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.

Estigma y discriminación ante la tuberculosis por profesionales de la salud de la costa pacífica colombiana / Stigma and discrimination facing tuberculosis in health workers in the colombian pacific coast / Estigma e discriminação ante a tuberculose por profissionais da saúde do litoral pacífico colombiano

Resumen Objetivo: Caracterizar los conocimientos, las actitudes y las prácticas de profesionales de la salud que reflejan estigma y discriminación frente a la tuberculosis (TB) en municipios prioritarios de la Costa Pacífica colombiana. Materiales y Métodos: Se realizó un estudio cualitativo descriptivo con 13 profesionales de la salud, vinculados a los programas de TB de 4 municipios prioritarios en la Costa Pacífica nariñense de Colombia. Se realizaron entrevistas en profundidad y grupos focales. Resultados: Los profesionales de la salud tienen adecuados conocimientos sobre la enfermedad y el tratamiento, pero sus creencias sobre las causas de la enfermedad y algunas actitudes frente a las personas con TB reflejan estigma. Sus prácticas fueron poco discriminatorias hacia los pacientes y sus familias, incluso tienen prácticas de riesgo para su salud como no usar las medidas de bioseguridad para evitar hacer sentir discriminados a los pacientes. La mayoría de los profesionales reportaron ser discriminados por su labor, la cual implica un contacto diario y un alto riesgo de infección, proviniendo estas actitudes por parte de sus familiares y de otros profesionales del sector salud. Conclusiones: Los resultados de este estudio señalan focos importantes de atención en las acciones de prevención del estigma y la discriminación frente a las personas con TB, que no han sido visibilizados por estudios cuantitativos en el país.

Abstract Objective: To characterize the knowledge, attitudes and practices of health professionals that reflect stigma and discrimination facing tuberculosis (TB) in critical municipalities of the Colombian Pacific Coast. Materials and Methods: A qualitative descriptive study was conducted with 13 health professionals, linked to TB programs in 4 critical municipalities in the Colombian Pacific Coast in the Department of Nariño. In-depth interviews and focus groups were conducted. Results: Health professionals have adequate knowledge about the disease and its treatment, but their beliefs about some TB causes and some attitudes towards patients with the disease reflect stigma. Their practices were not very discriminatory towards TB patients and their families, and they even have risk practices for their health such as not using biosecurity measures in order to avoid making patients feel discriminated. The majority of the professionals reported being discriminated against for their work which implies daily contact with patients and high risk of infection, attitudes that arise from their relatives and other professionals in the health sector. Conclusions: The results of this study point out important attention focus to be attended in the actions of prevention of stigma and discrimination against people with TB which have not been reported by quantitative studies in the country.

Resumo Objetivo: Caracterizar os conhecimentos, as atitudes e as práticas de profissionais da saúde que reflitam estigma e discriminação frente à tuberculose (TB) em municípios prioritários do Litoral Pacífico colombiano. Materiais e Métodos: Realizou se um estudo qualitativo descritivo com 13 profissionais da saúde, vinculados aos programas de TB de 4 municípios prioritários no Litoral Pacífico nariñense "Nariño cidade da Colômbia". Realisou se entrevistas em profundidade e grupos focais. Resultados: Os profissionais da saúde têm adequados conhecimentos sobre a doença e o tratamento, mas suas crenças sobre as causas da doença e algumas atitudes frente às pessoas com TB reflitam estigma. Suas práticas foram pouco discriminatórias para os pacientes e suas famílias, incluso tem práticas de risco para sua saúde como não usar as medidas de biossegurança para evitar fazer sentir discriminados os pacientes. A maioria dos profissionais reportou ser discriminada por seu labor, a qual implica um contato diário e um alto risco de infecção, provindo estas atitudes por parte de seus familiares e de outros profissionais do sector saúde. Conclusões: Os resultados de este estudo apontam focos importantes de atenção nas ações de prevenção do estigma e a discriminação frente ás pessoas com TB, que não tem sido visibilizados por estudos quantitativos no país.

Roles y desafíos de mujeres jefas de hogar con VIH/Sida / Roles and challenges of female heads of household with HIV/AIDS

Objetivo Caracterizar los roles y desafíos que enfrentan las mujeres con VIH, líderes de hogar, del Valle del Cauca, Colombia. Método Cualitativo exploratorio, basado en la Teoría Fundada. Los datos fueron recolectados a través de entrevistas en profundidad a 13 mujeres con VIH, jefas de hogar con edades entre los 19 y los 46 años que viven en las ciudades de Cali y Buenaventura. Resultados Los principales roles asumidos por las mujeres son el cuidado de sus hijos, el sostenimiento del hogar, las expresiones de afecto, el apoyo frente a diferentes situaciones de la vida y los procedimientos administrativos relacionados con el acceso a los servicios de salud. Entre los desafíos se mencionan aquellos aspectos relacionados con la crianza, ser modelo de autocuidado, acompañar y liderar el diagnóstico y la adherencia al tratamiento de quienes tienen menores VIH positivos, dar a conocer el diagnóstico, proveer las mejores condiciones de vida, y el proveer acceso a bienes y servicios. Conclusiones Los resultados del estudio resaltan los desafíos y roles que enfrentan las mujeres al vivir con una enfermedad crónica y que aún sigue estando cargados de estigma y discriminación. Se evidencian los aspectos sociales, económicos, culturales y en salud relacionados con las inequidades y desigualdades en salud, asociadas al género y al acceso a los servicios en salud, al trabajo decente y educación.(AU)

Objective To characterize the roles and challenges that female heads of households with HIV in Valle del Cauca, Colombia assume. Method A qualitative exploratory method, based on Grounded Theory was conducted. Data were collected through in depth interviews to 13 women with HIV, heads of household with ages between 19 and 46,who live in the cities of Cali and Buenaventura. Results The main roles assumed by women are taking care of their children and their homes, expressing affection, providing support during different life events and administrative procedures related to health care services access. The challenges expressed by these women include aspects related to parenting, being a self-care role model, accompanying and leading the diagnosis and adherence to the treatment children with HIV, revealing the diagnosis, providing the best living conditions, and providing access to goods and services. Conclusions The results of the study highlight the challenges that women living with a chronic illness, that is still loaded with stigma and discrimination, have to face. The social, economic, cultural and health aspects related to the inequities and inequalities in health, to gender and access to health services, to decent work and to education are made clear in this work.(AU)

Conocimientos, actitudes y prácticas frente a la tuberculosis en trabajadores del sector salud en municipios prioritarios de la Costa Pacífica colombiana / Health Workers' Knowledge, Attitudes and Practices Towards Tuberculosis in Priority Municipalities of the Colombian Pacific Coast / Conhecimentos, atitudes e práticas perante a tuberculose em trabalhadores da saúde em municipalidades prioritárias do litoral pacífico sul da Colômbia

Objetivo: Caracterizar los conocimientos, actitudes y prácticas frente a la tuberculosis (TB) en los trabajadores de la salud que participan en los programas de control en municipios prioritarios de la Costa Pacífica colombiana. Materiales y métodos: Se realizó un estudio descriptivo de corte transversal en 38 trabajadores de la salud, que corresponden a la mayor parte de la población del personal con funciones en los programas de TB de 10 municipios prioritarios en Nariño, Colombia. El instrumento utilizado fue un cuestionario estructurado, previamente validado a través de entrevistas cognitivas a personas con características similares a la población estudio, realizadas previamente a la recolección de información. Resultados: Los trabajadores reportan tener conocimientos sobre TB y su manejo de acuerdo a las normas de control establecidas. No obstante, se identificaron algunas prácticas de riesgo relacionadas con el cumplimiento de las medidas del plan de control de infecciones y actitudes que reflejan estigma frente a la enfermedad. Conclusiones: El estudio aporta información referente a los conocimientos, actitudes y prácticas del personal de salud en el pacífico nariñense, que se puede convertir en insumo de consulta al momento del diseño de estrategias de intervención que posibiliten el fortalecimiento del programa de control de TB con enfoque cultural en esta región.

Purpose: To describe knowledge, attitudes and practices of health workers of tuberculosis (TB) programs in priority municipalities of the Colombian Pacific coast. Material and Methods: A cross-sectional descriptive study was conducted with 38 health workers, corresponding to the entire population of people working at the TB programs in ten priority municipalities of Nariño, Colombia. A structured interview, previously validated trough cognitive interviews, was used. Results: Health workers report to have knowledge about TB and its management according to the established control guidelines. Nevertheless, some risk practices concerning biosecurity standards of infection control were found, that show some stigmatizing attitudes towards the illness. Conclusions: The study provides information about the health workers' knowledge, attitudes and practices towards TB in Nariño that can be used as input to the design of intervention strategies to strengthen the TB programs with local and cultural approach.

Objectivo: caracterizar os conhecimentos, atitudes e práticas perante a tuberculose em trabalhadores da saúde que participam dos programas de controle em municipalidades prioritárias do litoral pacífico colombiano. Materiais e métodos: Realizou-se um estudo descritivo de corte transversal com 38 trabalhadores da Saúde, os quais correspondem a maior parte da população de pessoas com funções nos programas de TBC em 10 municipalidades prioritárias num departamento do sul da Colômbia. Usou-se um questionário estruturado, previamente validado através de entrevistas cognitivas realizadas em pessoas com caraterísticas similares as da população de estudo e realizadas previamente à coleta da informação. Resultados: Os trabalhadores disseram ter conhecimentos sobre a TBC e saber como tratar os pacientes com a doença seguindo as normatividades estabelecidas. Porém, identificaram-se algumas práticas de risco relacionadas com o cumprimento das medidas do plano de controle de infecções e atitudes que refletem o estigma perante a doença. Conclusão: O estudo confere informação a respeito dos conhecimentos, atitudes e práticas das equipes de saúde no pacífico sul da Colômbia, a qual se pode converter em insumo de consulta no momento do planejamento de estratégias de intervenção que possibilitem o fortalecimento do programa de controle de TB com enfoque cultural nesta região.

Motivaciones y recursos para el consumo de sustancias psicoactivas en universitarios / Motivations and resources for the consumtion of psychoactive substancces by university students / Motivações e recursos para o consumo de substancias psicoativo nos universitarios

Objetivo: describir el consumo de sustancias psicoactivas –SPA– (alcohol, tabaco y drogas ilegales) de jóvenes universitarios colombianos y analizar su relación con las motivaciones y la disponibilidad de recursos para el consumo. Método: participaron 1811 estudiantes de seis universidades colombianas, con edades entre los 15 y 24 años (M=19,6; DT=2,0) seleccionados intencionalmente, quienes contestaron la subescala de consumo de sustancias psicoactivas del “Cuestionario de estilos de vida en jóvenes universitarios (CEVJU)”. Resultados: el 20% de los jóvenes informa consumir alcohol por lo menos una vez a la semana, el 13% fuma por lo menos una vez al día y el 4% consume drogas ilegales (marihuana, cocaína, éxtasis, heroína, popper, otros alucinógenos) por lo menos una vez a la semana. Entre los motivos del consumo se encuentran: sentirse mejor, disminuir la tensión, la ansiedad o el estrés y experimentar nuevas sensaciones. Quienes tienen mayores prácticas de consumo de SPA consideran que podrían cambiarlas pero no saben si lo harán. El consumo es mayor en los jóvenes que cuentan con dinero para comprarlas, que conocen sitios donde las venden dentro de la universidad y cerca de ella, y que frecuentan sitios en los cuales pueden adquirirlas. Conclusiones: a partir de los resultados se discute sobre la importancia de reorientar las acciones de prevención del consumo de SPA en los centros universitarios considerando los principales motivos y recursos que se relacionaron con éste.

Purpose: to describe the use of psychoactive substances –PS– (alcohol, tobacco and illegal drugs) in Colombian young university students and to analyze its relation with motivations and the availability of resources for consumption. Method: 1,811 students from six Colombian universities between 15 and 24 years old (M=19.6; SD=2.0) participated. Participants were selected intentionally and they answered the subscale of psychoactive substances consumption from the “College Youth Lifestyle Questionnaire”. Result: 20% of the students report using alcohol at least once a week; 13% smoke at least once daily, and 4% consume illegal drugs (marijuana, cocaine, ecstasy, heroine, popper, other hallucinogens) at least once a week. Feeling better, reducing stress or anxiety and feeling new sensations were motives to use PS. Those who have a higher use of PS think that they could change their practices but are not sure of doing so. Substance use is higher in students who have money to buy them, in those who know where to buy them in the university and close to it, and in those who go to places where they can get them. Conclusions: From the results, the importance of redirecting drug consumption prevention strategies used in universities is discussed, considering the main motives and resources related to it.

Objetivo: Descrever o consumo de substâncias psicoativas –SPA- (álcool, tabaco e drogas ilegais) de jovens universitários colombianos e analisar sua relação com as motivações e a disponibilidade de recursos para o consumo: Método: participaram 1811 estudantes de seis universidades Colombianas, com idades entre 15 e 24 anos (M=19,6; DT=2,0) selecionados intencionalmente, quem responderam a sub- escada de consumo de sustâncias psicoativas do “Questionário de estilos de vida em jovens universitários (CEVJU)”. Resultados: o 20% dos jovens informa consumir álcool pelo menos uma vez à semana, o 13% fuma pelos menos uma vez ao dia e o 4% consume drogas ilegais (maconha, cocaína, êxtases, heroína, Popper, outros alucinógenos) pelo menos uma vez por semana. Entre os motivos do consumo encontram se: sentir se melhor, diminuir a tensão, a ansiedade o estresse e experimentar novas sensações. Quens tem maiores praticas de consumo de SPA consideram que poderiam cambiar- las, mas não sabem se o farão. O consumo é maior nos jovens que contam com o dinheiro para comprá-las que conhecem sítios onde as vendem dentro da universidade e perto dela, e que frequentam sítios nos quais podem adquiri-las. Conclusões: a partir dos resultados se discute sobre a importância de reorientar as ações de prevenção do consumo de SPA nos centros universitários considerando os principais motivos e recursos que se relacionaram com este.

Evaluación de las conductas de salud en jóvenes universitarios / Assessing young university students' behaviour regarding health

Objetivo Construir y analizar las propiedades psicométricas de un cuestionario que evalúa las conductas de salud que hacen parte del estilo de vida de los universitarios. Métodos Se realizó un estudio de validación con dos fases. La primera con 1485 estudiantes (63,2 por ciento mujeres), de cuatro universidades de Colombia, cuya edad media fue de 20,7 años (DT=2,5). La segunda con 1811 estudiantes (55,8 por ciento mujeres) de seis universidades del país, con una edad media de 19,7 (DT=2,0). Se hicieron análisis para la validez de contenido, análisis de discriminación de ítems, análisis factoriales y de consistencia interna. Resultados La versión final del "Cuestionario de estilos de vida de jóvenes universitarios" [CEVJU-R] quedó constituida por 40 ítems que evalúan conductas en ocho dimensiones del estilo de vida: Actividad física, Tiempo de ocio, Alimentación, Consumo de alcohol, cigarrillo y drogas ilegales, Sueño, Habilidades interpersonales, Afrontamiento y Estado emocional percibido. Adicionalmente, incluyó 28 ítems que evalúan, en siete de las ocho dimensiones, las motivaciones para llevar a cabo o no las prácticas y para cambiarlas, así como los recursos que facilitan o dificultan su realización. El nivel de fiabilidad de las dimensiones fue de aceptable a moderado (entre 0,6 y 0,7). Conclusiones El CEVJU-R presenta propiedades psicométricas adecuadas y constituye un avance en la medición de los estilos de vida de los universitarios. Podría utilizarse para la identificación de las necesidades de los jóvenes y para la definición de las acciones de promoción y prevención dentro de las universidades.

Objective Constructing a questionnaire for assessing university students' behaviour regarding health forming part of their life-styles and evaluating its psychometric properties. Methods A two-phases validation study was conducted; the first covered 1,485 students (63.2 percent female) from four Colombian universities having a mean age of 20.65 years (SD=2.5) and the second covered 1,811 students (55.8 percent female) from six universities having a mean age of 19.65 years (SD=2.0). A content validity analysis, an item discrimination analysis, a factorial analysis and reliability assessment were done. Results The final version of the university students' life-style questionnaire [CEVJU-R, by its Spanish's abbreviations] finally consisted of 40 items related to health and life-style regarding eight factors: physical activity, leisure time, eating habits, alcohol, cigarette and drug use, sleep, interpersonal abilities, coping and perceived emotional state. It also included 28 items evaluating motivation (whether to engage in certain practices regarding health and whether to change them) and the availability of resources facilitating or interfering with such behaviour in seven out of the eight dimensions. Factor reliability level was acceptable (ranging from 0.6 to 0.7). Conclusions The CEVJU-R had suitable psychometric properties and constituted an advance in measuring university students' life-styles and could help identify health need and focus health promotion and prevention strategies in this population.