Itinerário terapêutico de pessoas transgênero: assistência despersonalizada e produtora de iniquidades

Abstract

Resumo Este artigo analisa o itinerário terapêutico de pessoas transgênero em uma cidade do interior da Bahia. Os participantes foram selecionados pelo critério do método da “bola de neve” e utilizou-se entrevista semiestruturada para produção dos dados. Na análise dos itinerários terapêuticos, emergiram três categorias temáticas: 1) Lugares de busca para o cuidado em saúde: traçadores de iniquidades no SUS; 2) Abordagem profissional: reforça os estigmas e cinde a relação terapêutica; e 3) Demandas específicas por cuidado: percalços ao longo do itinerário terapêutico. Os resultados mostraram que o acesso ao serviço formal esteve permeado por barreiras simbólicas, técnicas e/ou organizacionais que, muitas vezes, transferiam para cada um/uma dos/as entrevistados/as a responsabilidade pela busca de outros percursos formais ou recomposição do cuidado por trajetórias nem sempre seguras. A busca pelo setor privado foi preponderante e, paralelamente, houve a desvalorização do SUS. O estigma institucional resultou em abandono de tratamento, retardo na busca por cuidado ou desistência de procura aos serviços. Por fim, a dificuldade de acesso no SUS produzia iniquidades e conduzia as pessoas transgênero, sobretudo as mais vulneráveis, a exposição e experimentação de procedimentos, muitas vezes, inadequados.

Nursing care for the transgender population in primary health care: an integrative review

“…(4,31,32) In this sense, user embracement is a fundamental tool for an inclusive work process with the potential to break barriers of access in PHC, as it mobilizes the sensitivity of health workers, requiring reflective action, ethical and solidary development to listen and dialogue, generating reciprocal satisfaction. (13) User embracement is still a major challenge for the SUS, especially when directed at the transgender population, (10) who requires health professionals with knowledge about gender and sexuality, who break social taboos in a way to overcome many of the discriminations experienced by this public. (5,33) Thus, it is necessary to break with social stigmas, address concepts permeating the transgender population and know their main demands and needs.…”

“…User embracement is still a major challenge for the SUS, especially when directed at the transgender population, 10 who requires health professionals with knowledge about gender and sexuality, who break social taboos in a way to overcome many of the discriminations experienced by this public. 5 , 33 Thus, it is necessary to break with social stigmas, address concepts permeating the transgender population and know their main demands and needs.…”

“…(10) The transgender population faces greater difficulties in social insertion because their differences are marked in their bodies, often read as abject and, thus, placed on the social margins. (10) Transgender people do not identify with the gender assigned to them at birth, and may identify as a transsexual man, transsexual woman or transvestite, whether or not they are in the man or woman binarity. (11) In this scenario, transgender people have specific health needs, such as carrying out body modifications through hormone therapy, gender reassignment surgery, among others, often demanded for their gender affirmation.…”

“…(17) In this context, in spite of what is provided for by legislation and health policies, care to the transgender population has been neglected by PHC professionals. (10) This population faces different types of barriers to access health services, such as weaknesses in user embracement, inadequate training of professionals and incipient implementation of the PNSI-LGBT. (5) These barriers also result from social prejudice and stigma, which act through institutional discrimination and distance transgender patients from health services.…”

“…8 , 9 In addition, formal access to health services is permeated by symbolic, technical or organizational barriers that commonly depersonalize care and produce inequities. 10 The transgender population faces greater difficulties in social insertion because their differences are marked in their bodies, often read as abject and, thus, placed on the social margins. 10 Transgender people do not identify with the gender assigned to them at birth, and may identify as a transsexual man, transsexual woman or transvestite, whether or not they are in the man or woman binarity.…”