Health of Lesbians, Gays, Bisexuals, Transvestites and Transsexuals: from Medical Training to Professional Activities

ABSTRACT Introduction The LGBT (Lesbian, Gay, Bisexual, Transvestite and Transsexual) population is inserted in a very specific context, in terms of their degree of vulnerability to disease, bringing challenges for the consolidation of the Sistema Único de Saúde (SUS) as a universal, integral and equitable system. Thus, medical practices for the implementation of actions aimed at the care of LGBT can contribute substantially to improving the quality of access to basic health services, but first, health practitioners must undergo medical education and training. Objective To analyze the medical training for health care of the LGBT population from the perspective of primary care physicians. Methods This is an exploratory, descriptive study, with qualitative analysis. The key subjects were 14 physicians who work in Primary Care. Semi-structured interviews were used for the data collection, and the Meanings Interpretation Method was used to produce the data. Results Two categories emerged; the first highlighted the importance of the construction of medical-scientific knowledge for LGBT health, pointing out deficiencies, from the curricular training of the medical course through to the training offered by the services. The second category outlined the fragilities of daily life in the health care of LGBT, pointing out the realities in LGBT health care in the health units. Conclusion there is an urgent need to disseminate and implement a National Health Policy for LGBT, as an effective tool for promoting human rights among medical professionals, from graduation through to professional practice.

摘要
引言 女同性恋、男同性恋、双性恋、易装癖与跨性别者（Lesbian, Gay, Bisexual, Transvestite and Transsexual，LGBT）群体在疾病易感性层面处于极为特殊的社会语境中，这为巴西统一卫生系统（Sistema Único de Saúde，SUS）推进全民性、整体性与公平性的卫生体系建设带来了诸多挑战。据此，面向LGBT群体的医疗照护实践可显著提升基础医疗服务的可及性与服务质量，但首要前提是医疗从业者需接受系统的医学教育与专项培训。
研究目的 本研究从基层医疗医师的视角出发，分析针对LGBT群体的医疗照护培训现状。
研究方法 本研究为探索性描述性研究，采用质性分析方法。研究对象为14名就职于基层医疗岗位的医师，数据采集采用半结构化访谈法，数据处理则采用意义诠释法（Meanings Interpretation Method）。
研究结果 本研究提炼出两大核心范畴：其一凸显了构建LGBT群体健康相关医学科学知识的必要性，同时指出从医学课程的学历教育到医疗机构的在职培训均存在明显短板；其二则梳理了LGBT群体医疗照护日常工作中的薄弱环节，揭示了各卫生机构在开展LGBT群体健康照护时面临的现实困境。
研究结论 当前亟需推广并实施针对LGBT群体的国家卫生政策，以此作为从医学教育阶段到临床执业全过程中，提升医疗从业者人权意识的有效工具。