Abstract
Correctly recognizing gender identity in population-based surveys is essential to develop effective public health strategies to improve the living conditions of transgender and gender-diverse populations, as well as to adequately collect data on cisgender individuals. This study aims to present the two-step measure as the best strategy for assessing gender identity in Brazilian surveys, thus we performed two separate analyses. Firstly, we conducted a systematic review concerning HIV-related care among Brazilian transgender and gender-diverse populations to assess the strategy used to identify participants' gender identity. Secondly, we re-analyzed data from a recent survey that included Brazilian transgender populations, comparing characteristics and health outcomes from the sample identified by single-item and by the two-step measure. Concerning the systematic review, from 6,585 references, Brazilian research teams published seven articles, and only one study used the two-step measure. Regarding this survey, the two-step measure recognized 567 cisgender and 773 transgender and gender diverse participants among the 1,340 participants who answered the questionnaire, whereas the single-item measure was able to recognize only 540 transgender and gender diverse people. Furthermore, 31 transgender women self-identified as "transgender men" on the single-item measure. Therefore, although scarcely used in Brazil, the two-step measure is a more accurate strategy to recognize gender identity.
Highlights
In the early 1990s, transgender appears as an umbrella term encompassing a wide spectrum of gender identity variations that share the incongruence between one’s current gender identity and one’s gender assigned at birth
As described in Box 1, most studies assumed that recruiting a sample from social organizations aiming to provide help to transgender populations, such as lesbian, gay, bisexual, transgender non-governmental organizations (LGBT NGO), would be enough to assure that participants were transgender people – an approach that, as peer-identification, we named as “trans-assumption”
The most used method to assess gender identity was peer-identification, or “trans-assumption”, in the context of respondentdriven sampling (RDS) and TLS, that is, researchers went to places where transgender people usually gather and asked them to self-identify and/or to refer their peers
Summary
In the early 1990s, transgender appears as an umbrella term encompassing a wide spectrum of gender identity variations that share the incongruence between one’s current gender identity and one’s gender assigned at birth. A subgroup of transgender people may seek medical gender affirmation – such as hormonal therapy and surgical procedures – transgender is not a nosological classification 1,2. Gender identities as social categories vary significantly across cultures. In Brazil, for example, subgroups of transgender populations may self-identify as travestis and/or trans(sexual) people 3. Both terms have strong cultural roots and political meanings outside the scope of this study 4. Travesti is a Latin American gender identity generally understood as a person who performs roles socially perceived as feminine without necessarily changing their primary sexual characteristics 5
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