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      ATENÇÃO À SAÚDE DE LÉSBICAS, GAYS, BISSEXUAIS, TRAVESTIS E TRANSEXUAIS NA ESTRATÉGIA SAÚDE DA FAMÍLIA Translated title: HEALTH CARE FOR LESBIAN, GAY, BISEXUAL, TRANSVESTITE AND TRANSGENDER INDIVIDUALS IN THE FAMILY HEALTH STRATEGY Translated title: ATENCIÓN DE SALUD A LESBIANAS, GAYS, BISEXUALES, TRAVESTIS Y TRANSEXUALES EN LA ESTRATEGIA SALUD DE LA FAMILIA

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          Abstract

          Objetivo analisar a atenção à saúde prestada à população de Lésbicas, Gays, Bissexuais, Travestis e Transexuais na Estratégia Saúde da Família. Método estudo qualitativo desenvolvido em junho de 2014 com 12 enfermeiros, no interior do Ceará, Brasil, por meio de entrevista semiestruturada. Os dados foram organizados e analisados com base na análise categorial temática e eixos estratégicos da política nacional de saúde integral. Resultados as ações de promoção e vigilância da saúde eram reducionistas, fragmentadas, enviesadas em função da orientação sexual e afetadas pela baixa assiduidade, estereótipos e barreiras nos atendimentos. Esse contexto era agravado por lacunas na formação acadêmica, qualificação dos profissionais sobre sexualidade e dificuldade de implementação, monitoramento e avaliação da política de saúde. Conclusão a atenção à saúde prestada à população de Lésbicas, Gays, Bissexuais, Travestis e Transexuais na Estratégia Saúde da Família exige mudanças paradigmáticas desde o âmbito teórico-organizacional às relações de cuidado.

          Translated abstract

          Objective analyze the health care provided to the lesbian, gay, bisexual, transvestite and transgender population in the Family Health Strategy. Method qualitative study developed in June 2014 involving 12 nurses, in the interior of the state of Ceará, Brazil, through a semistructured interview. The data were organized and analyzed based on thematic categorical analysis and strategic axes of the Brazilian comprehensive health policy. Results the health promotion and surveillance actions were reductionist, fragmented, biased in function of the sexual orientation and affected by the low attendance, stereotypes and barriers in care. Gaps in the academic background, in the professionals' qualification about sexuality and difficulties to implement, monitor and assess the health policy aggravated this context. Conclusion the health care provided to the lesbian, gay, bisexual, transvestite and transgender population in the Family Health Strategy requires paradigmatic changes ranging from the theoretical-organizational sphere to the care relationships.

          Translated abstract

          Objetivo analizar la atención de salud prestada a la población de lesbianas, gays, bisexuales, travestis y transexuales en la estrategia Salud de la Familia. Método estudio cualitativo desarrollado en junio de 2014 con 12 enfermeros, en el interior del estado de Ceará, Brasil, mediante entrevista semiestructurada. Los datos fueron organizados y analizados con base en el análisis categorial temático y ejes estratégicos de la política nacional de salud integral. Resultados las acciones de promoción y vigilancia de salud eran reduccionistas, fragmentadas, sesgadas en función de la orientación sexual y perjudicadas por la baja asistencia, estereotipos y barreras en las atenciones. Ese contexto era agravado por deficiencias en la formación académica, cualificación de los profesionales sobre sexualidad y dificultad de implementación, monitoreo y evaluación de la política de salud. Conclusión la atención de salud prestada a la población de lesbianas, gays, bisexuales, travestis y transexuales en la estrategia Salud de la Familia demanda cambios paradigmáticos desde el ámbito teórico-organizacional hasta las relaciones de cuidado.

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          Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations

          Background Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers. Methodology LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and “outness,” and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals’ demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas. Results Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men. Conclusions The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients’ disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas.
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            "Never in All My Years... ": Nurses' Education About LGBT Health.

            In spite of recent calls for patient-centered care and greater attention to the needs of lesbian, gay, bisexual, and transgender (LGBT) patients, nurses still lack basic education about LGBT patient care and, as a result, may have negative attitudes, endorse stereotypes, and/or feel uncomfortable providing care. This study reports on education/training of practicing nurses and explores some of the reasons for nurses reporting feelings of discomfort with LGBT patient care. Transcripts from structured interviews with 268 nurses in the San Francisco Bay Area revealed that 80% had no education or training on LGBT issues. Although most said they were comfortable with LGBT patient care, some of their comments indicated that they might not be providing culturally sensitive care. Implications for nursing education and for policies and procedures of health care institutions are addressed.
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              Addressing Health Care Disparities Among Sexual Minorities.

              There is evidence of health disparities between sexual minority and heterosexual populations. Although the focus of lesbian, gay, bisexual, and transgender health research has been human immunodeficiency virus/acquired immunodeficiency syndrome and sexually transmitted infection among men who have sex with men, there are health disparities among sexual minority women. Using the minority stress framework, these disparities may in part be caused by individual prejudice, social stigma, and discrimination. To ensure equitable health for all, there is urgent need for targeted culturally sensitive health promotion, cultural sensitivity training for health care providers, and intervention-focused research.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rbaen
                Revista Baiana de Enfermagem
                Rev. baiana enferm.
                Universidade Federal da Bahia (Salvador, BA, Brazil )
                0102-5430
                2178-8650
                April 2019
                : 32
                : 0
                : e26475
                Affiliations
                [1] Crato Ceará orgnameUniversidade Regional do Cariri orgdiv1Departamento de Enfermagem Brazil jam.ex@ 123456hotmail.com
                [4] Crato Ceará orgnameUniversidade Regional do Cariri Brazil
                [3] Crato Ceará orgnameUniversidade Regional do Cariri Brazil
                [5] Crato Ceará orgnameUniversidade Regional do Cariri Brazil
                [2] Crato Ceará orgnameUniversidade Regional do Cariri Brazil
                Article
                S2178-86502018000100357
                10.18471/rbe.v32.26475
                3943094a-fa21-4ceb-9e35-944086b9da3e

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 15 May 2018
                : 13 November 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 35, Pages: 0
                Product

                SciELO Revista de Enfermagem

                Categories
                Artigos Originais

                Sexual Minorities,Comprehensive Health Care,Health Status Disparities,Primary Care Nursing,Primary Health Care,Minorías Sexuales,Atención Integral de Salud,Disparidades en el Estado de Salud,Enfermería de Atención Primaria,Atención Primaria de Salud,Minorias Sexuais,Assistência Integral à Saúde,Desigualdades em Saúde,Enfermagem de Atenção Primária,Atenção Primária à Saúde

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