“Existimos”: Health and social needs of transgender men in Lima, Peru

Abstract

Background The health of transgender men (trans men)–individuals who identify as men and were assigned a female sex assigned at birth–is overlooked globally. This mixed-methods exploratory study sought to understand the lived experiences, health, and social needs of trans men in Lima, Peru to bring visibility to specific health needs and inform responsive and holistic public health efforts. Methods Between July 2016-January 2017, 46 trans men in Lima, Peru participated in a mixed-methods study. Four focus group discussions were conducted, complemented with 10 one-on-one interviews to explore in-depth issues that arose in groups. Two individuals participated in both a focus group and an interview. All participants completed a brief survey assessing sociodemographic characteristics and experiences with healthcare, mental health, and stigma. Audio files were transcribed verbatim and analyzed using an immersion crystallization approach to identify themes. Results Participants had a mean age of 24 years (range 18–48). Trans men reported a lack of awareness and information among medical providers, avoidance of healthcare due to discrimination and maltreatment, an absence of public services for medical gender affirmation (hormones, surgeries), and unmet mental health needs. Trans men described health as multidimensional and influenced by social, economic, and legal contexts including family, school, employment and work, legal identity recognition, discrimination in public spaces, and peer support. Violence, stigma, and intersecting forms of oppression were described as limiting social and legal recognition of trans identity a central dimension of health. Peer support, often in an online environment, was described as important to resistance and well-being. Conclusions Findings demonstrate that the physical and mental health of trans men, as well as unmet needs for healthcare services, are influenced by a complex set of social, economic, and legal challenges due to the social exclusion of trans people in Peruvian society. Results are a call to action for stakeholders in Peru to guarantee the rights, health, and wellbeing of this community.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

“…Lack of access to appropriate and affordable health care can lead to a greater reliance on informal knowledge systems. This includes information about self-administration of hormones, which, in many cases, is undertaken without necessary medical monitoring or supervision (e.g., Do et al., 2018 ; Liu et al., 2020 ; Rashid et al., 2022 ; Reisner et al., 2021 ; Winter & Doussantousse, 2009 ).…”

“…While overall health care services are diverse across the world (in terms of availability, accessibility, and quality), those services available to TGD people are often inadequate. Numerous reports from diverse regions worldwide show, while TGD people may report positive health care experiences, many others do not (e.g., Callander et al., 2019 ; Costa, da Rosa Filho et al., 2018 ; Do et al., 2018 ; Gourab et al., 2019 ; Health Policy Project et al., 2015; Liu et al., 2020 ; Motmans et al., 2017 ; Muller et al., 2019; PAHO, 2014 ; Reisner et al., 2021 ; Strauss et al., 2017 ; TGEU, 2017 ). Mainstream health care options often do not meet their needs for general, sexual, or gender-affirming health care.…”

Chilean Trans Men: Healthcare Needs and Experiences at the Public Health System

“…In addition, it is important to consider that each TM has different needs and characteristics, similar to what was reported by Peruvian TM in a recent study in which the diverse needs of TM and the social complexity they face are reported. 40 Therefore, it should not be assumed that everyone has initiated or wishes to initiate medical TP. Likewise, it is necessary to consider that the needs of individuals go beyond interventions of this type, so that care should be comprehensive and consider multiple aspects of their lives.…”

Self-reported health conditions, quality of Primary Health Care and associated factors according to sexual and gender minorities

“…Taken together, the data on the relationships between sociodemographic variables and health conditions/situations of the participants with the PHC quality scores generated by them signal the importance of rescuing and applying references such as the social determination of health-disease as possible explanatory models for LGBTQIAP+ health and its interfaces. A study conducted in a South American country with trans men about their social and health needs described health as multidimensional and influenced by social, economic, and legal contexts, including family, school, employment and work, legal identity recognition, discrimination in public spaces and peer support 28 .…”