12147-019-09239-x
38. Borck C, Moore L. This is my voice on T: Synthetic testosterone, DIY surveillance, and transnormative masculinity. Surveill Soc. 2019;17(5):631–40. http://dx.doi.org/10.24908/ss.v17i5.12931
39. Catalano D. “Trans Enough?” The pressures trans men negotiate in higher education. Transgender Stud Quart. 2015;2(3):411–30. http://dx.doi.org/10.1215/23289252-2926399
40. Reisner SL, Silva-Santisteban A, Salazar X, Vilela J, D’Amico L, Perez-Brumer A. “Existimos”: Health and social needs of transgender men in Lima, Peru. PLoS One. 2021;16(8):e0254494. http://dx.doi.org/10.1371/JOURNAL.PONE.0254494
41. Donoso C, Nuñez S, Parra-Villarroel J. Significado que otorgan las personas trans a sus experiencias en la atención en el sistema de salud chileno. Rev Chil Salud Púb. 2018;22(2):126–34. http://dx.doi.org/10.5354/0719-5281.2018.53235
42. Chile. Ministerio de Salud. Orientaciones técnicas para actualizar o elaborar protocolo de trato y registro para personas trans, en el marco de la circular N° 21. 2019. pp. 1–11.
43. Fredriksen Goldsen KI, Romanelli M, Hoy-Ellis CP, Jung H. Health, economic and social disparities among transgender women, transgender men and transgender nonbinary adults: Results from a population-based study. Prev Med. 2021;156:106988. http://dx.doi.org/10.1016/j.ypmed.2022.106988
44. White J, Reisner S, Pachankis E. Transgender stigma and health: A critical review of stigma determinants, mechanism, and interventions. Soc Sci Med. 2015;147:222–231. http://dx.doi.org/10.1016/j.socscimed.2015.11.010
45. Bockting W, Coleman E, Deutsch MB, Guillamon A, Meyer I, Meyer W 3rd, et al. Adult development and quality of life of transgender and gender nonconforming people. Curr Opin Endocrinol Diabetes Obes. 2016;23:188–97. http://dx.doi.org/10.1097/MED.0000000000000232
46. Roberts T, Fantz C. Barriers to quality health care for the Transgender population. Biochem Clin. 2014;47(10):983–87. http://dx.doi.org/10.1016/j.clinbiochem.2014.02.009
47. Dolores M, Solano M. La aplicación del modelo de competencia cultural en la experiencia del cuidado en profesionales de Enfermería de Atención Primaria. Atención Primaria. 2017;49(9):549–56. http://dx.doi.org/10.1016/j.aprim.2016.10.013
2. Zapata A, Díaz K, Barra L, Maureira L, Linares J, Zapata F. Atención de salud de personas transgéneros para médicos no especialistas en Chile. Rev Méd Chil. 2019;147(1):65–72. http://dx.doi.org/10.4067/S0034-98872019000100065
3. Day M. La discriminación que enfrentan personas trans y no binarix en servicios de salud en Santiago, Chile. Chile: Salud Pública, Medicina Tradicional y Empoderamiento de La comunidad; 2017. pp. 1–35.
4. Melin A, Ruíz P. Experiencias trans en el sistema público de salud de la región de los ríos. Universidad Austral de Chile, Tesis de Grado; 2019. pp. 1–66.
5. Movimiento de Integración y Liberación Homosexual. Encuesta Identidad; 2018.
6. Jaffee KD, Shires DA, Stroumsa D. Discrimination and delayed health care among transgender women and men. Med Care. 2016;54(11):1010–6. http://dx.doi.org/10.1097/MLR.0000000000000583
7. Organización Panamericana de la Salud. Por la salud de las personas trans: Elementos para el desarrollo de la atención integral de personas trans y sus comunidades en Latinoamérica y el Caribe. Buenos Aires, Argentina; 2016.
8. Giblon R, Bauer GR. Health care availability, quality, and unmet need: A comparison of transgender and cisgender residents of Ontario, Canada. BMC Health Serv Res. 2017;17(1):1–10. http://dx.doi.org/10.1186/s12913-017-2226-z
9. Macapagal K, Bhatia R, Greene G. Diferencias en el acceso a la atención médica, el uso y las experiencias dentro de una muestra comunitaria de lesbianas, gays, bisexuales, transgénero y adultos emergentes racialmente diversos. Salud LGBT. 2016;3(6):434–42.
10. Barrientos J, Saiz L, Gómez F, Guzmán M, Espinoza R, Cárdenas M, et al. La Investigación Psicosocial Actual Referida a la Salud Mental de las Personas Transgénero: Una Mirada Desde Chile. Psykhe. 2019;28(2):1–13. http://dx.doi.org/10.7764/psykhe.28.2.1482
11. Shires DA, Jaffee K. Factors associated with health care discrimination experiences among a national sample of female-to-male transgender individuals. Health Soc Work. 2015;40(2):134–41. http://dx.doi.org/10.1093/hsw/hlv025
12. Davies J, McCrae BP, Frank J, Dochnahl A, Pickering T, Harrison B, et al. Identifying male college students’ perceived health needs, barriers to seeking help, and recommendations to help men adopt healthier lifestyles. J Am Coll Health. 2000;48(6):259–67. http://dx.doi.org/10.1080/07448480009596267
13. Pinto Novais de Azevedo, D. Acolhimento de Homens Trans em Consultas de Ginecologia. Universidade Beira Interior, Tesis Doctoral; 2021. pp. 1–68.
14. Peitzmeier S, Khullar K, Reisner S, Potter J. Pap test use is lower among female-to-male patients than non-transgender women. Am J Prev Med. 2014;47:808–12. http://dx.doi.org/10.1016/j.amepre.2014.07.031
15. Peitzmeier S, Reisner L, Harigopal P, Potter J. Female-to-male patients have high prevalence of unsatisfactory Paps compared to non-transgender females: Implications for cervical cancer screening. J Gen Intern Med. 2014;29:778–84. http://dx.doi.org/10.1007/s11606-013-2753-1
16. Braz C. “Acá yo soy un pibe normal”: Narrativas sobre la espera y el acceso a derechos entre varones trans en Argentina. Sexualidad, Salud y Sociedad. Rev Latinoamericana. 2019;119–38. http://dx.doi.org/10.1590/1984-6487.sess.2019.31.07.a
17. Peitzmeier SM, Agénor M, Bernstein IM, McDowell M, Alizaga NM, Reisner SL, et al. “It can promote an existential crisis”: Factors influencing Pap test acceptability and utilization among transmasculine individuals. Qual Health Res. 2017;27(14):2138–49. http://dx.doi.org/10.1177/1049732317725513
18. Adauy A, Sandoval J, Ríos R, Cartes A, Salinas H. Terapia hormonal en la transición femenino a masculino (ftm) androgénica, para trans masculino o para hombre transgénero. Rev Chil Obstet Ginecol. 2018;83(3):318–28. http://dx.doi.org/10.4067/s0717-75262018000300319
19. González V, Catalán M, Pantoja de Prada V. Evaluación con enfoque de salud de la situación de personas trans en Chile: Una realidad invisibilizada. Cuadernos Méd Soc. 2018;58(2):49–55.
20. Aylagas M, García Ó, Rodríguez B. Barreras en la asistencia sociosanitaria en personas transexuales: Revisión sistemática de estudios cualitativos. Enferm Clín. 2018;28(4):247–59. http://dx.doi.org/10.1016/j.enfcli.2017.09.004
21. Valenzuela A, Cartes R. Salud comunitaria, la experiencia de salud trans en el Servicio de Salud Talcahuano, Chile. Psicoperspectivas. 2020;19(2):142–53. http://dx.doi.org/10.5027/psicoperspectivas-vol19-issue2-fulltext-1789
22. Tomicic A, Gálvez C, Quiroz C, Martínez C, Fontbona J, Rodríguez J, et al. Suicide in lesbian, gay, bisexual and trans populations: Systematic review of a decade of research (2004–2014). Rev Méd Chil. 2016;144(6):723–33. http://dx.doi.org/10.4067/S0034-98872016000600006
23. Romanelli L, Lu W, Lindsey M. Examining mechanisms and moderators of the relationship between discriminatory health care encounters and attempted suicide among US transgender help-seekers. Adm Policy Ment Health. 2018;45(6):831–49. http://dx.doi.org/10.1007/s10488-018-0868-8
24. Movimiento de Integración y Liberación Homosexual. Informe Anual de Derechos Humanos (HECHOS, 2020) 2020.
25. Creswell J. Five qualitative approaches to inquiry qualitative inquiry and research design: Choosing among five approaches. Thousand Oaks, CA: Sage; 2017. pp. 53–84.
26. Lewis S. Qualitative inquiry and research design: Choosing among five approaches. Health Promot Pract. 2015;16(4):473–75. http://dx.doi.org/10.1177/1524839915580941
27.Troncoso-Pantoja C, Amaya-Placencia A. Entrevista: Guía práctica para la recolección de datos cualitativos en investigación de salud. Rev Fac Med. 2017;65(2):329–32. http://dx.doi.org/10.15446/revfacmed.v65n2.60235
28. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. http://dx.doi.org/10.1191/1478088706qp063oa
29. Braun V, Clarke V. Can I use TA? Should I use TA? Should I not use TA? Comparing reflexive thematic analysis and other pattern‐based qualitative analytic approaches. Couns Psychother Res. 2021;21(1):3747. http://dx.doi.org/10.1002/capr.12360
30. Quattrucci C. Los límites del dispositivo médico en la atención de la salud sexual de hombres trans. [Presentación de congreso]. XXX1 Congreso ALAS Uruguay 2017. Montevideo, Uruguay; 2017. pp. 1–12.
31. Dowshen N, Lee S, Franklin J, Castillo M, Barg F. Access to medical and mental health services across the HIV care continuum among young transgender women: A qualitative study. Transgend Health 2017;2,81–90. http://dx.doi.org/10.1089/trgh.2016.0046
32. Denson DJ, Padgett P, Pitts N, Paz-Bailey G, Bingham T, Carlos JA, et al. Health care use and HIV-related behaviors of black and latina transgender women in 3 US metropolitan areas: Results from the transgender HIV behavioral survey. J Acquir Immune Defic Syndr. 2017;7(5):268–75. http://dx.doi.org/10.1097/QAI.0000000000001402
33. Oberheim ST, DePue MK, Hagedorn WB. Substance use disorders (SUDs) in transgender communities: The need for trans-competent SUD counselors and facilities. J Addict Offender Couns. 2017;38,33–47. http://dx.doi.org/10.1002/jaoc.12027
34. Puckett JA, Cleary P, Rossman K, Newcomb ME, Mustanski B. Barriers to gender-affirming care for transgender and gender nonconforming individuals. Sex Res Soc Policy. 2018;15:48–59. http://dx.doi.org/10.1007/s13178-017-0295-8
35. Madera SLR, Díaz NV, Padilla M, Pibernus XR, Neilands TB, Segarra ER, et al. Just like any other patient: Transgender stigma among physicians in Puerto Rico. J Health Care Poor Underserved. 2019;30:1518–42. http://dx.doi.org/10.1353/hpu.2019.0089
36. Abelson M. ‘You aren’t from around here’: Race, masculinity, and rural transgender men. Gender Place Culture. 2016;23(11):1535–46. http://dx.doi.org/10.1080/0966369X.2016.1219324
37. Anderson A, Irwin J, Brown A, Grala C. “Your picture looks the same as my picture”: An examination of passing in transgender communities. Gender Issues. 2020;37(1):44–60. http://dx.doi.org/10.1007/s12147-019-09239-x
38. Borck C, Moore L. This is my voice on T: Synthetic testosterone, DIY surveillance, and transnormative masculinity. Surveill Soc. 2019;17(5):631–40. http://dx.doi.org/10.24908/ss.v17i5.12931
39. Catalano D. “Trans Enough?” The pressures trans men negotiate in higher education. Transgender Stud Quart. 2015;2(3):411–30. http://dx.doi.org/10.1215/23289252-2926399
40. Reisner SL, Silva-Santisteban A, Salazar X, Vilela J, D’Amico L, Perez-Brumer A. “Existimos”: Health and social needs of transgender men in Lima, Peru. PLoS One. 2021;16(8):e0254494. http://dx.doi.org/10.1371/JOURNAL.PONE.0254494
41. Donoso C, Nuñez S, Parra-Villarroel J. Significado que otorgan las personas trans a sus experiencias en la atención en el sistema de salud chileno. Rev Chil Salud Púb. 2018;22(2):126–34. http://dx.doi.org/10.5354/0719-5281.2018.53235
42. Chile. Ministerio de Salud. Orientaciones técnicas para actualizar o elaborar protocolo de trato y registro para personas trans, en el marco de la circular N° 21. 2019. pp. 1–11.
43. Fredriksen Goldsen KI, Romanelli M, Hoy-Ellis CP, Jung H. Health, economic and social disparities among transgender women, transgender men and transgender nonbinary adults: Results from a population-based study. Prev Med. 2021;156:106988. http://dx.doi.org/10.1016/j.ypmed.2022.106988
44. White J, Reisner S, Pachankis E. Transgender stigma and health: A critical review of stigma determinants, mechanism, and interventions. Soc Sci Med. 2015;147:222–231. http://dx.doi.org/10.1016/j.socscimed.2015.11.010
45. Bockting W, Coleman E, Deutsch MB, Guillamon A, Meyer I, Meyer W 3rd, et al. Adult development and quality of life of transgender and gender nonconforming people. Curr Opin Endocrinol Diabetes Obes. 2016;23:188–97. http://dx.doi.org/10.1097/MED.0000000000000232
46. Roberts T, Fantz C. Barriers to quality health care for the Transgender population. Biochem Clin. 2014;47(10):983–87. http://dx.doi.org/10.1016/j.clinbiochem.2014.02.009
47. Dolores M, Solano M. La aplicación del modelo de competencia cultural en la experiencia del cuidado en profesionales de Enfermería de Atención Primaria. Atención Primaria. 2017;49(9):549–56. http://dx.doi.org/10.1016/j.aprim.2016.10.013