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Experiências no acesso e utilização de cuidados de saúde primários de pessoas trans em Portugal
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RESUMO - A identidade de género corresponde ao sentido interno e individual de ser mulher, homem, ambos, nenhum ou outra identidade, podendo ou não coincidir com o sexo atribuído à nascença. Trata-se de uma vivência plural que transcende a visão binária tradicional. Pessoas trans são aquelas cuja identidade de género difere do sexo atribuído ao nascimento. Em Portugal, apesar dos avanços legislativos na proteção dos seus direitos, persistem desigualdades no acesso aos cuidados de saúde primários (CSP). O presente estudo teve como objetivo conhecer as experiências e perceções de indivíduos trans no acesso e utilização dos CSP.
Este estudo transversal, com abordagem qualitativa, realizado através de entrevistas semiestruturadas a 13 pessoas trans residentes na região de Lisboa e Vale do Tejo, recorreu a análise temática indutiva para identificar padrões e significados nos relatos sobre acesso, utilização, barreiras, facilitadores e propostas de melhoria nos CSP.
Os resultados revelam experiências mistas, oscilando entre acolhimento inclusivo e episódios de discriminação. Entre as principais barreiras relatadas surgem a insuficiente formação dos profissionais, obstáculos administrativos na atualização de registos, tempos de espera prolongados e dificuldades económicas. Como facilitadores destacam-se relações terapêuticas respeitosas e a presença de profissionais sensibilizados. As sugestões de melhoria incluem formação obrigatória, implementação de protocolos inclusivos, criação de unidades de referência e nomeação de profissionais especializados em cuidados de saúde trans.
Conclui-se que, apesar de existir legislação protetora, permanecem barreiras estruturais e institucionais que afetam o acesso e a utilização dos CSP por pessoas trans. A adoção de uma perspetiva interseccional — que reconheça a interação entre género, classe social, etnia e orientação sexual na produção de desigualdades — e o investimento em formação e protocolos inclusivos são fundamentais para promover cuidados equitativos e respeitadores da diversidade de género.
ABSTRACT - Gender identity refers to an individual’s internal and personal sense of being a woman, a man, both, neither, or another identity, which may or may not align with the sex assigned at birth. It represents a plural lived experience that transcends the traditional binary view of male and female. Trans people are those whose gender identity differs from the sex assigned to them at birth. In Portugal, despite legislative advances in protecting their rights, inequalities persist in access to primary health care (PHC). The present study aimed to explore the experiences and perceptions of trans individuals regarding access to and use of primary health care services This cross-sectional qualitative study, conducted through semi-structured interviews with 13 trans individuals residing in the Lisbon and Tagus Valley region, employed inductive thematic analysis to identify patterns and meanings in participants’ accounts regarding access to, use of, barriers to, facilitators of, and suggestions for improving PHC services. Findings reveal mixed experiences, ranging from inclusive and welcoming encounters to episodes of discrimination. Key barriers identified included insufficient professional training, administrative obstacles in updating personal records, long waiting times, and economic constraints. Facilitators highlighted by participants included respectful therapeutic relationships and the presence of sensitized health professionals. Suggestions for improvement encompassed mandatory training, implementation of inclusive protocols, creation of referral units, and appointment of professionals specialized in trans health. In conclusion, despite the existence of protective legislation, structural and institutional barriers continue to affect the access to and use of PHC by trans people. The adoption of an intersectional perspective—acknowledging how gender, social class, ethnicity, and sexual orientation intersect to produce inequalities—and investment in training and inclusive protocols are essential to ensure equitable care that respects gender diversity.
ABSTRACT - Gender identity refers to an individual’s internal and personal sense of being a woman, a man, both, neither, or another identity, which may or may not align with the sex assigned at birth. It represents a plural lived experience that transcends the traditional binary view of male and female. Trans people are those whose gender identity differs from the sex assigned to them at birth. In Portugal, despite legislative advances in protecting their rights, inequalities persist in access to primary health care (PHC). The present study aimed to explore the experiences and perceptions of trans individuals regarding access to and use of primary health care services This cross-sectional qualitative study, conducted through semi-structured interviews with 13 trans individuals residing in the Lisbon and Tagus Valley region, employed inductive thematic analysis to identify patterns and meanings in participants’ accounts regarding access to, use of, barriers to, facilitators of, and suggestions for improving PHC services. Findings reveal mixed experiences, ranging from inclusive and welcoming encounters to episodes of discrimination. Key barriers identified included insufficient professional training, administrative obstacles in updating personal records, long waiting times, and economic constraints. Facilitators highlighted by participants included respectful therapeutic relationships and the presence of sensitized health professionals. Suggestions for improvement encompassed mandatory training, implementation of inclusive protocols, creation of referral units, and appointment of professionals specialized in trans health. In conclusion, despite the existence of protective legislation, structural and institutional barriers continue to affect the access to and use of PHC by trans people. The adoption of an intersectional perspective—acknowledging how gender, social class, ethnicity, and sexual orientation intersect to produce inequalities—and investment in training and inclusive protocols are essential to ensure equitable care that respects gender diversity.
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Palavras-chave
Pessoas Trans Cuidados de Saúde Primários Determinantes Sociais da Saúde Acesso aos Serviços de Saúde Transgender Persons Primary Health Care Social Determinants of Health Health Services Accessibility