Access to transition-related health care among transmasculine people in India: A mixed-methods investigation.

Autor:	Chakrapani V; Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India.; National Institute of Advanced Studies, Bengaluru, India., Santos H; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America., Battala M; Population Council, New Delhi, India., Gupta S; Our Health Matters, Dehradun, India., Sharma S; Our Health Matters, New Delhi, India., Batavia A; TWEET Foundation, Bangalore, India., Siddiqui SJ; Transmen Collective, New Delhi, India., Courts KA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America., Scheim AI; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America.; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada.; Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2024 Oct 29; Vol. 4 (10), pp. e0003506. Date of Electronic Publication: 2024 Oct 29 (Print Publication: 2024).
DOI:	10.1371/journal.pgph.0003506
Abstrakt:	Little research has examined the health care experiences of transmasculine people in India, where government initiatives to improve access to transition-related (also called gender-affirmative) care have recently been announced. We draw on data from 'Our Health Matters', a mixed-methods community-based participatory research project, to characterize the transition-related care experiences of transmasculine people in India. Peer researchers conducted 40 virtual qualitative interviews in Hindi or Marathi from July to September 2021. Between November 2022 and January 2023, 377 transmasculine people participated in a multi-mode survey available in five languages. Qualitative data were analysed with a combination of framework analysis and grounded theory techniques. Data were mixed using a convergent parallel approach. Transmasculine persons' care journeys began with information-seeking, relying on peers and internet searches. In choosing between the public and private healthcare systems, they weighed issues of quality and affordability: the public system was perceived as lower-quality and difficult to access but most could not afford private care, leading to delays in care. Indeed, unmet need was common; 36.4% of survey participants were planning but had not begun to receive transition-related care and 80.2% wanted at least one transition-related surgery. Although some participants encountered stigma and refusal of care when seeking hormones, survey participants reported largely positive experiences with their hormone prescribers, which may reflect the influence of peer referrals. Participants underwent psychological assessments prior to transition-related care, which some experienced as disempowering and a barrier to disclosing mental health challenges. Finally, participants who were able to access care reported improved well-being, although surgical dissatisfaction was not uncommon (26.2%). Trans-inclusive medical training and continuing education are critical to enhancing access to high-quality transition-related care. Transmasculine people generally relied on peers and grassroots organizations for information, system navigation, and financial assistance. Strengthening these existing community resources may improve access to care. Competing Interests: The authors have declared that no competing interests exist. (Copyright: © 2024 Chakrapani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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