Abrindo os armários do acesso e da qualidade: uma revisão integrativa sobre assistência à saúde das populações LGBTT

Knowledge, practices and barriers to access sexual health of women in the menopausal stages: a cross-sectional study with Brazilian gynecologists

BACKGROUND

Sexual health access and care for women in the menopausal stages face significant barriers, presenting deficits in relation to diagnosis and treatment. Although epidemiological data indicate high prevalence of problems related to sexual health in this population, traditionally, the theme is not discussed in health care settings. This study aimed to analyze knowledge, practices and barriers to access sexual health of women in the menopausal stages in the context of women's health care in Brazil.

METHODS

With a cross-sectional design, a questionnaire was distributed electronically, encompassing variables related to knowledge; practices; and barriers to access sexual health of women in the menopausal stages. The data obtained were subjected to analysis using both descriptive and inferential statistics. Specifically, we employed multivariate analysis, employing multiple linear regression models, to discern potential factors associated with outcomes concerning the level of knowledge and the frequency of addressing the topic in professional practice.

RESULTS

The sample included 70 physicians with specialization in obstetrician/gynecologists who work in health care with women in the menopausal transition or postmenopausal women. A high level of self-reported knowledge about sexual health was identified. Regarding the practices, most of them reported directly proposing the subject and not using instruments. Although they reported frequently addressing the topic in general, topics related to vaginal lubrication, dyspareunia, and sexual dysfunction have been more present in the clinic compared to sexual orientation and women's relationship with themselves. The main barriers were time limitation and patient discomfort with the topic. The multivariate models indicated that female gynecologists and professionals with higher levels of knowledge on the subject had a higher frequency of addressing sexual health in clinical practice with women in menopausal stages.

CONCLUSIONS

Sexual health access and care for brazilian women in the menopausal stages presents discrepancies in the frequency of approach between the various topics, in addition to the predictive character of technical knowledge in the practices of professionals. To ensure universal access to sexual health services for this population, an active approach through specific instruments is important, as well as the reinforcement of strategies to improve the level of knowledge of professionals.

Tobacco use by sexual and gender minorities: findings from a Brazilian national survey

OBJECTIVE

The study aims to identify the prevalence of use of tobacco products by sexual and gender minorities (SGM) in Brazil, the users' profile and associations between tobacco use and social and behavioural variables.

METHODOLOGY

The study used data from a representative nationwide household survey of the Brazilian population aged 12-65 years-the first one to address the issue of sexual orientation/gender identity. The study sample consisted of 15 801 individuals. Social and behavioural characteristics and the use of tobacco products were compared according to sexual orientation/gender identity. A multivariate logistic model was constructed to assess the association between tobacco use and sexual orientation/gender identity, as well as models stratified by SGM and non-SGM.

RESULTS

Prevalence of any tobacco product use was 44.7% among SGM and 17.0% among non-SGM. Water pipe use was ~8 times higher for SGM than for non-SGM (13.5% vs 1.6%). SGM tobacco users were younger and had more schooling than non-SGM tobacco users. After adjusting for social and behavioural variables, the multivariate model showed that SGM were 150% more likely to use tobacco products than non-SGM (adjusted OR 2.52; 95% CI 1.61 to 3.95). In the model for SGM, schooling, alcohol consumption, illicit drug consumption, violence and anxiety/depression were significantly associated with tobacco use.

CONCLUSION

Prevalence of tobacco use among SGM was higher than among non-SGM, and the profile of tobacco users differed between them. It is urgent to monitor health issues in SGM in Brazil and to adopt tobacco control strategies for this group.

Transforming the invisible into the visible: disparities in the access to health in LGBT+ older people

OBJECTIVES

To compare variables of access to healthcare between the LGBT+ population aged 50 and over and those non-LGBT+.

METHODS

A cross-sectional study was carried out in Brazil through a confidential online questionnaire. The use of the health system was characterized by the number of preventive tests performed and measured by the PCATool-Brasil scale (a 10-point scale in which higher scores were associated with better assistance in healthcare). The association between being LGBT+ and access to health was analyzed in Poisson regression models.

RESULTS

6693 participants (1332 LGBT+ and 5361 non-LGBT+) with a median age of 60 years were included. In the univariate analysis, it was observed not only lower scores on the PCATool scale (5.13 against 5.82, p < 0.001), but a greater proportion of individuals among those classified with the worst quintile of access to healthcare (< 4 points), 31% against 18% (p < 0.001). Being LGBT+ was an independent factor associated with worse access to health (PR = 2.5, 95% CI 2.04‒3.06). The rate of screening cancer, for breast, colon, and cervical cancer was also found to be lower in the LGBT+ population.

CONCLUSION

Healthcare access and health service experiences were worse in the LGBT+ group than in their non-LGBT peers. Inclusive and effective healthcare public policies are essential to promote healthy aging for all.

Construction of LGBT health policies in Brazil: a historical perspective and contemporary challenges

Abstract This essay presents a timeline of the construction of health policies for lesbians, gays, bisexuals, transvestites and transsexuals (LGBT) in Brazil drawing on the concepts of sexual politics. Beginning with the creation of the Unified Health System, we outline the first health care policies developed in response to the AIDS epidemic in the 1990s. We then go on to show how, the fruit of dialogue between the government and the gay rights movement, LGBT health became the object of public policies focusing on human rights, comprehensive care, and strengthening the citizenship for people who deviate from hetero-cis-normativity. Against the backdrop of the rising tide of conservatism and dismantling of progress on LGBT rights, we highlight current challenges for achieving comprehensive health care that takes into account sexual and gender diversity.

Construction of LGBT health policies in Brazil: a historical perspective and contemporary challenges

This essay presents a timeline of the construction of health policies for lesbians, gays, bisexuals, transvestites and transsexuals (LGBT) in Brazil drawing on the concepts of sexual politics. Beginning with the creation of the Unified Health System, we outline the first health care policies developed in response to the AIDS epidemic in the 1990s. We then go on to show how, the fruit of dialogue between the government and the gay rights movement, LGBT health became the object of public policies focusing on human rights, comprehensive care, and strengthening the citizenship for people who deviate from hetero-cis-normativity. Against the backdrop of the rising tide of conservatism and dismantling of progress on LGBT rights, we highlight current challenges for achieving comprehensive health care that takes into account sexual and gender diversity.

Where are LGBTT populations in the Family Health Strategy? narratives of health professionals in Teresina, Piauí, Brazil

The populations of lesbians, gays, bisexuals, transvestites, and transsexuals (LGBTT) have not had a place in the "official history" of humanity, except as secondary actors that deviate, distort, or even tarnish popular memory, guided by cisheteronormativity. These same subjects often experience obstacles in the care provided by the Family Health Strategy (ESF) within a universal, comprehensive, and equitable system. This paper seeks to analyze experiences narrated by primary care professionals in health care for LGBTT populations in Teresina, Piauí, Brazil. This is qualitative research conducted with 32 professionals working at a PHC unit. The analysis was based on three dimensions - relational, organizational, and contextual - inspired by the Giovanella and Fleury theoretical discussion. Primary care, which should be one of those responsible for community health actions and prioritize health promotion and prevention, is the same that has provided denials, violence, and neglect in the care of LGBTT people. Therefore, we selected listening as one of the keys to respecting sexual and gender diversity so that these people are recognized as ESF users.