The epistemological construction of transsexuality: the science, nursing and common sense / La construcción epistemológica de la transexualidad: la ciencia, enfermería y el senso común / A construção epistemológica da transexualidade: a ciência, enfermagem e o senso comum

Abstract Objective: To know the common sense of transsexual women in reaction to the transsexual process and to discuss the epistemological construction about the transsexuality and nursing in this process. Method: Qualitative research, carried out between May and June 2017, with 90 transsexual women attending a specialized center. Results: The common sense of the interviewees evidenced the transsexuality as an identity issue and not a disease, barriers to attendance in health demands and absence of the nursing professional. Discussion: The epistemological construction of the transsexuality takes place through science, which instrumentalized the Transsexual Process Policy and does not have the knowledge presented by the common sense of the users. Conclusion and implications for nursing practice: Science has a role to create order and practices from the refinement of common sense, but does not use the common sense of transsexual women in the epistemological construction of transsexuality, which compromises care and reinforces stereotyped and pathological character by health professionals. Science has the power to validate common sense, sedimenting the care to transsexual women, especially nursing practice. Nursing has the challenge of understanding issues related to transsexuality by articulating common sense with scientific knowledge.

Resumen Objetivo: Conocer el sentido común de mujeres transexuales en reacción al proceso transexualizador y discutir la construcción epistemológica acerca de la transexualidad y de la enfermería en ese proceso. Método: Investigación cualitativa, realizada entre mayo y junio de 2017, con 90 mujeres transexuales atendidas en centro especializado. Resultados: El sentido común de las entrevistadas evidenció la transexualidad como una cuestión identitaria y no una enfermedad, trabas en la atención en demandas de salud y ausencia del profesional de enfermería. Discusión: La construcción epistemológica de la transexualidad, se da por medio de la ciencia, que instrumentalizó la Política del Proceso Transexualizador y no dispone de conocimiento presentado por el sentido común de las usuarias. Conclusión e implicaciones para la práctica de enfermería: La ciencia tiene un papel de crear orden y prácticas a partir del refinamiento del sentido común, pero no utiliza el sentido común de las mujeres transxuales en la construcción epistemológica de la transexualidad, que compromete la asistencia y refuerza el carácter estereotipado y patológico por los profesionales de salud. La ciencia tiene el poder de validar el sentido común, sedimentando la asistencia a las mujeres transexuales, en especial, la práctica de enfermería. La enfermería tiene el desafío de comprender las cuestiones relacionadas a la transexualidad articulando el sentido común con el saber científico.

Resumo Objetivo: Conhecer o senso comum de mulheres transexuais em reação ao processo transexualizador e discutir a construção epistemológica acerca da transexualidade e da enfermagem nesse processo. Método: Pesquisa qualitativa, realizada entre maio e junho de 2017, com 90 mulheres transexuais atendidas em centro especializado. Resultados: O senso comum das entrevistadas evidenciou a transexualidade como uma questão identitária e não uma doença, entraves no atendimento em demandas de saúde e ausência do profissional de enfermagem. Discussão: A construção epistemológica da transexualidade, se dá por meio da ciência, que instrumentalizou a Política do Processo Transexualizador e não dispõe de conhecimento apresentado pelo senso comum das usuárias. Conclusão e implicações para a prática de enfermagem: A ciência tem um papel de criar ordem e práticas a partir do refinamento do senso comum, mas não utiliza o senso comum das mulheres transexuais na construção epistemológica da transexualidade, que compromete a assistência e reforça o caráter estereotipado e patológico pelos profissionais de saúde. A ciência tem o poder de validar o senso comum, sedimentando a assistência às mulheres transexuais, em especial, a prática de enfermagem. A enfermagem tem o desafio de compreender as questões relacionadas à transexualidade articulando o senso comum com o saber científico.

Cuidar de pessoas transexuais na ótica dos residentes de enfermagem / Care for transgender people from the nursing resident's perspective / Cuidar de personas transexuales en la óptica de los residentes de enfermería

Objetivos: identificar a formação dos enfermeiros residentes para o cuidar qualificado de pessoas transexuais e analisar o processo de cuidar de enfermagem dessa clientela, na perspectiva do residente de enfermagem. Metodologia: foi realizada pesquisa qualitativa, descritiva, exploratória, mediante entrevista semiestruturada, numa unidade de urologia, de um hospital universitário, situado no município do Rio de Janeiro, com 13 residentes de enfermagem do Programa de Clínica Cirúrgica do 1º e 2º ano, em 2017. Resultados: os discursos analisados levaram a duas categorias: a formação do enfermeiro e o cuidar de pessoas transexuais e o processo do cuidar de enfermagem na perspectiva do residente. Conclusão: os achados denotam a necessidade da inserção de discussões e abordagens sobre a temática no processo formador dos profissionais de enfermagem e no cuidar desses clientes.

Objectives: to identify training of resident nurses for qualified care of transgender people, and analyze the process of nursing care for transgender people from the nursing resident's perspective. Method: an exploratory, qualitative, descriptive study was conducted in 2017, in the urology unit of a university hospital Rio de Janeiro city, by semi-structured interview of 13 first- and second-year nursing residents of the clinical surgery program. Results: the accounts analyzed led to two categories: nursing training and care for transgender people, and nursing care from the resident's perspective. Conclusion: the findings point to a need to include discussions of, and approaches to, the subject in the nurses' training process, and in care for these clients.

Objetivos: identificar la formación de los enfermeros residentes para el cuidado cualificado a personas transexuales y analizar el proceso de cuidar de enfermería de esa clientela, en la perspectiva del residente de enfermería. Método: Se realizó una investigación cualitativa, descriptiva, exploratoria, por entrevista semiestructurada en unidad de urología, de un hospital universitario situado en el municipio de Río de janeiro, con 13 residentes de enfermería del programa de clínica quirúrgica del 1º y 2º año de 2017. Resultados: las declaraciones analizadas conllevaron a dos categorías: la formación del enfermero y el cuidar de personas transexuales y el proceso de cuidar de enfermería en la perspectiva del residente. Conclusión: los hallazgos muestran la necesidad de la inserción de discusiones y abordar la temática en el proceso formador de los profesionales de enfermería y en el cuidado de esos clientes.

La otra migración. Historias de discriminación de personas que vivieron con VIH en México / The other migration. Histories of discrimination of people who lived with HIV in Mexico

Mexican migration to the United States has been attributed to the poverty and economic polarization in Mexico. Although the dismantling of the peasant economy persists as a factor in demographic displacement, there have been recent changes in the causes that provoke the migration of Mexicans. Family violence, for example, appears as an important motivator in pushing women into the migratory flow, especially in rural areas of the country where women's sexual and reproductive rights appear to be less respected. Homophobia is another point of reference which, along with hate crimes, generates a new category of migration to the United States. Although violence is beginning to be recognized and viewed sociologically as a factor in migratory displacement, it is a phenomenon that has been little explored in Mexico until now. This article proposes to analyze sexual violence and discrimination as motivators of an emerging migratory phenomenon among transgender and transsexual groups within the Mexican population. The article is based on a qualitative study which explored the universes of sense and meaning through the stories of four Mexican women, three transgender and one transsexual, infected with HIV-AIDS in Mexico and who are currently seeking political asylum in San Diego, California. The fieldwork was done between August and September 2003 in San Diego County. Interviews and ethnographic observations were carried out in three geographic regions in the city where neighborhoods of transgender and transsexual migrants of Mexican origin were detected, as well as Non-Governmental Organizations (NGOs) that provide medical and psychological care to undocumented migrants of Latin American origin who live with HIV/AIDS: Northern Region: Carlsbad and Rancho Bernardo; Central Region: North Hill Park and Balboa Park; Southern Region: San Ysidro and Imperial Beach. The article provides anthropological data regarding the contexts, practices and magnitude of rejection and violence that the subjects suffered in Mexico. Four settings are emphasized: family life, interaction in the streets, the relationship with police and the relationship with health services related to caring for HIV/AIDS. To support the analysis it was considered advisable to resort, on the one hand, to phenomenology as a methodological approach to daily life and, on the other hand, to semiotics, where culture is understood as the expression of symbolic forms and objectivizations of sense and meaning that exist in the context of asymmetrical social relationships. This theoretical framework allowed us to postulate that sexual violence is a structural process based on asymmetrical power relationships and that it implies social norms and ideologies of male hegemony that contribute to the social acceptance of violent practices against transgender and transsexual men, which can make them go unnoticed in the community. For the interviewees, migration became a resort for asserting their right to health care, and even a means to preserve their lives. In Mexico, their presence in public places would frequently provoke attacks, scorn and mockery, which could lead to physical and emotional wounds. Civil society is not the only source of violence against transsexual and transgender individuals. Some police organizations systematically persecute them and submit them to violence. The harassment of homosexuals is routine practice among police officers. Their physical appearance is interpreted as a moral misdemeanor. Under this argument, they can become the victims of a complex range of abuses and humiliations that include blackmail or extortion and can lead to physical assault and sexual violence. This last type of aggression is one of the most dangerous because it implies a homosexual conduct on the part of the aggressor. Because there is a risk that his victim might press charges, the violence exercised against the transgender individual by the aggressor may be aggravated, which initiates a cycle of territorial mobility linked to exile because of the fear of being killed. Violence against transsexuals is reinforced by Mexican laws and bureaucratic procedures, which only recognize two genders and thus make it more complicated for transsexuals to prove their legal right to initiate proceedings or a lawsuit. These legal-bureaucratic loopholes help make the aggressor's impunity acceptable and his violations socially invisible. The stories make it possible to understand that in Mexico transphobia is a specific form of sexual violence which, linked to the social construction of male dominance, exists out of social fear of homosexuality as the foundation that legitimizes discrimination, hate, persecution and aggression against transgender and transsexual individuals. One aspect that seems to intensify these forms of violence is the appearance of sexually transmitted viral infections. In fact, the history of infectious diseases shows that homosexuals, sexual workers and migrants appear over and over again in the collective imagination as those responsible for the origin of epidemics. In today's epidemiological context, transgender is seen as a scapegoat for HIV/ AIDS. In Mexico, this situation appears to reinforce the preconceptions of social hatred against transgender persons who are HIV positive, who may end up living with the social stigma of those who believe that the infection is fitting punishment. The evidence suggests that, when transgender individuals are HIV carriers, discrimination against them is worse. The prejudice of medical personnel and the financial inability of health institutions to treat HIV/AIDS lead to precarious care and, occasionally, denial of access to antiretroviral medications. Ethnography suggests that violence against transsexuals is not eliminated when they immigrate to the United States. They experience less aggression than in Mexico, but in the United States they suffer racial and job discrimination. The benefit resides in that, despite their undocumented status, they have free access to antiretroviral drugs and to psychological care offered by the NGOs in San Diego that assist persons infected with HIV/AIDS. The discrimination and sexual violence described by those interviewed amount to a triple stigmatization (because they are itinerant populations, because they are transgender and because they live with HIV). This is a system of stigmatization that not only affects their quality of life by excluding them from jobs and the legal system, but also because it keeps them from being recognized as subjects with rights to health care, especially with regard to access to antiretroviral drugs and medical care related to control of HIV/AIDS, decisive factors which trigger the decision to migrate. This paper suggests the development of a model aimed at making medical practitioners and, in general, health systems personnel more aware of the diversity of sexual practices and identities and emphasizes the right to sexual and mental health care for individuals who live with HIV, regardless of their sexual preference or gender. It is fundamental to develop policies that will prevent the stigmatization and discrimination of persons with HIV and that will recognize the right to health care among populations that have been stigmatized historically.

La migración mexicana a Estados Unidos se ha interpretado como un proceso demográfico que existe en respuesta al empobrecimiento y a la polarización económica en México. Aunque la desarticulación económica y el abandono de las regiones rurales de México persisten como factores de expulsión de población, la migración de mexicanos muestra cambios recientes en las causas que la originan. La violencia familiar, por ejemplo, aparece como un detonante importante de la incorporación de la mujer en los flujos migratorios, particularmente es el caso de zonas rurales del país. La homofobia es otro referente que, relacionado a los crímenes de odio, parece generar un nuevo orden de migración hacia Estados Unidos. No obstante que la violencia empieza a ser reconocida y vista sociológicamente como un factor de expulsión migratoria, en México es un fenómeno que hasta ahora se ha explorado poco. En este trabajo se analizan la violencia sexual y la discriminación como detonantes de un fenómeno migratorio emergente entre grupos de población homosexual. Se trata de un estudio cualitativo de tipo fenomenológico con el que se exploraron los universos de sentido y significado por medio de las historias de vida de migrantes transgénero y transexuales que viven con VIH en San Diego. El trabajo de campo se realizó en agosto de 2003 en condados de San Diego, California, en Estados Unidos. Se realizaron entrevistas y observaciones etnográficas en tres regiones geográficas de la ciudad donde se detectó la presencia de vecindarios de migrantes transgénero y transexuales de origen latinoamericano. En este artículo se describen precisamente las historias de personas transgénero y transexuales que se infectaron de VIH-sida en México. Para estas personas, la migración se convirtió en un recurso para atender su derecho a la salud e incluso para conservar la vida. El objetivo de este artículo es dar cuenta de las formas de agresión física y de discriminación que llevaron a los entrevistados a solicitar asilo político en San Diego, California. Las narraciones permiten comprender que en México la transfobia es una forma de violencia sexual que, ligada a la construcción social de la masculinidad dominante, existe a partir del miedo social a la homosexualidad como el basamento que legitima la discriminación, la persecución y la agresión de personas transgénero y transexuales. Un aspecto que parece recrudecer estas formas de violencia es la aparición de infecciones sexualmente transmisibles de tipo viral. De hecho, la historia de las enfermedades infecciosas muestra que homosexuales, trabajadoras sexuales y migrantes son figuras que aparecen de manera recurrente en el imaginario colectivo como responsables del origen de las epidemias. En el contexto global actual destaca la construcción del transgénero como víctima propiciatoria del VIH/sida. En México, esta coyuntura parece reforzar los esquemas de odio social en contra de las personas homosexuales que son VIH positivas, quienes pueden llegar a vivir con el estigma social de quien cree que la infección es un castigo meritorio. La discriminación y la violencia sexual que describen las informantes tiene que ver con la triple estigmatización (por ser poblaciones móviles, por ser transgénero y además por vivir con VIH). Se trata de un sistema de estigmatización que no sólo afecta la calidad de vida al excluirles laboral y jurídicamente, sino que impide reconocerles como sujetos de derecho a la salud, especialmente en materia de acceso a medicamentos antirretrovirales y de atención médica relativa al control del VIH/sida. Es necesario desarrollar un modelo de sensibilización dirigido a personal médico y, en general, de los sistemas de salud sobre la diversidad de prácticas e identidades sexuales y hacer énfasis en los derechos a la salud sexual y mental de las personas que viven con VIH, sin importar su preferencia sexual y de género.