Opening the closets of access and quality: an integrative review on the health of LGBTT populations

Abstract The research aimed to study the situations that condition access and quality of health care to lesbians, gays, bisexuals, transvestites and transsexuals (LGBTT) in health services from an integrative review of national and international literature, whose sample of 41 papers was selected in PubMed, Lilacs and SciELO databases from 2007 to 2018. Access and health issues of LGBTT people were discussed in three dimensions: relational, concerning intersubjective relationships among users and professionals; organizational, concerning the organization of services and work processes; and contextual, which covers the effect of vulnerable situations enmeshed with social determinants on the conditions of satisfaction of health needs. The related data showed that LGBTT populations are the target of prejudice, violence, and discrimination, which, added to different social indicators, engender a context of vulnerabilities in access and healthcare. It is necessary to transform health institutions’ practices and social relationships. Otherwise, there is a risk of increasingly warding off those populations from health services.

摘要 本研究旨在通过整合国内外现有文献，探究制约女同性恋者、男同性恋者、双性恋者、异装者与跨性别者（Lesbians, Gays, Bisexuals, Transvestites and Transsexuals，LGBTT）在医疗服务中获取照护的条件与照护质量的相关情境；研究于2007年至2018年间，从PubMed、Lilacs及SciELO数据库中筛选出41篇文献作为样本。
本研究从三个维度探讨LGBTT群体的医疗可及性与健康议题：一是关系维度，聚焦服务使用者与医护专业人员间的主体间互动关系；二是组织维度，关乎医疗服务体系与工作流程的组织架构；三是情境维度，涵盖与社会决定因素交织的脆弱处境对健康需求满足状况的影响。
相关研究数据显示，LGBTT群体是偏见、暴力与歧视的针对目标，加之各类社会指标层面的不利条件，进一步加剧了该群体在医疗可及性与照护服务中的脆弱处境。当前亟需变革医疗机构的服务实践与社会互动模式，否则将面临此类群体愈发远离医疗服务体系的风险。