Risk reduction strategies for transgender people regarding sexually transmitted diseases and health promotion: a systematic review of activist literature

Abstract

Transgender people are a heterogeneous and growing population in visibility and numbers. They face documented difficulties in accessing health care systems, mainly based on the lack of training of professionals and discrimination. In addition, the organization of health care systems is still largely based on a psychiatric and pathologizing approach that reduces the possibilities of intervention and excludes people from the health care system as well as research and policy-making. Multiple international studies document a high prevalence of HIV and other sexually transmitted infections in this population. This work is based on field initiatives in health promotion and emphasizes the recognition of the expertise of organizations and field actors with the aim of identifying applicable and acceptable approaches for intervention. We conducted a systematic review of activist literature from European organizations and French local associations. After analyzing the quality of the included documents, we performed a thematic analysis aiming at identifying the courses of action and strategies to be used for health promotion interventions and campaigns. The results highlight the multiplicity and expertise of associations in the field of harm reduction in sexual health. Transgender people face specific issues mainly related to social exclusion and inadequate health care systems. These issues are all the more important when people have a poor experience of medical services or exist outside of a heterosexual gender binarity. The implementation of strategies to promote the health of transgender people regarding sexually transmitted diseases requires major epistemic and social changes. Individuals themselves seem best equipped to deal with field challenges. Moreover, their concerns are in line with scientific data and policies promoted by the World Health Organization. The major difficulty seems to be linked to Western care systems and therefore associations should be put in a decision-making position for public health policies. For this presentation, the authors declare having no conflict of interest.