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INTRODUCTION
The general knowledge what if lives in one society binary, The general knowledge what if lives in one society binary, where if grow up identifying as girl or boy, man or woman, revering sex biological. the term cisgender It is introduced for characterize individuals whose identity in gender It is befitting to the sex checked to the birth. In contrast to the sex biological, what It is established per determinants chromosomal, anatomical It is hormones, a person transgender no if sets up to the sex assigned to the birth, second the your identity in gender1.
Homosexuality and transgenderism have always been judged from a pathological perspective. Thus, general practitioners, psychiatrists, psychologists and sexologists claim to be a anomaly that is essential for correction. With this narrative, “transgenderism” could be compared to a disease mental health, being identified in this way for years in the health field, especially by the medical profession2.
In this way, people outside the heteronormative standard were sent to asylum institutions for treatment of individuals with disorders mental, judged as crazy in search of a “cure”.
Unlike the term homosexuality, “transgenderism” was maintained until mid-2019 on the International Classification of Diseases list as a paraphilic disorder, being relocated from it to a new category called sexual health3.
Currently, even with the gradual growth in visibility and the acquisition of rights on the part of the LGBTQIA+ population (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual), prejudice and discrimination regarding sexual orientation and gender identity are still perceived in different sectors of society. civil society, pushing these people to death, and, uniquely, in institutions social issues that surround public policy intermediations and human rights4.
These people have gender identities that differ from what is expected by a society rooted us archetypes heteronormative, soon, generate one discussion how much to the hegemonic thought that biological sex directly comprises identity of gender. Therefore, any individual not belonging to these binary parameters and dichotomous, are seen with disgust5.
The beginning from the search by the services health care for the transgender population gained strength in the 1980s due to the episode of the Human Immunodeficiency Virus (HIV)/Human Immunodeficiency Syndrome (AIDS) epidemic. Since then, growth can be observed regarding the accessibility of these services, especially under the validity of the Single System of Health (SUS), one procedure established at the model biomedic, o Process Transgenderizer (PrTr). This process was implemented by the Ministry through ordinances n° 457 and n° 2803, covering the national guidelines for the process, ensuring to the individual trans O right the surgery in reassignment sexual. Per therefore, o PrTr It is characterized per one set in strategies in attention The health what correspond to the processes of transformation of sexual characteristics through which transgender will pass6.
Even though the achievements resulting from the implementation of the SUS are evident, structural problems are noted that undermine the guarantee of universal access to services. services in health in quality for population Brazilian. In this context, it is essential that the planning and execution of public health policies targeted at different social groups are prepared in a way that takes into account the policies from the SUS, based in theorists in universality, completeness It is equity7.
From this perspective, it is worth highlighting the importance of assistance from professionals of Primary Health Care (PHC), which are responsible for prevention and promotion from the health. There is like this, one assistance what pervades no just for the clinic, but especially for promoting the health from the population.
The 2030 Agenda is also highlighted as a guiding instrument for the formulation of public policies at a global level that aims to implement a sustainable and inclusive development model. There are 17 Sustainable Development Goals (SDGs) and, among these, SDG7, which refers to gender equality. Transgender care in primary health care is directly related to several SDGs, especially that focused-on health, equality, and reducing inequalities. Health actions not only help promote the health and well-being of the transgender population, but also contribute to the achievement of the SDGs, promoting a fairer and more inclusive society for all8.
In this context, it is in extreme importance reflect critically about o process in work of the professionals from the Family Health Strategy (ESF) in caring for the transgender population, in sense of overcoming practices still characteristic of traditional models of care for health hegemonic, setting up like this, as one problem the to be overcome. O study justified by the timely need to understand and give visibility to more whole grains of what you models assistance institutionalized, publicizing as The health care for this population, in particular, health educational actions are being developed.
Therefore, the objective of this study is to analyze the acting of the professionals from the health from the attention primary how much the practices in health developed for the transgender population.
METHODS
Study design
This is a descriptive research with a qualitative approach, developed according to the international “guideline” for qualitative research COREQ (consolidated specifications for reporting qualitative research9.
Study location
The study was carried out in the municipality of Vitória, Espírito Santo, Brazil, setting was Family Health Units belonging to the Family Health Strategy (eSF) that have support from the Expanded Family Health and Primary Care Center (NASF-AB), regulated by Ordinance N°. 2,436 in the municipality of Vitória/ ES10. The NASF-AB works in an integrated manner with the ESF teams and is made up of a multidisciplinary team that includes: social worker; physical education professional/teacher; pharmaceutical; physiotherapist; speech therapist; gynecologist/obstetrician; homeopathic doctor; nutritionist; pediatrician; psychologist; psychiatric doctor; occupational therapist, among others. The demand for these professionals is made by municipal managers, according to local needs and priority criteria identified by epidemiological health data.
The municipality has a total of 29 health units, 13 of which are classified as ESF. Among these, there are 8 NASF-AB teams. Vitória also has 79 family health teams distributed across six health regions, forming an average of 3.4 teams per unit.
The distribution of teams can have 2,3,4 and up to 5 teams for each ESF unit, and are planned according to the demographic density of each population depending on the unit in each region.
Research participants
The following took part in the study: nurses, nursing technicians, doctors and community agents, professionals working in the ESF. And also, social workers, psychologists, pharmacists, speech therapists, pharmacy and oral health technicians and dentists, who make up the NASF-AB team in the municipality of Vitória. Therefore, the research followed the following inclusion criteria: (1) minimum experience of six months working in a Health Unit covered by NASF-AB, and (2) voluntarily participating in the study.
As this is a qualitative research, it did not have a closed sample, however, for this study, it worked with a convenience sample, selected following prior appointments. The professionals were randomly selected, considering distribution by region, to define the health units that were part of the study. Thus, the random draw took place in principle, with one health unit per region, and, shortly after, a new draw so that there were at least two units per region. The region that has only one unit was considered as a whole, with the number of units in another health region also being increased randomly. And so, the professionals from the selected teams were the participants in this study.
Furthermore, considering that there are eight NASF teams, all were contacted and invited to participate in the study, and only professionals who do not meet the study’s inclusion criteria and/or who do not accept participation in the research will be left out.
Collection methods
Data collection took place through the use of a semi-structured interview guide, made with guiding questions that were directed to the investigation of health practices developed by primary care professionals, regarding assistance and articulation of strategies in primary care aimed at the population. transgender.
The interview aimed at professionals addressed aspects relating to their training in relation to health practices aimed at assisting and articulating health strategies for the Transgender segment of the LGBTQIA+ population.
The interviews were carried out following prior contact with the director of the Health Unit to be drawn and the working professionals. The interviews lasted an average of 10 to 15 minutes and were carried out using a video conference call system that included media resources such as Skype, Zoom or WhatsApp, at the discretion of the interviewee. All interviews were recorded and were later transcribed in full. Data collection corresponded to the period of 2020.
The interviews were carried out by the main researcher and a nursing student. This person received prior training with the research guiding professor regarding the data collection process in semi-structured interviews. It is emphasized that there was no personal relationship between researchers and participants before carrying out the interviews, in which they only knew their occupation as a teacher and their lines of activity in academic work.
Data organization and analysis
The following identifications of the interviewees were used, followed by a number in ascending order, according to the number of interviewees, for example, p.1, p.2.
The organization occurred through content analysis, following three steps to guide the process: pre-analysis, which included the organization of the material, selecting documents for analysis, the formulation of hypotheses and objectives, and the development of indicators that supported the interpretation Final; exploration of the material, focused mainly on coding, categorization or enumeration operations, according to rules established in advance; treatment and interpretation of the results obtained, where the data was processed in order to give it meaning at the end of the process11.
Thus, following the steps above, based on floating reading, the documents were organized to construct the research corpus, which consisted of 35 interviews carried out with professionals. After building the corpus, the codifications were operationalized, identifying the recording units and, subsequently, the context units. These were found in the speeches, through words, which were grouped together, according to their similarities and identified meanings.
It highlights that context units were constructed, which provide better interpretation for analysis. Thus, after identifying these units, the material was organized according to thematic categories. As demonstrated in figure 1.
Figure 2 shows the subsequent steps according to the content analysis steps.
Following the flowcharts described, below are the registration units, context units and thematic categories developed in the study.
Based on the data organization technique, three thematic categories were constructed, which are evident from the registration and context units, as proposed by the steps of the content analysis technique.
Frame 1 Registration unit, context unit and analytical categories according to Bardin’s technique
| Registration unit | Context unit | Thematic categories |
|---|---|---|
| Prejudice; Stigmata; Reception; Exclusion; Barriers, knowledge. | Health care is mediated by prejudiced and stigmatic practices. Presenting weaknesses in the recognition of health needs. | Professional approach towards transgender people: stigmas |
| One-off; nonexistent; Prevention | Educational actions are specific, aimed at preventing sexually transmitted diseases. | Health education: a tool to promote health for trans people |
| Health policy; Health assistance; Health services | Health Policies is a tool that guides professionals regarding qualified assistance. | Public health policies for transgender people |
Source: own authorship
RESULTS AND DISCUSSION
Initially, the profile of the participants was drawn up, with sociodemographic and academic data, to meet the conditions for constructing care practices, based on the plurality of characteristics of the population group assisted.
Among the 35 participants, the sample was mainly composed of females, the feminization of professionals who made up the Family Health Strategy (ESF) team was 30 (86.0%) among the interviewees and the rest were male. The majority were aged between 24 and 65 years old, with an average of 38.85.
Regarding the academic profile of the study participants, the largest number of interviewees with higher education corresponded to professionals with a Nursing degree (n=06; 17.6%), followed by Psychologists (n=5; 14.7%). As for technical level training, 06 were nursing technicians. Regarding participants with high school, the largest number were Community Health Agents (CHA) (n=04; 11.8%), as shown in table 1.
Table 1 Characterization of study participants
| Variables | N(35) | % |
|---|---|---|
| Gender | N | % |
| Feminine | 30 | 86.0 |
| Masculine | 5 | 14.0 |
| Age | ||
| 24 to 35 | 16 | 47.1 |
| 35 to 45 | 9 | 26.5 |
| 46 or more | 9 | 26.5 |
| Average | 38.8529 | |
| Professional Profile | ||
| Social Worker | Two | 5.9 |
| Community Health Agent | 4 | 11.8 |
| Dental assistant | 1 | 2.9 |
| Nursing assistant | Two | 2.9 |
| Nursing | 6 | 17.6 |
| Pharmaceutical | 1 | 2.9 |
| Physiotherapy | 1 | 2.9 |
| Speech therapist | 1 | 2.9 |
| Doctor | 3 | 8.8 |
| Psychologist | 5 | 14.7 |
| Pharmacy technician | 1 | 2.9 |
| Nursing technician | Two | 5.9 |
| Oral health technician | Two | 2.9 |
| Dentist | Two | 2.9 |
Source: survery data
Taking the study categories as a reference, the evidence expressed in the statements was sought. The following frame presents the categories and evidence that guided the organization process of this phase of the study (frame 2).
Frame 2 Evidence from the study and thematic categories according to Bardin’s technique
| Thematic categories | Evidence from the study |
|---|---|
|
Professional approach to assisting transgender people: stigmas - Exclusionary |
- Fragmented assistance |
|
Health education: a tool to promote health for trans people - Participation in educational practices |
- Specific actions |
| Public health policies for transgender people | - Public Policy for the construction of health-promoting practices |
Source: survery data
The assistance provided by health professionals to transgender people in the context of primary health care presents factors that interfere with the quality of care for this population group, such as lack of knowledge, prejudices and gaps regarding knowledge and applicability of public policies healthcare for transgender people. Training health professionals plays a fundamental role in improving care provided to transgender people and other gender-sensitive contexts. Through adequate training, professionals can acquire the knowledge, skills and attitudes necessary to provide inclusive, respectful and culturally sensitive healthcare. Figure 3 presents a summary of the results, addressing the evidence perceived in the study categories.
Professional approach towards transgender people: stigmas
Gender is conceived as a category, a social marker with which attitudes, expectations and behaviors are constructed through which society defines the reference values and the standard of normality, in force at a given time. The behaviors expected of people, the so-called gender roles, are not inherent to their birth sex, they are shaped based on social, economic, religious and cultural demands12.
In what corresponds to gender identity, it arises from the intrinsic perception of a person being a man, a woman, some alternative gender or a combination of them, while gender expression consists of the manifestation of gender identity based on physical appearance, clothing, gestures, way of speaking and behavior patterns when interacting with other people13.
Thus, the term “trans” has been used to designate all people with gender variability and “cisgender” to refer to those who correspond to their sexual designation at birth and their performed gender identity. Transgender refers to a diverse group of people whose gender identities differ, to varying degrees, from the sex they were assigned at birth. Such definitions are full of ideologies, their limits are imprecise and are constantly changing14.
Trans or gender-variant people have specific health needs and demand services that offer a multidisciplinary approach, mental health care, hormonal therapies and various surgeries. Furthermore, they share needs common to any person, such as adopting healthy lifestyle habits, disease prevention and tracking, treatment and rehabilitation15.
Health care for transgender people presents barriers and challenges in terms of resoluteness in meeting the specific needs of this population. The reports of the statements described here suggest a lack of knowledge and sensitivity on the part of health professionals, as well as the recognition of issues related to gender identity, characterizing this as a restriction on transgender people’s access to health equipment.
”I think the main difficulty is precisely that, it should be better [...] the system itself induces us to treat the person differently. If she already has a social name when you get a prescription issued, it doesn’t come by her social name, but by her birth name, and it starts there, that would be the beginning” (p.3)
I think it’s the difficulty of understanding that I’m a professional and that’s all there is to it. What she thinks, what I think of what the person told me, I don’t think it’s up to us to make that kind of judgement, right. Accessibility... when the person... comes in, I think that the way we deal or treat them, the person will feel open to say things or they will feel more closed. (p.8)
[...] There has to be an attitude that we are discriminating [...] (p.22)
The lack of knowledge about gender identity permeates health practices aimed at negative actions by professionals, in order to prevent this population from accessing services16. Hostility and prejudice on the part of health professionals create power differentials between population groups, negatively influencing the quality of health and behavior of individuals or groups.
Access is an important category to be considered in the formulation and implementation of public policies, due to its potential for improving the organization of the SUS. However, there are limiting factors regarding access, such as low accessibility, the fragmented system and the lack of equity and reception.
Weaknesses in assisting trans people in healthcare facilities are related to professionals’ lack of knowledge about gender and sexuality issues, as evidenced in the narratives:
“The difficulty I think is really [...] less knowledge because it is more atypical than [...] the issues we are more used to dealing with” (p.5).
“Difficulties, I think I even talked about them a little, but I think it’s the difficulty of understanding that I’m a professional and that’s all there is to it. What she thinks, what I think of what the person told me, I don’t think it’s up to us to make that kind of judgement, right” (p.6).
“What I find difficult is really the lack of team, structure, public policies, for this population” (p.9)
The lack of education, knowledge and competence in the dialogue of ESF professionals to deal with gender diversity in their professional practice makes it impossible to increase/include access to health care. Health care for trans people must encompass comprehensive care, in order to recognize and identify health needs and the social context in which they are inserted, as well as other intersectionalities that interfere in their lives17.
Therefore, the need for a team of professionals who can meet health needs is recognized, providing care in a safe and prejudice-free environment, understanding the nuances surrounding gender identity and reducing its stigmatization18. However, it was observed that the majority of health professionals feel able to meet the needs of these people highlighted in the participants’ statements:
“Because I’m a family doctor and I’m able to provide longer monitoring of both the person and their family and everything, [...] so I can talk more openly with the person, I can talk more openly with their family, they listen to me more [...]” (p.13)
I think ease would be in the sense... and it’s a very personal thing about my work, right? [...] I always try to look for the issue of respect, empathy, but that’s with any user I come across” (p.16)
It is understood that trans people are often removed from traditional means of support, such as family, school, health services, religious environments, and the local community, due to prejudice, mistreatment and violence experienced in these spheres. Studies indicate difficulties in providing care to trans people in public and private health institutions. These are often related to a moral judgment, evidenced by the resistance of professionals to use social names, as well as discriminatory gestures, looks and speech19.
Such actions can be traumatic and cause many transsexuals to only seek care services in extreme cases of illness. Therefore, it is necessary to improve the training of health professionals to serve the trans population, being the first step in dealing, respectfully, with this group that presents such vulnerability20.
In this context, the need to identify the social determinants of health is highlighted, which allows us to examine the relationship that such conditions have with regard to interference with the reach of qualified assistance, highlighting greater synergies between health and other sectors, capable of providing execution and implementation of policies aimed at reducing risks21.
In Brazil, the Primary Health Care (PHC) model, centered on the Family Health Strategy (ESF), it is represents a powerful strategy for reducing health inequities and must, therefore, be strengthened and structured, given its high degree of capillarization across the national territory and the reach of significant portions of the population exposed to excessive risks due to their living conditions22.
Health education: a tool to promote health for trans people
The educational actions in health are recognized as a paradigm of a new model of care, in response to the medicalization of health. Thus, health education presents itself as a resignifying model, which enables the construction of integral health practices, as it is dedicated to expanding the interrelationship between different professions, specialties, services, citizens, family members, neighbors and organizations local social groups involved in combating a specific health problem, strengthening and reorienting their practices, knowledge and popular struggles23.
There is a need for educational practices that can break with the traditional health model, as it is necessary to reflect on the mechanisms that concern the health object. Under this need for health practices, which dialogue about the development of intervention actions on the understanding of individual and collective social determinants of health, it becomes essential to identify associated and associable abstract elements, which place at risk of exposure to health events. health, with physical, psychological and/or social impairment24.
Based on this, it is pointed out that the health education practices developed in the PHC scenario for the transgender population are specific and/or centered on the traditional health model, as expressed in the participants’ narratives:
“No, we don’t have it” (ENF1)
Health education... we receive several notes, there are always technical notes coming from the health department, [...] we read that there, about health education practices, [...] carried out in schools, through “PSE” (DENT 1)
“General, like this? [...] Health education [...] is, family planning, specifically teenage pregnancy, there are moments of hypertension and diabetes, mental health, the issue of increased depression [...] related to self-care. (PSI1)
“So, specifically focused on him, no... it’s for us, in health education practice we have women’s health (it’s all very simple like that), elderly people’s health, children’s health, adolescents’ health [...] we have the oral health part, mental health, but like... specific to this public? I think how to insert it into what already exists, in these places that already exist [...]” (ASS 1)
It is observed that health education practices for transgender people in the context of PHC operate in comparison to conventional health practices guided by actions focused on the disease, anchored in classic causal models. In this context, the importance of developing health practices stands out, permeated by assistance that sees the individual in their entirety, dynamism, historicity, determined by the form of organization of the society in which they live and by their insertion in a distinct social group by social class, ethnicity, generation and gender relations, therefore in its collective face25.
From this perspective, it is necessary to recognize the needs of different social groups, under the understanding of the health-disease process, manifested in the collective, covering profiles of social reproduction with the corresponding potentialities, wear and tear and the understanding of the biological phenomena that make up the patterns typical health-disease characteristics of these groups and their individuals26.
In this way, health needs and their responses are not limited to issues related to illnesses and demands for medical services, and can change depending on the individual’s entire historical and social context. Using health needs as an object in clinical practices encompasses the biological, cultural, economic, ecological and political dimensions, controlled in the capitalist mode of production by the economic dimension27.
Therefore, the need to develop educational practices for transgender people that can meet their health needs is recognized. In this context, listening to the user allows shaping the real demands of their care process and allowing them to meet their main needs through a reconfiguration of the service and their way of relating to it26.
Health promotion arises from the perspective of investigating the health-disease process of the social determinants of health, strengthening collective participation in the process of maintaining quality of life. It is assumed that the subjects involved in this collective process are in cooperation with the environment, creating opportunities and resolving conflicts through social participation, adopting as main strategies political actions, the promotion of healthy spaces, empowerment, the development of skills and knowledge28.
The National Health Promotion Policy (PNPS) proposes that the planning of care actions be based on a concept of health that goes beyond the absence of biological aspects of illness, favoring self-care choices in everyday life that increase quality of life29.
Based on this, health educational practices for the transgender population must be aimed at transforming subjects’ behaviors, which focuses on educational components, primarily related to behavioral risks that can be changed.
In this approach, the development of health practices for the transgender population must be based on a liberating pedagogy, as a tool for social transformation, as it attempts to break with curative practices. Proposing to transform the traditional model of health education, predominantly focused on disease prevention, to a practice focused on the emancipation and empowerment of subjects, favoring dialogue30.
That being said, the need for care practices with a broader perspective emerges, which encompasses and articulates different centers in the health field, causing a greater impact in terms of managing the risk of vulnerabilities experienced by this population group.
It is identified in the results that the health education practices developed by professionals are directed to themes pre-established by PHC programs. This fact reveals the lack of knowledge regarding the care approach to the trans population, which triggers specific and fragmented forms of care31.
This fact may be related to the training of health professionals. A study points out that the lack of sensitivity of professionals is associated with the non-inclusion of healthcare for transgender people in undergraduate courses, directly impacting their care practice32.
At this juncture, the qualification of health professionals allows the implementation of assistance aimed at welcoming, specialized care that can meet the health demands of the trans population. Thus, there is an urgent need for public health policies that favor new strategies in health care and promotion, in order to ensure access to health and a gender equality.
Public health policies for transgender people
Starting from the dimension of applicability of health-promoting practices in care, this category emerged with the intention of explaining the importance of knowing public health policies and, based on them, recognizing the real health needs of the trans population.
Here, the importance of continuous care processes for the implementation of equitable assistance, versed with the production of effective care, which meets the health needs of the trans population, is reiterated. The effectiveness of plans, programs and conferences aimed at the process of building public policies for LGBT populations, were initially anchored in attempts to combat the AIDS epidemic that arrived in the country in 1982, so that health actions were taken by association with LGBT sociability20.
In this way, there is a milestone in care aimed at LGBT people based on procedures for treating AIDS and/or Sexually Transmitted Diseases (STDs), based on care practices in the biomedical model. Furthermore, the democratization model that emerged from the 1988 Federal Constitution brought social and economic policies that expanded access to health for individuals, making notable agendas aimed at favoring a common right to universal, comprehensive and equitable health33.
The expansion of access to health services by the trans population, especially through the Unified Health System (SUS), initially occurred with the Transsexualizing Process (PrTr). Instituted and regulated by the MS, through Ordinances that define national guidelines for the process, ensuring since 2008 the right of transsexual people to sexual reassignment surgery. PrTr comprises a set of health care strategies involved in the process of transforming the sexual characteristics that transgender people go through at a certain point in their lives34.
In the health area, three priority actions were established for the LGBT population: the formalization of the LGBT Health Technical Committee (CTSLGBT) by the Ministry of Health, with the purpose of developing a National LGBT Health Policy; the production of specific knowledge about LGBT health; and the training of health professionals to better serve this population. The CTSLGBT, coordinated by the Participatory Management Support Department and composed of representatives from LGBT collectives and technical areas of the MS, aims to promote health equity for the LGBT population, reducing inequalities in universal access to SUS health services35.
The promotion of universal access for trans people in the SUS was the introduction, through the Charter of Health Users’ Rights in 2006, of the right to use their social name, whether in specialized services that already accommodate transsexuals and transvestites, or in any other public health network service36.
The participants’ speeches reveal a lack of knowledge about public health policies aimed at the population of LGBTQIA+ people. The lack of knowledge, skills and cultural competence focused on sexual and gender diversity can lead to hegemonic and prejudiced health practices.
”I think there is still a long way to go, I think there is a long way to go because the policy is not getting off the ground. Today here in primary care I see that [...] I didn’t have any course, any training or anything about it, so the policies that exist don’t reach the tip, where it’s really necessary, because the patient’s first contact is here [...] So I think it should be stronger here” (p.3)
“I wasn’t trained, there wasn’t any training that addressed the LGBTQIA+ population” (p.9)
“[...] Technical support, none. I seek theoretical support a lot depending on demand, until now I have never served this audience, but whenever I find myself in a new situation, I try to research through databases, you know, always based on evidence, on what science brings, in what scientific productions bring to better service to the public I serve” (p.14)
In this context, there are gaps in the training and training of health professionals related to the health of LGBTA+ patients. The study highlights the need for interventions and the urgency of institutional initiatives to include specific curricular assessments on the LGBT public and to focus efforts on the needs of LGBTQIA+ patients related to the level of knowledge, skills and cultural competence required by professionals - all elements aimed at sexual and gender diversity37.
The National Curricular Guidelines for courses in the health field point to the direction of curricula aimed at understanding the plural context and cultural diversity, including ethical and humanistic dimensions, with attitudes and values oriented towards citizenship and capable of leading to the understanding of social, cultural, behavioral, psychological determinations, at the individual and collective levels of the health-disease-care process38.
However, there are challenges regarding the implementation of questions that guide content that can cover more expressive aspects of LGBTQIA+ health, limited to comments and exemplifications as a complement to content from other disciplines39.
In a study that analyzed health curricula, in order to identify disparities and specific care for the LGBTQIA+ public, it was evident that practices covering the LGBT public did not meet the health needs of this group. Therefore, there is a need to include content and materials focused on LGBT public, related to health care disparities of these various sexual and gender identities40,41.
The strengthening of health care practices presents itself as potential for the applicability and development of public health policies, which may lead to reflections on the need for cultural and social changes around problems faced by the LGBTQIA+ population, possibilities for promotion of well-being and the search for equity in health care from the perspective of acquiring skills for health professionals related to the care of this population42.
FINAL CONSIDERATIONS
Observed that the health care itineraries of this population group have a strong marker of exclusion due to stigma and discrimination. Discrimination in health services and equipment for transsexuality produced by heteronormative matrices for understanding genders, leads to the production of suffering and illness in the transgender population, and the reproduction of hegemonic health practices.
It was found that the development of health education practices, developed by professionals in PHC, is incipient and isolated, focusing on topics related to sexually transmitted diseases. Therefore, I infer that the care practices produced by professionals are related to the biomedical concept, the disease, not understanding subjectivity, expressions of identities and health needs.
Despite advances in the creation of specific public policies, the results showed that professionals are unaware of them. This fact may be related to training rather than professional training, producing prejudiced and biomedical care practices. Furthermore, the strengthening and development of programs and policies aimed at the health of the transgender population is seen as a tool to combat discrimination of homophobic origin, as well as guaranteeing specific services for the LGBTQIA+ population, such as a transsexualization process, guaranteeing access to healthcare.
