Health care of sexual and gender minorities: an integrative literature review

an integrative literature review based on systematic steps, in MEDLINE, LILACS AND SciELO databases and/or electronic libraries. It was held from September to November 2018, with articles published between 2012 and 2017, available in full in Portuguese, English, and Spanish, addressing health care to that population group.

Results:

fourteen articles were included. Most of the articles were about the trajectory of individuals within health services and showed limitations and obstacles in the use of these services.

Final Considerations:

there is evidence that factors related to organization of services, attitude of professionals, stigma, and discrimination experienced undermine health care practices. Therefore, it is essential to carry out educational activities in health services and educational institutions.

Descriptors:
Sexual and Gender Minorities; Transgender Persons; Delivery of Health Care; Health Services; Review

TITLE	AUTHOR(S) YEAR COUNTRY	OBJECTIVE	METHOD	RESULTS	LEVEL OF EVIDENCE
A Política Nacional de Saúde Integral de Lésbicas, Gays, Bissexuais e Transgêneros (LGBT) e o acesso ao Processo Transexualizador no Sistema Único de Saúde (SUS): avanços e desafios ⁽ ¹³13 Popadiuk GS, Oliveira DC, Signorelli MC. The National Policy for Comprehensive Health of Lesbians, Gays, Bisexuals and Transgender (LGBT) and access to the Sex Reassignment Process in the Brazilian Unified Health System (SUS): progress and challenges. Ciênc Saúde Coletiva [Internet]. 2017[cited 2019 Jan 15];22(5):1509-20. Available from: http://www.scielo.br/pdf/csc/v22n5/1413-8123-csc-22-05-1509.pdf http://www.scielo.br/pdf/csc/v22n5/1413-... ⁾	Popadiuk GS, Oliveira DC, Signorelli MC. Brazil/2017	To analyze how the Transsexualizing Process has been implemented.	Descriptive Mixed Methods	It is observed that from 2008 onwards, the transsexual population started to receive care based on their specificities through ambulatories and hospitals qualified for the Transsexualizing Process. The quantitative data showed that there is a constancy in performing sexual reassignment surgeries, even though there is a need to expand access to this service.	LoE 4b
Addressing Health Care Disparities Among Sexual Minorities⁽¹⁴14 Baptiste-Roberts K, Oranuba E, Werts N, Edwards LV. Addressing Health Care Disparities Among Sexual Minorities. Obstet Gynecol Clin North Am [Internet]. 2017 [cited 2019 Jan 15];44(1):71-80. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28160894 https://www.ncbi.nlm.nih.gov/pubmed/2816... ⁾	Baptiste-Roberts K, Oranuba E, Werts N, Edwards LV. The United States/2017	To discuss health disparities among women of sexual minorities (lesbians, bisexual women, women who have sex with women).		Sexual minority women are more likely to report poorer physical and mental health and less access to health services.	LoE 4b
LGBT Identity, Untreated Depression, and Unmet Need for Mental Health Services by Sexual Minority Women and Trans-Identified People⁽¹⁵15 Steele LS, Daley A, Curling D, Gibson MF, Green DC, Williams CC, Ross LE. LGBT Identity, Untreated Depression, and Unmet Need for Mental Health Services by Sexual Minority Women and Trans-Identified People. J Womens Health (Larchmt)[Internet]. 2017 [cited 2019 Jan 15];26(2):116-127. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27898255 https://www.ncbi.nlm.nih.gov/pubmed/2789... ⁾	Steele LS, Daley A, Curling D, Gibson MF, Green DC, Williams CC, Ross LE. Canada/2017	To compare unmet mental health needs and untreated depression across four groups: heterosexual women, lesbians, bisexual women and transgender people.	Descriptive Cross-sectional	Higher rates of unmet mental health needs and untreated depression were identified in trans and bisexual participants partly explained by differences in social factors, including experiences of discrimination, lower levels of social support and systemic exclusion from health services.	LoE 4b
A grounded theory of bisexual individuals' experiences of help seeking⁽¹⁶16 MacKay J, Robinson M, Pinder S, Ross LE. A grounded theory of bisexual individuals’ experiences of help seeking. Am J Orthopsychiatry [Internet]. 2017 [cited 2019 Jan 15];87(1):52-61. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27148752 https://www.ncbi.nlm.nih.gov/pubmed/2714... ⁾	MacKay J, Robinson M, Pinder S, Ross LE. Canada/2017	To examine the demand for mental health services among bisexuals.	Descriptive Qualitative	The participants' narratives described mental health services as discriminatory, medicalizing, characterized by poor relationship with providers and being useless. Negative experiences led to greater stress and participants generally discontinued using the service.	LoE 4b
Health care availability, quality, and unmet need: a comparison of transgender and cisgender residents of Ontario, Canada⁽¹⁷17 Giblon R, Bauer GR. Health care availability, quality, and unmet need: a comparison of transgender and cisgender residents of Ontario, Canada. BMC Health Serv Res [Internet]. 2017 [cited 2019 Jan 15];17:283. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5395792/pdf/12913_2017_Article_2226.pdf https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	Giblon R, Bauer GR Canada/2017	To measure health inequities by comparing health care between transgender individuals and their cisgender peers.	Descriptive Cross-sectional	Unmet health needs are identified among transgender individuals when compared to their cisgender peers.	LoE 4b
Exploring Perceived Discrimination Among LGBT Individuals in Turkey in Education, Employment, and Health Care: Results of an Online Survey⁽¹⁸18 Göçmen I, Yılmaz V. Exploring perceived discrimination among LGBT individuals in Turkey in education, employment, and health care: results of an online survey. J Homosex [Internet]. 2017 [cited 2019 Jan 15];64(8):1052-68. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27645489 https://www.ncbi.nlm.nih.gov/pubmed/2764... ⁾	Göçmen I, Yılmaz V. Turkey/2017	To measure the perceived discrimination that lesbians, gays, bisexuals and transsexuals report in education, income, employment, and health care.	Descriptive Cross-sectional	LGBT individuals report experiencing discrimination in access to education, employment and health care.	LoE 4b
Barriers to Health Care Among Adults Identifying as Sexual Minorities: A US National Study⁽¹⁹19 Dahlhamer JM, Galinsky AM, Joestl SS, Ward BW. Barriers to Health care among adults identifying as sexual minorities: A US National Study. Am J Public Health [Internet]. 2016 [cited 2019 Jan 15];106(6):1116-22. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26985623 https://www.ncbi.nlm.nih.gov/pubmed/2698... ⁾	Dahlhamer JM, Galinsky AM, Joestl SS, Ward BW. The United States/2016	To assess the extent to which lesbian, gay and bisexual adults (18 to 64 years old) face barriers to health care.	Descriptive Cross-sectional	Members of the sexual minorities studied may be delayed or stopped receiving health care due to concerns or fears about disclosing their sexual orientation, lack of adequate prevention services, or absence of providers versed in the needs of these groups.	LoE 4b
Correlates of clinical breast examination among lesbian, gay, bisexual, and queer women⁽²⁰20 Lacombe-Duncan A, Logie CH. Correlates of clinical breast examination among lesbian, gay, bisexual, and queer women. Can J Public Health [Internet]. 2016 [cited 2019 Jan 15];107(4-5):e467-e472. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28026715 https://www.ncbi.nlm.nih.gov/pubmed/2802... ⁾	Lacombe-Duncan A, Logie CH. Canada/2016	To analyze compliance with breast cancer screening among women of sexual minorities.	Descriptive Cross-sectional	Perception of stigma and belief that the caregiver is uncomfortable with the patient's sexual orientation were identified as responsible for a lower demand for screening services.	LoE 4b
Saúde de Minorias Sexuais do Nordeste Brazileiro: Representações, Comportamentos e Obstáculos ⁽ ²¹21 Garcia CL, Albuquerque GA, Drezett J, Adami F. Health of sexual minorities in north-eastern Brazil: representations, behaviours and obstacles. J Hum Growth Dev [Internet]. 2016 [cited 2019 Jan 15];26(1):94-100. Available from: http://pepsic.bvsalud.org/pdf/rbcdh/v26n1/14.pdf http://pepsic.bvsalud.org/pdf/rbcdh/v26n... ⁾	Garcia CL, Albuquerque, GA, Drezett J, Adami, F Brazil/2016	To analyze Social Representations about health and the main iniquities, deadlocks, and challenges experienced by this minority group when accessing health services.	Descriptive Qualitative	The study population presented reductionist representations of health, sought health services from a healing perspective and faced challenges/obstacles in accessing health services.	LoE 4b
Dificuldades vividas por pessoas trans no acesso ao Sistema Único de Saúde ⁽ ²²22 Rocon PC, Rodrigues A, Zamboni J, Pedrini MD. Difficulties experienced by trans people in accessing the Unified Health System. Ciên Saúde Coletiva [Internet]. 2016 [cited 2019 Jan 15];21(8):2517-26. Available from: http://www.scielo.br/pdf/csc/v21n8/en_1413-8123-csc-21-08-2517.pdf http://www.scielo.br/pdf/csc/v21n8/en_14... ⁾	Rocon PC, Rodrigues A Zamboni J, Pedrini MD. Brazil/2016	To discuss the difficulties of transgender people in the metropolitan region of Grande Vitória, state of Espírito Santo, in accessing health services.	Descriptive Qualitative	The results pointed out disrespect to the social name, discrimination and diagnosis in the Transsexualizing Process as main limitations in access to the health system.	LoE 4b
Experiences of homosexual patients' access to primary health care services in Umlazi, KwaZulu-Natal⁽²³23 Cele NH, Sibiya MN, Sokhela DG. Experiences of homosexual patients’ access to primary health care services in Umlazi, KwaZulu-Natal. Curationis [Internet]. 2015 [cited 2019 Jan 15];38(2):1522. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26842074 https://www.ncbi.nlm.nih.gov/pubmed/2684... ⁾	Cele NH, Sibiya MN, Sokhela DG. South Africa/2015	To describe the experiences of homosexual patients who use primary health care services.	Descriptive Qualitative	Participants cited experiences of prejudice and stigmatization as the main reasons for not receiving adequate treatment from health care providers after gaining access to these services. Discrimination was noted by the participants when they received different treatment from heterosexuals.	LoE 4b
Navigating the System: How Transgender Individuals Engage in Health Care Services⁽²⁴24 Roller CG, Sedlak C, Draucker CB. Navigating the System: How Transgender Individuals Engage in Health Care Services. J Nurs Scholarsh[Internet]. 2015 [cited 2019 Jan 15];47(5):417-24. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26243380 https://www.ncbi.nlm.nih.gov/pubmed/2624... ⁾	Roller, CG, Sedlak C, Draucker, CB. The United States/2015	To describe the process by which transgender individuals engage in health care.		Participants report "challenging and frustrating" trajectories in health services.	LoE 4b
Cuidado com saúde: as travestis de Santa Maria, Rio Grande do Sul ⁽ ²⁵25 Souza MHT, Pereira PPG. Health care: the transvestites of Santa Maria, Rio Grande do Sul, Brazil. Texto Contexto Enferm [Internet]. 2015 [cited 2019 Jan 15];24(1):146-53. Available from: http://www.scielo.br/pdf/tce/v24n1/pt_0104-0707-tce-24-01-00146.pdf http://www.scielo.br/pdf/tce/v24n1/pt_01... ⁾	Souza, MHT; Pereira, PPG. Brazil/2015	To present the health care of transvestites in the city of Santa Maria, state of Rio Grande do Sul, Brazil.		In the rare situations in which they sought health services, they did not meet expectations or respond to users' demands.	LoE 4b
Survey of lesbian, gay, bisexual, and transgender people's experiences of mental health services in Ireland⁽²⁶26 McCann E, Sharek D. Survey of lesbian, gay, bisexual, and transgender people’s experiences of mental health services in Ireland. Int J Ment Health Nurs[Internet]. 2014 [cited 2019 Jan 15];23(2):118-27. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23473079 https://www.ncbi.nlm.nih.gov/pubmed/2347... ⁾	McCann E, Sharek D. Ireland/2014.	To explore the experiences and needs of LGBT subjects in relation to mental health services.	Descriptive Cross-sectional	Two-thirds of respondents felt that mental health services were unable to respond to health needs, while one-third felt they could not speak to their health care provider about LGBT issues. Most respondents felt that the team assumed they were heterosexual.	LoE 4b

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[1] Corresponding author: Jedison Feliciano Silva. E-mail: jedison.fs@gmail.com