Experiences of transgender women/transvestites with access to health services: progress, limits, and tensions.

Given both the changes in sexual customs, norms and policies and the persistent patterns in Brazil, the article analyzes the experiences of transgender women/transvestites with access to health services and discusses sexual/gender discrimination and their demands for gender transition and AIDS prevention services. The study involved interviews with nine transgender women/transvestites 23-45 years of age from low-income strata in the Baixada Fluminense region of Greater Metropolitan Rio de Janeiro, Brazil, in 2016 and observation of contexts of prostitution and sociability. Compared to the violence experienced years previously, the narratives of transgender women/transvestites highlight important social strides. They report that health professionals do not discriminate against them based on their condition, although they resist calling them by their social names. This embarrassment and the structural problems of the Brazilian Unified National Health System (SUS) are minimized by the agency of trans women/transvestites in obtaining care, such as recourse to contact networks and awareness of their civil rights. The narratives on their search for body changes for transitioning often reveal a tense combination of the technologies offered by health services and those managed by transvestites themselves. Although AIDS policies focus on measures for trans women/transvestites, HIV prevention is not among their main demands on health services. There are subjective barriers for accessing services, resulting from internalized stigma and the association of HIV infection with their living conditions. Improvement in healthcare for the trans/travestite population requires a debate on structural problems in the SUS, the defense of its expanded view of care, and investments in professional training.