Atención de los profesionales de la salud a personas trans en América Latina y el Caribe / Health professionals care for trans people in Latin America and the Caribbean

Resumen El presente estudio tuvo por objetivo analizar las características de artículos científicos publicados durante el último quindenio respecto a la atención en salud a personas trans en América Latina y el Caribe. Se desarrolló una revisión sistematizada de artículos publicados en cuatro bases de datos, entre los años 2005 y 2020, en la que se encontraron 20 estudios que fueron objeto de análisis. En su mayoría, estos dan cuenta de las percepciones que tienen las comunidades trans y, en menor frecuencia, las experiencias de los profesionales de la salud sobre la atención en salud. Los resultados permiten identificar barreras que influyen en los procesos de atención y los desafíos para mejorarla. Sobresale la formación deficiente e insuficiente en los profesionales sobre identidades trans y los enfoques diferenciales y afirmativos del género, y la necesidad de fortalecer los abordajes integrales entre las comunidades académicas, de la salud y la generación de políticas públicas transformativas.

Abstract Health care is important for the transitions of people with trans life experiences and to strengthen the processes of health and disease. Health professionals are educating and accompanying agents; however, the literature frequently reports that there are barriers perceived by professionals regarding their competencies to accompany such processes, in addition to others related to social representations regarding trans identities, the limited scientific evidence regarding the processes of gender reaffirmation and representing the communities themselves according to their historical and sociocultural characteristics. The aim of this study was to analyze the characteristics of scientific articles published during 15 years regarding health care for trans persons in Latin America and the Caribbean. A systematized review of articles published in four databases between 2005 and 2020 was carried out. 20 studies were analyzed in the research. Most of them report the perceptions of trans communities and, less frequently, the experiences of health professionals on health care. The results allow the identification of barriers that influence the processes of care and the challenges to improve it. The deficient and insufficient training of professionals on trans identities and differential and affirmative gender approaches stand out, as well as the need to strengthen comprehensive approaches among the academic and health communities and the generation of trans affirmative public policies. On the other hand, the results evidence a construction of science with respect to gender that is cisnormative and invisibilizes gender diversities. In addition, many of the studies establish vertical relationships between participants, including researchers, which generates research dynamics in which trans communities are considered more as informants and less as expert peers, community researchers or participants in a collaborative and co-creative research process. These findings support the need and renew the urgency to generate processes of knowledge construction with and for trans communities that allow nurturing educational, social, public policy and health spaces that represent their needs for gender transitions, in case the person considers so, and that welcome in an integral and humanized way the processes of health and disease. Research on health and health care in trans communities both in Colombia and in the rest of Latin America and the Caribbean does not show the implementation of health policies focused on the community and that respond to their health needs. Health professionals, around the world, should accompany from care actions focused on the processes of self-identification and self-determination of gender. Being recognized and made visible based on gender identities and expressions has a positive impact on the mental health of trans people and their well-being. In professional practice, it is important and essential to overcome the barriers of social inequality, promoting a critical social vision and understanding of the reality of this population. It is necessary to expand research from gender diversities and separate from the LGBTIQ+ umbrella given the complex social, cultural, biological, and psychological diversities faced by each community. As for health professionals, it is necessary to deepen the measurement and understanding of attitudes, knowledge, beliefs, skills and gaps identified by all staff, from doctors and nurses to institution managers. This in order to articulate and triangulate information and develop intervention programs aimed at comprehensive and accessible care, especially for their reports about the little information on sexual and gender diversity received during their professional training process and organizational culture. Finally, each country should develop clinical guidelines based on local, national, and international evidence that responds to the psychological and sociocultural needs and experiences of trans communities that include the process of gender transitions from hormone therapy, affirmative surgeries and other non-binary processes of gender expressions, family, psychosocial support, and community accompaniment.

Bienestar en mujeres trans: aproximaciones desde las trayectorias ocupacionales de profesionales de la salud / Well-being in trans women: approaches from the occupational trajectories of health professionals

Resumen El bienestar de las mujeres trans se ha visto afectado por el estigma, la discriminación, las altas brechas en salud, la falta de oportunidades laborales y educativas, además de la ausencia de apoyo social. Los profesionales de la salud juegan un papel importante dentro del bienestar y la salud de las mujeres trans, por tanto, en este estudio se planteó como objetivo reconocer el significado que tienen los profesionales de la salud sobre el bienestar en mujeres trans. Esta es una investigación cualitativa, diseño narrativo, en la cual participaron ocho profesionales de la salud (medicina, psicología y auxiliar de enfermería) con experiencia en atención a la comunidad, con quienes se realizó una entrevista en profundidad. Estos profesionales reconocen que el bienestar de las mujeres trans se ve afectado por múltiples factores socioculturales, económicos, relacionados con la salud mental, la discriminación a las que siguen expuestas, la transfobia internalizada y el poco apoyo familiar y social. Se requieren acciones concretas desde las entidades de salud, de educación superior y gubernamentales, que favorezcan procesos afirmativos de las mujeres trans, y la promoción en los procesos de atención en salud de la sensibilidad y compromiso con el desarrollo humano de estas mujeres a partir de la protección de sus derechos.

Abstract The well-being of trans women has been affected by stigma and discrimination, and great gaps in health, employment and educational opportunities and the absence of social support. The role of health professionals plays an important role in the well-being and health of trans women, therefore, the objective is to recognize the meaning that health professionals have on the well-being of trans women. Method: Qualitative research, narrative design. Eight health professionals (medicine, psychology, and nursing assistant) with experience in community care participated in an in-depth interview. In conclusion, the health professionals recognize that the well-being of trans women is affected by multiple sociocultural and economic factors related to mental health, discrimination to which they are still exposed, internalized transphobia, and the lack of family and social support. Concrete actions are required from health, higher education, and governmental entities capable of favoring affirmative processes for trans women and promoting in healthcare processes the sensitivity and commitment to their human development based on the protection of their rights.

Neumonitis intersticial linfoidea en niños infectados por el virus de inmunodeficiencia humana-1 en zona de alta prevalencia de tuberculosis pulmonar / Lymphoid interstitial pneumonitis in children infected with type 1 human immunodefi ciency virus from areas with high pulmonary tuberculosis prevalence

Antecedentes : Poco se sabe sobre la neumonitis intersticial linfoidea (NIL) en niños con infección por el virus de inmunodeficiencia humana-1 (VIH-1) Objetivos: Describir las características clínicas y patológicas de NIL en niños infectados por VIH-1 en un centro de referencia para VIH pediátrico en Cali (Colombia). Métodos: Se llevó a cabo una descripción de serie de casos de NIL basados en revisión retrospectiva de historias clínicas de todos los casos de niños con enfermedad pulmonar crónica y LIP confirmada por biopsia entre los años 2001 y 2012. Resultados y conclusiones: Diez de 12 casos con NIL fueron confirmados por biopsia pulmonar. Se observó una respuesta clínica y de función respiratoria luego del tratamiento con prednisona, excepto en un caso que presentó tos persistente. No se encontraron casos de tuberculosis pulmonar (TP) en nuestra serie y el papel de la biopsia pulmonar fue crítico para alcanzar un diagnóstico preciso.

Background: Little is known about Lymphoid Interstitial Pneumonitis (LIP) in children with HIV infection. Aims: To describe the clinical and pathological characteristics of LIP in infected children in a referral center for pediatric HIV in Cali (Colombia). Methods: Case series based on retrospective analysis of clinical charts among HIV-infected children with chronic lung disease and lung-biopsy proven LIP between the years 2001 and 2012. Results and conclusions: 10 of 12 cases of LIP were confirmed by lung biopsy. Significant clinical and respiratory functional improvement was obtained in all cases after prednisone therapy, excepting one child who presented persistent cough. No case of pulmonary TB was detected in our cohort. Lung biopsy was critical to obtain an accurate diagnosis.

Descripción de los conocimientos, actitudes, susceptibilidad y autoeficacia frente al VIH/SIDA en un grupo de adolescentes colombianos

La presente investigación tiene como objetivo describir y comparar los conocimientos correctos,las ideas erróneas, las actitudes, la susceptibilidad y autoeficacia frente al VIH/SIDA en un grupode adolescentes colombianos. La muestra está conformada por 222 adolescentes de ambos sexos,entre los 10 y 18 años (media 14.10 y desviación típica 1.925) que pertenecen a una instituciónpública de la ciudad de Cali. Es una investigación descriptivo-correlacional (Montero y León, 2005).La información se recogió mediante la aplicación de la Adaptación Colombiana de la escala VIH-65 (Bermúdez, Buela-Casal y Uribe (2005), que mide conocimientos, actitudes, susceptibilidad yautoeficacia frente al VIH/SIDA. Los resultados evidencian que la escala que obtuvo mayor puntuaciónes la de conocimientos erróneos, lo que indica que aún persisten conceptos errados y mitos frente alVIH/SIDA. Igualmente, se encontró que existen diferencias significativas en función de la edad, laescolaridad y el sexo...

The objective of this research is to describe and compare correct knowledge, incorrect ideas, attitudes,susceptibility and self-efficacy in cases of HIV/AIDS in a group of Colombian adolescents. Thesample consists of 222 adolescents of both sexes between the ages of 10 and 18. (Average 14.10 anda typical deviation of 1.925), who belong to a public institution in the city of Cali. This is descriptivecorrelationalresearch (Montero and León, 2005). The information was gathered by the applicationof the Colombian adaptation of the HIV-65 scale (Bermúdez, Buela-Casal and Uribe (2005), whichmeasures knowledge, attitudes, susceptibility, and self-efficacy in cases of HIV/AIDS. The results show that the scale obtaining the highest score is that of incorrect knowledge, which suggests thatthere are still erroneous and mythical concepts about HIV/AIDS. It was also found that there aredifferent meanings depending on age, academic level and sex...

A presente investigação tem como objetivo descrever e comparar os conhecimentos corretos, asidéias errôneas, as atitudes, a suscetibilidade e auto-eficácia contra o HIV/AIDS em um grupo deadolescentes colombianos. A mostra está conformada por 222 adolescentes de ambos sexos, entre os10 e 18 anos (meia 14.10 e desvio típica 1.925) que pertencem a uma instituição pública da cidade deCali. É uma investigação descritivo-correlacional (Montero y León, 2005). A informação se recolheumediante a aplicação da Adaptação Colombiana da escala HIV-65 (Bermúdez, Buela-Casal y Uribe(2005), que mede conhecimentos, atitudes, suscetibilidade e auto-eficácia contra o HIV/AIDS. Osresultados evidenciam que a escala que obteve maior pontuação é a de conhecimentos errôneos, o queindica que ainda persistem conceitos errados e mitos contra o HIV/AIDS. Igualmente se encontrouque existem diferenças significativas em função da idade, a escolaridade e o sexo...

Diferencias evolutivas en la actitud ante la muerte entre adultos jóvenes y adultos mayores / Developmental differences in attitudes toward death between young and older adults / Diferenças evolutivas na atitude ante a morte entre adultos jovens e adultos maiores

El concepto de la muerte a través de los años ha ido cambiado, percibiéndose actualmente como un tema del que pocos quieren hablar y al que muchos evaden, y que genera en las personas actitudes de miedo y ansiedad. De esta manera, el presente articulo tiene como objetivo evaluar la actitud evolutiva ante la muerte en una muestra de 343 personas, adultos jóvenes y adultos mayores, por medio del Perfil Revisado de Actitudes hacia la Muerte (PAM-R), el cual mide cinco dimensiones: miedo a la muerte, evitación de la muerte, aceptación neutral, aceptación de escape, y aceptación de acercamiento. Para ello, se tuvieron en cuenta las variables género y edad. Los resultados muestran diferencias significativas en función de la edad; en relación al género, las diferencias se presentan entre hombres y mujeres del grupo de adultos mayores.

Throughout the years the concept of death has been redefined and it currently generates attitudes of fear and anxiety, where death is regarded as a topic that few want to discuss and that many evade. The aim of the present article was to assess the developmental changes in attitude toward death in a sample of 343 persons, composed by young adults and older adults. The variables age and gender were taken into account. The Revised Profile of Attitudes toward Death, which measures five dimensions: fear of death, avoidance of death, neutral acceptance, acceptance of escape, and acceptance of approach was administered to the participants. Results showed significant differences as a function of age, and in relation to gender, significant differences were found between men and women in the group of older adults.

Através dos anos o conceito sobre a morte tem mudado. Atualmente é percebido como um tema do qual muito poucos desejam falar, muitos evadem, e que gera temor e ansiedade nas pessoas. O objetivo deste artigo é avaliar a atitude evolutiva ante a morte em uma amostra de 343 pessoas (adultos jovens e adultos maiores) mediante o Perfil de Atitudes para a Morte (PAM-R), que mede cinco dimensiones: temor à morte, evasão da morte, aceitação neutral, aceitação de fuga e aceitação de aproximação. Foram tidos em conta as variáveis gênero e idade. Os resultados mostram diferenças importantes quanto a idade; em relação ao gênero, as diferenças estão no grupo de adultos maiores entre homens e mulheres.

Integración social y habilidades funcionales en adultos mayores / Social integration and functional skills in older adults

El objetivo del presente estudio es identificar la relación entre las variables, habilidades funcionales e integración social del adulto mayor y conocer si existen diferencias en función del sexo, la edad y el estado civil. Los resultados muestran diferencias significativas en la integración social en función del estado civil, siendo mayor en los adultos mayores solteros y viudos. En función de la edad, se encuentran diferencias significativas en las habilidades funcionales, siendo mayor en los adultos entre los 60 y 65 años. No se encontraron diferencias significativas en función del sexo. Se concluye que la autonomía y las habilidades funcionales del adulto mayor están estrechamente relacionadas con la frecuencia de las actividades físicas y de integración social, lo que favorece su calidad de vida y obstaculiza la aparición de cambios biopsicosociales significativos en esta etapa.

The objective of this study is to identify the relationship between variables: functional abilities and social integration of older persons and to know whether there were differences according to sex, age and marital status. The results show significant differences in social integration on the basis of marital status, being higher in the elderly unmarried and widowed; Depending on age there are significant differences in functional abilities, being higher in adults between 60 and 65 years. There were no significant differences according to sex. The conclusion is that the autonomy and functional abilities of the Elderly are closely related to the frequency of physical activities and social integration, which promotes the quality of life of older people and hampering the emergence of significant biopsychosocial changes in this stage of life.