Search Results (11)

Institutional violence against transgender individuals in healthcare is a structural phenomenon with multifactorial roots and is embedded in social, cultural, political, and economic dynamics. Drawing on Michel Foucault’s concept of the microphysics of power, this study analyzes how such violence unfolds within Brazil’s healthcare system. For Foucault, power is not solely exercised through centralized institutions but is diffuse and present in everyday practices, relationships, and discourses. Institutional violence, while often manifesting in individual acts, is defined by its persistence and systematic occurrence over time. In healthcare settings, this violence assumes symbolic, structural, psychological, and physical forms ranging from neglect and verbal abuse to sexual violence. Foucault’s framework allows for a deeper understanding of how power relations perpetuate exclusionary and dehumanizing practices. By interpreting these dynamics through the Microphysics of Power, the study reveals that institutional violence against transgender individuals extends beyond explicit acts, encompassing routine interactions that reproduce inequality and restrict access to fundamental rights such as healthcare. These practices sustain a logic of control and exclusion that operates subtly but effectively within healthcare systems, reinforcing the marginalization of trans people and undermining their right to dignified and equitable care. Full article

The persistence of a binary biomedical framework in healthcare has become increasingly inadequate to address the realities of human diversity. Recent literature highlights how this dichotomous model reinforces inequities for transgender and intersex populations, sustaining barriers to access, stigmatisation, and poorer health outcomes. In this Perspective, I critically reflect on the limitations of the binary paradigm and draw on developments in science, clinical practice, education, and policy to propose a future-oriented approach to health equity. Emerging evidence underscores the complexity of sexual development as a spectrum and the urgent need to move from pathological frameworks toward affirming care based on rights. Key advances include the adoption of affirmative care models, reforms in medical curriculum, and the rise of inclusive research methodologies that capture gender diversity beyond binaries. However, structural barriers—such as rigid clinical protocols, outdated educational content, and insufficient policy alignment—continue to hinder meaningful change. This article advocates for systemic transformation in healthcare education, practice, and research. I outline strategic priorities for the field are the implementation of gender diversity in medical training, the implementation of rights-based clinical guidelines, and the design of inclusive methodologies that remove structural discrimination. These actions are essential to build a more precise, ethical and universally inclusive health system. Ultimately, ensuring sustainable and equitable outcomes requires bridging scientific innovation with human rights principles and focussing on the lived experiences of transgender and intersex individuals. Full article

This study examines the trends, impacts, and challenges of HIV in Bangladesh from 2000 to 2024, with a focus on its epidemiology, demographic distribution, and socioeconomic determinants. Despite maintaining one of the lowest HIV prevalence rates globally (<0.1%), Bangladesh faces a concentrated epidemic among high-risk populations, including people who inject drugs (PWID), men who have sex with men (MSM), sex workers, transgender individuals, and migrant workers. Analysis reveals a steady increase in reported infections, attributed to enhanced diagnostic capacities and public awareness. The 25–49 year age group remains the most affected, accounting for over 65% of cases, underscoring the vulnerability of the economically active population. Gender disparities persist, with males representing the majority of infections but lower ART coverage among females and transgender individuals. While interventions such as PMTCT programs, ART expansion, and targeted awareness campaigns have contributed to improved outcomes, barriers such as stigma, healthcare inequities, and limited rural access hinder progress. The study also evaluates Bangladesh’s progress toward the 95-95-95 targets, highlighting significant strides in treatment and viral suppression but gaps in diagnosis. Future research must address behavioral trends, stigma reduction, and integration of HIV services for marginalized populations. This paper emphasizes the need for evidence-based strategies to ensure equitable healthcare delivery and sustainable progress in combating HIV. Full article

Background: Brazil’s Unified Health System (Sistema Único de Saúde—SUS) has played a crucial role in reducing health disparities by providing universal and free healthcare to a diverse population. However, the COVID-19 pandemic exposed significant barriers to healthcare access among vulnerable groups, particularly due to the intersection of multiple vulnerabilities. This study aimed to examine how intersectionality—specifically sex/gender, race/ethnicity, and education level—has influenced inequalities in healthcare service utilization among vulnerable populations during the COVID-19 pandemic in Brazil. Methods: This cross-sectional study is part of the “COVID-19 Social Thermometer in Brazil” project, conducted between May 2022 and October 2023 in Brazil’s state capitals and the Federal District, focusing on populations considered socially vulnerable during the pandemic. Participants were selected using sequential sampling and completed a structured questionnaire. Statistical analyses—performed using Excel, RStudio (version 4.3.2), and ArcGIS—included sociodemographic profiling, the construction of the Jeopardy Index (a measure of social vulnerability), and binary logistic regression to explore associations between Jeopardy Index and healthcare service utilization. Results: 3406 participants, the majority were men (60%), aged 30 to 59 years (65.1%), and identified as Black or Brown (72.2%). Most participants were concentrated in the Northeast (26.6%) and North (22.3%) macroregions. A high reliance on public healthcare services (SUS) was observed, particularly in the Southeast (96%). According to the Jeopardy Index, the most socially vulnerable groups—such as women, transgender individuals, Black people, and those with no formal education—were significantly more likely to rely on SUS (OR = 3.14; 95% CI: 1.34–7.35) and less likely to use private healthcare (OR = 0.07; 95% CI: 0.02–0.20), reflecting a 214% higher likelihood of SUS use and a 93% lower likelihood of private service utilization compared to the most privileged group. Conclusions: Our findings reveal that individuals experiencing intersecting social vulnerabilities face marked inequalities in healthcare access. Without SUS, these populations would likely have been excluded from essential care. Strengthening SUS and implementing inclusive public policies are critical to reducing disparities and ensuring equitable healthcare access for historically marginalized groups. Full article

Childhood sexual abuse (CSA) is a prevalent form of violence against children, associated with profound negative impacts on survivors’ health and well-being. In Bangladesh, sociocultural and economic barriers hinder CSA prevention and intervention, particularly for vulnerable populations such as transgender individuals. This study explores the experiences of CSA among Bangladeshi transgender individuals, focusing on their coping mechanisms and resilience-building strategies. A qualitative narrative approach was employed, using life story-telling interviews with four transgender CSA survivors, and data were analyzed thematically. The findings reveal significant challenges, including social exclusion, humiliation, and lack of family support. Participants reported experiencing physical injuries, mental trauma, and loss of trust due to CSA, while the conservative nature of Bangladeshi society often prevented them from disclosing their abuse or seeking healthcare. These barriers exacerbate health inequalities among gender-minority children. Despite these adversities, participants described engaging in resilience-building strategies such as self-care, personal development, advocacy, and efforts to derive meaning from their experiences, while highlighting the perceived importance of family support. This study provides insights into the unique experiences of transgender CSA survivors in Bangladesh and calls for efforts towards gender-inclusive education, mental health support, and further research to address CSA-related adversity, encourage disclosure, and promote health equity for gender-minority groups. Full article

Gender incongruence is a current issue with implications in the legislative, social, and healthcare fields. In this context, misinformation is, at present, the main enemy of transgender rights equity. Over time, the scientific community has worked to reclassify this condition, removing it from psychiatric diagnoses. The method of our work involved investigating and comparing the different social and legislative measures adopted by various countries to ensure the rights and equality of individuals with gender incongruence. The result showed that there are various international approaches allowing adult and minor patients to access medical and administrative procedures for gender transition. In conclusion, there appears to be a need for international bioethical and legislative guidance in order to reduce and eventually eliminate the social inequalities faced by individuals with gender incongruence. Full article

Transgender individuals are an underserved, vulnerable population. They face many inequities including barriers in both accessing and receiving adequate healthcare. These inequities are proposed here to be rooted in a lack of education about transgender people and their experiences. We begin by exploring the existing transgender healthcare research carried out in the USA, examining client experiences, provider education and attitudes, and the barriers transgender people face to obtaining proper healthcare. Secondly, we look at the previous research on educational interventions implemented with medical students and practitioners in the USA to enhance knowledge about transgender people, and increase sensitivity and awareness, while also increasing the level of comfort in working with these clients. The limitations in these fields of study are discussed in order to understand how to better serve transgender clients in the USA. We will do this through a narrative review to determine evidence-based best practices for educational intervention, uncovering gaps in the literature and highlighting where to focus in future work for researchers and practitioners. Full article

Although Thailand is overtly open to diversity and promotes equality, discrimination of minorities based on gender, ethnicity, and/or certain occupations is unfortunately still prevalent. Society either obstructs their inclusion or accepts them but only under certain conditions. The objective of this study is to examine the discrimination of TGWs with intersectional identities within Thai society. A total of 19 TGW participants were recruited and underwent in-depth thematic interviews about their experiences of discrimination. Rechecking of the extracted information from the interview transcripts and the subsequent encoding process were conducted using the NVivo program. The results show that the median age was 30 years old, and the majority of the individuals with intersectional identities were ethnic minority TGWs (47%). The in-depth interviews were divided into four main themes, including discrimination at an educational institution, discrimination in the workplace, discrimination in daily life, and discrimination at a healthcare facility. Our findings reflect problems associated with multiple sources of discrimination aimed at transgender women with an intersectional identity in Thailand in every aspect, including harsh speech or physical abuse; occupational, social, and legal inequality; and healthcare provision disparity. Raising awareness about gender diversity and intersectionality, as well as enforcing anti-bullying legislation and anti-discrimination laws, should be continually pursued in order to protect the rights and improve the quality of life of transgender individuals with an intersectional identity. Full article

Background: Lesbian, gay, bisexual, and transgender (LGBT) people present poorer mental and physical health results compared to the heterosexual and cisgender population. There are barriers in the healthcare system that increase these health inequities. Objective: To synthesise the available evidence on how nurses can intervene in reducing health inequities in LGBT people, identifying their specific health needs and describing their experiences and perceptions of the barriers they face in the healthcare system. Methods: Systematic review. Between March and April 2021, a bibliographic search was carried out in the Cuiden, LILACS, PubMed, Dialnet, SciELO, Trip Database, and Web of Science databases and metasearch engines. Inclusion criteria: Articles published in the last 5 years that address the specific health needs of LGBT people, their experiences and perceptions, or interventions in this group in which nurses may engage. Results: A total of 16 articles were selected. Health disparities were detected in the LGBT community, which exhibited higher rates of mental health problems, substance abuse, risky sexual behaviours, self-harm, and suicide. These inequalities were related to minority stress, and each of them differently impacted individual populations within the broader LGBT community depending on their sexual orientations and gender identities. The impact of these factors was, in turn, modified by the intersections of race/ethnicity, geographic region, and socioeconomic factors. LGBT people described discriminatory experiences by health professionals, as well as their distrust and fear in this setting. Nurses can carry out interventions such as inclusive education about sex and sexual and gender diversity and bullying and suicide prevention programmes, and can provide gender-affirming and family-centred care. Conclusions: LGBT people experience health inequities and discrimination in the healthcare system. Nurses can implement diverse interventions to reduce these problems and, moreover, these health professionals are obliged to acquire cultural competence regarding LGBT health. Full article

Introduction: The lesbian, gay, bisexual, and transgender (LGBT+) population experience health and social inequalities, including discrimination within healthcare services. There is a growing international awareness of the importance of providing healthcare professionals and students with dedicated training on LGBT+ health. Methods: We introduced a compulsory teaching programme in a large London-based medical school, including a visit from a transgender patient. Feedback was collected across four years, before (n = 433) and after (n = 541) the session. Student confidence in using appropriate terminology and performing a clinical assessment on LGBT+ people was assessed with five-point Likert scales. Fisher exact tests were used to compare the proportion responding “agree” or “strongly agree”. Results: Of the students, 95% (CI 93–97%) found the teaching useful with 97% (96–99%) finding the visitor’s input helpful. Confidence using appropriate terminology to describe sexual orientation increased from 62% (58–67%) to 93% (91–95%) (Fisher p < 0.001) and gender identity from 41% (36–46%) to 91% (88–93%) (p < 0.001). Confidence in the clinical assessment of a lesbian, gay or bisexual patient increased from 75% (71–79%) to 93% (90–95%) (p < 0.001), and of a transgender patient from 35% (31–40%) to 84% (80–87%) (p < 0.001). Discussion: This teaching programme, written and delivered in collaboration with the LGBT+ community, increases students’ confidence in using appropriate language related to sexual orientation and gender identity, and in the clinical assessment of LGBT+ patients. Full article

While LGBT studies have been problematizing normative categories of sexuality primarily in Western cultures, the status of lesbian, gay, bisexual, and transgender (LGBT) individuals in non-Western societies remains understudied. This study examines the political attitudes toward LGBT individuals in Turkish society and explores the experiences of transgender individuals. While Turkey holds a strong economic position among Western countries, the situation of sexual minorities lags behind international standards. This study explores two research questions. First, what is the Turkish government’s outlook for the LGBT community? Secondly, what kind of problems and challenges do trans-individuals experience in Turkey? This study first introduces a macro-level analysis of the politics of gender identity in Turkey by analyzing the debates of four deputies in the Turkish Parliament, each representing their parties’ disparate viewpoints. Secondly, a micro-level analysis of previously collected interviews with twenty-five trans-individuals are also examined that shed light on the difficulties of being a trans-individual in Turkey. The content analysis shows that trans-individuals experience physical, sexual, and emotional violence, in addition to experiencing discrimination in employment, housing, and healthcare. The findings of this micro-level analysis elucidate the continuous discrimination, inequality, and violence that these individuals experience, while the macro-level analysis portrays the state’s discriminatory policies toward LGBT individuals in Turkey. Full article