lgbt people and discrimination in the area of healt in spain

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lgbt people and discrimination in the area of healt in spain
LGBT PEOPLE AND DISCRIMINATION
IN THE AREA OF HEALT IN SPAIN
Authorship.
Alberto Martín-Pérez Rodríguez.
Elena González Rojo
Nayra Marrero Jaén.
Jenifer Rebollo Norberto
This report is funded by ILGA-Europe under its 12th call for proposals within its Documentation
and Advocacy Fund – Data collection on LGBTI discrimination in health
With the collaboration of the Ministry of Health, Social Services and Equality.
Correspondence: Alberto Martín-Pérez Rodríguez [email protected]
Suggested citation: MARTIN-PÉREZ A, GONZÁLEZ E, MARRERO N, REBOLLO J. LGBT people and
discrimination in the area of health in Spain. FELGTB 2015.
List of acronyms:
ABF: [Person] assigned at birth as female
ABM: [Person] assigned at birth as male
ART. Assisted reproductive techniques
FELGTB. Spanish Federation of Lesbians, Gays, Transsexuals and Bisexuals.
DGI: Different Gender Identity
FGI: Female Gender Identity
GB: gay and bisexual [men]
GP: general practitioner
GRS: gender reassignment surgery
HIV: Human Immunodeficiency Virus
HPV: Human papilloma virus
ILGA-Europe: Association of Equality for lesbian, gay, bisexual , transsexual and intersex people
in Europe
LB: lesbian and bisexual [women]
LGBT: lesbian, gay, bisexual and transgender [people]
MGI: Male Gender Identity
MSSSI. Ministry of Health, Social Services and Equality
PHC: Primary healthcare.
SHC: Specialized healthcare.
STI: Sexually Transmitted Infection.
UTIG: Gender Identity Disorders Units
Introduction.
ILGA-Europe launched a call for member organizations November 2013 under their
Documentation and Advocacy Fund. The goal was to allocate grants to:
-
Explore the concept of “discrimination in health” and the diversity of barriers that
hinder access to appropriate and patient-centred healthcare of LGBTI people.
Document the reality of those discriminatory practices and barriers
Identify health policies, programmes and practices that successfully contributed to
overcome those barriers.
In a context where international (World health organization) and regional (European Union,
Council of Europe) organisations are increasingly aware of specific health inequalities faced by
LGBTI people, it is critical to ensure that LGBTI rights organizations are equipped with the
necessary knowledge and know-how in this area so that they can support policy maker’s
initiatives.
FELGTB proposal for this call consisted of a two section report consisting on:
-
A set of indicators of existence of health services, benefits and interventions for LGBTI
population in different Spanish Regions and variations between 2008 and 2014.
An online survey for LGBT population to explore different determinants of health and
the impact on their health and wellbeing.
In order to limit the scope of the study, we focused on three areas:
1) HIV prevention, testing, care and support services, policies and strategies.
2) Health care services related to transition process for transgender people.
3) Assisted reproduction services for lesbian and bisexual women.
With this report, the aim of FELGTB is to highlight inequalities in access to health care and
services and to use the produced information to reduce such inequalities and promote equal
coverage.
Background
Since health competences were totally devolved to the regional level in 2002, the Ministry of
Health, Social Services and Equality (MSSSI) is responsible for national coordination of
programs and for guaranteeing equitable functioning of health services across the country.
Regional service coverage and portfolios are coordinated by the Inter-territorial Council of the
National Health System (SNS). However, Regional Governments are entitled to include certain
services and benefits within their own portfolios which led to health coverage disparities. In
the case of HIV, as with many other public health areas, competences for prevention and
control are shared between the central government and the 17 autonomous communities (AC)
and 2 autonomous cities that are responsible for surveillance, prevention, care and social
assistance.
The austerity measures introduced by the conservative government after 2011 have led to
reduction of service coverage in the three following areas.
a) The budget for HIV prevention and control has been reduced in 75%-90% in 2012. The
funding for NGOs prevention programmes in 2012 dropped from € 3,8 million to € 1,00
million. Since NGO services were co-funded with regional budgets, the absence of
transferred funds from the Ministry to regional governments for prevention,
surveillance and control programs since 2012 provoked the closure of NGO and
services essential for MSM and transgender people. Some regions have stopped (or
significantly reduced) funding for NGO services and have not put in place public
alternative testing, prevention or support services. In addition, the Royal Decree
16/2012 of National Health System Sustainability withdraws illegal immigrants from
free medical care, being entitled only to emergency medical care and assistance with
pregnancy and childbirth. Numerous cases of exclusion from HIV antiretroviral
treatment have already been reported in some regions that are implementing the RD
16/2012 more consistently than others. It is noteworthy that, according to our data,
up to 90% of transgender sex workers in Spain are of migrant origin (MARTIN-PEREZ
2008 and NAVAZO 2008), do not contribute to the social security and thus are not
entitled to health care. It is estimated that 25%-30% are women living with HIV.
b) Health care for transgender people in Spain is rather unequal. The common services
portfolio of the National Health System does not include transgender health care
services so it’s up to regions to develop them. In Castile-Leon or La Rioja, the primary
health care centres are the only services in which transgender people can seek care
and they can not be referred to specialised services. Thus the quality of the care
provided will depend on the awareness and knowledge of the general practitioner
(GP). In these regions no surgery to adapt the body to the gender identity is available.
In Andalusia or Madrid the GP can refer patients to public Gender Identity Disorders
Units (UTIG), with specialised professionals and comprehensive care at the social
security costs and covering all aspects of transgender processes including plastic
surgery and GRS.
c) In some Spanish regions lesbian and single women are entitled to free assisted
reproductive techniques (ART). In other regions the interpretation of the Law of
Assisted Reproductive and Infertility Treatments of 2006 has been rather
discriminatory towards lesbian women. In November 2014 the MSSSI established that
only couples with sterility can benefit from ART, which, in practice exclude women
without biological sterility but who can not conceive due to absence of a male partner.
Sterility is defined in the legislation as “failure in achieving successful pregnancy after
12 months of unprotected vaginal intercourse” a rationale discriminatory for lesbian
couples. Regions such as Extremadura have stated that they will nevertheless offer
ART to lesbian and single women, at the region’s own expenses. Under a restrictive
and discriminatory common criterion, this will create social, economic and geographic
inequalities among women in accessing these services.
Goals
-
To assess the public coverage of specific health services for LGBT people in Spain,
more specifically:
o Assisted Reproductive Techniques for single women and couples of women.
o Comprehensive Health Care for transgender people.
o HIV and STI prevention, testing care and support services
-
To assess the impact of budget cuts in coverage of these services
-
To assess the declared and perceived health status of LGBT Spanish people, their
preventive practices and their experiences of discrimination in accessing health care
and using health services.
Methodology
In order to build the online questionnaire, we reviewed different surveys and questionnaires.
Finally the documents that helped us more in shaping our questionnaire were:
-
Lambda Legal. When health care isn’t caring. Lambda legal’s survey on discrimination
against LGBT people and people living with HIV
Rainbow Health Initiative. Voices of Health. A survey of LGBTQ health in Minnesota
(2012)
LGBT Centre for health and wellbeing. LGBT community needs assessment report
(2007)
Spanish National health survey questionnaire. 2011-2012.
The questionnaire was tested by 25 volunteers who provided feedback and suggested
changes.
The final questionnaire was available online at www.encuestafacil.com between October the
2nd and November the 31st 2014. It was viewed 9.786 times and answered by 879 individuals.
Only 704 were finished and 685 where considered as valid.
We designed a set of 40 indicators to assess and monitor the level of availability and
development of health services and strategies of relevance to health of LGBT population.
Health Administrations and institutions are entitled to put into force such services, benefits
and strategies. However, we included within our set some indicators related to activities and
services delivered by NGO, as a way to have a complete picture of the degree of support that
these services obtain from the administration as complementary or alternative health services
for the target population.
We defined these indicators so that they could be answered with either “yes” or “no”. Each
“yes” was then assigned with 1 point, except for indicators 1 to 3 and indicator number 16.
Indicators 1 to 3 were given 2 points when answered affirmatively. They monitor very general
health topics/services related to LGBT health:
-
-
Guarantee of health coverage for all individuals despite their administrative situation.
This was particularly relevant for transgender sex workers. According to our services
and programmes data, up to 90% of transgender sex workers contacted to our HIV
prevention projects are migrant and up to 40% have an irregular administrative status
in the country. Also, Spain has become in recent years a destination residence country
for LGBT migrants, specially from South America, due to more advanced legislation
and perception of better social acceptance of sexual diversity.
Training offered by authorities to health professionals on LGBT issues.
Existence of services within the social services or health system providing mental
health counselling and support services to LGBT population.
Indicator 16 subtracts 1 point when answered affirmatively since it is a punitive measure.
However, we will in the future reshape the formulation for future monitoring.
Once reviewed, the set of indicators was sent to member organizations for its completion.
The questionnaire was sent to 39 professionals. Although e-mails were received from all of
them. Only 41% sent back the questionnaire filled.
The questionnaire was sent to different professional profiles:
-
Professionals working on health policies.
General Practitioners.
Staff and volunteers from our entities.
Civil servants working on health issues.
Reproductive care medical clinics.
Overall, the proportion of replies received to e-mails sent during the period under review
probably remains low because filling the questionnaire takes time and since the economic
crisis began professionals are quite overwhelmed.
When responses were not coherent, we looked for verification documents in order to validate
responses.
PART I
LGBT health survey
Results
1. Description of the sample
Our sample consists of 685 finished questionnaires. There were a total of 704 finished
questionnaires. Non-residents in Spain at the time of the survey (N=16), under-aged (N=1)
and/or heterosexual respondents who did not identified as trans people (N=6) were
eliminated for the analysis.
There were questionnaires from all Spanish Regions except for the autonomous cities of Ceuta
and Melilla. Madrid Region is the most represented in the sample with 158 questionnaires,
followed by the Region of Valencia (provinces of Alicante, Castellón and Valencia; N=114); and
Catalonia (Barcelona, Gerona, Lérida and Tarragona; N=85). Figure 1 shows the distribution of
the sample for Regions.
Fig 1. Region Sample Distribution
180
158
160
140
114
120
100
80
85
66
63
60
34
40
20
0
13
34
20
6
12
0
30
20
17
3
0
3
8
The majority of our respondents were Spanish born LGBT people (93%). 1,89% of the sample
consist of EU natives while 5,10% were born in a country outside the EU.
The main group of respondents were shaped by people from 18 to 39 years (74,6%). 50,5% of
respondents was assigned as men at birth and 49,2% as women. Two respondents reported
being intersexual individuals.
Cissexual men accounted for 45,7% (N=314), while cisgender women represented 43% of the
sample (N=295). Table 1 shows age, sexual orientation, civil status, and other sociodemographic characteristics of both cisgender men and women.
CISGENDER MEN
N=314
% (N)
Age
CISGENDER WOMEN
N=295
% (N)
18-29
30-39
40-49
50-65
>65
38% (119)
31% (98)
21% (67)
9% (29)
0% (1)
Gay
Lesbian
Bisexual
Queer
Not sure
Other
92% (290)
5% (16)
1% (4)
1% (3)
75% (221)
20% (59)
2%
(7)
0%
(1)
2%
(7)
Spanish nationality
EU native
Permanent permit of
residence
Temporary permit of
residence
Student visa
98% (307)
2% (5)
0% (1)
98% (285)
0% (1)
1% (3)
Married/legally recognized
partnership
Widow/separated/ divorced
Single
Cohabiting with partner
Not cohabiting with partner
Other
16% (50)
4% (12)
44% (138)
16% (49)
18% (56)
3% (8)
6%
27%
21%
23%
7%
Same sex
Different sex
98% (150)
2% (3)
93% (174)
7% (13)
Yes
No
4% (11)
96% (303)
17% (50)
83% (242)
Unfinished primary studies
Finished primary
Secondary
Technical
Universitary
Post-degree
Other
1%
(3)
6% (18)
15% (44)
20% (59)
41% (120)
14% (42)
2% (6)
1% (3)
5% (16)
14% (43)
18% (58)
39% (122)
23% (71)
0% (1)
Sexual Orientation
Administrative
situation
Civil Status
Sex of partner
Children under care
Education level
Labour situation
Full time student
Full time employee
Part time employee
Unemployed, registered
Unemployed, unregistered
Pensioner (health/disability)
Retiree
Migrant irregular situation
Submerged economy
I’d rather not answer
Other
Monthly income
<550 €
551 - 800 €
801 - 1050 €
1051 – 1300 €
1301 – 1550 €
1551 – 1850 €
1851 – 2250 €
2251 – 2700 €
2701 – 3450 €
<3450€
I’d rather not answer
24%
34%
13%
14%
2%
2%
1%
0%
2%
1%
7%
(69)
(99)
(37)
(40)
(6)
(7)
(2)
(1)
(7)
(3)
(21)
36% (104)
11% (31)
7% (19)
12% (35)
7% (20)
6% (17)
6% (16)
2% (6)
1% (2)
0% (1)
13% (38)
48% (141)
32% (95)
17% (49)
3% (9)
0% (1)
0%
(1)
1%
(2)
20% (58)
(17)
(79)
(62)
(67)
(13)
18% (57)
43% (134)
9% (27)
16% (49)
4% (13)
2% (6)
2% (6)
0% (0)
1% (3)
1% (2)
5% (17)
26%
10%
11%
9%
12%
6%
8%
4%
2%
1%
12%
(82)
(31)
(33)
(18)
(37)
(18)
(24)
(13)
(6)
(3)
(36)
Among women, a small percentage chose to identify themselves with other than the proposed
categories. 5 of these 7 women identified themselves as pansexual. Overall, the vast majority
of men identified themselves as gay, with a small percentage of bisexual men. The small size of
this sample (16 individuals) must be taken into account during the following analysis. Among
women, the percentage of those who identified themselves as bisexual increases up to 20%.
We had a small sample of trans people in our survey (10,8% of the sample; N=74). We included
here all those respondents who answered other than “no” to question 7 (Do you identify
yourself as a non-conforming gender identity person –i.e. transsexual, transgender, trans or
gender variant-?). Additionally we had 2 respondents who identified themselves as intersex.
62% of respondents in this group stated having a gender identity opposite to the sex assigned
at birth. However, we found a significant percentage (16%) of people who currently do not
identify neither as men nor women. Also, there were an additional 16% of respondents in this
group whose gender identity is not clear. Figure 2 reflects the gender identities for this group
of respondents.
Fg 2. Gender identity of non-gender conformity respondents
16%
38%
16%
ABM - FGI
ABM - DGI
ABF -MGI
ABF - DGI
24%
5%
Not sure
ABM – FGI: I was assigned as a male at birth and currently my gender identity is female; ABM – DGI: I was
assigned as a male at birth and currently, I have a different gender identity; ABF-MGI: I was assigned as a
female at birth and currently my gender identity is male; ABF-DGI. I was assigned as a female at birth and
currently I have a different gender identity.
All ABM and ABF respondents in this group will be referred from now onwards as trans or
transgender women and men respectively, for clarity. However this is a reductionist measure
and might not explain the diversity of identities in this sub-group. Table 2 shows sociodemographic characteristics of transgender individuals. People who ticked “I don’t know/I’m
not sure” to the mentioned question number 7 were twelve respondents. Of those, three were
assigned as male at birth, eight as women and one stated being intersexual. These twelve
individuals are not included in table 2.
TRANS WOMEN N
=32
Age
TRANS MEN
N=30
18-29
30-39
40-49
50-65
>65
41% (13)
31% (10)
16% (5)
9% (3)
3% (1)
57% (17)
23% (7)
3% (1)
13% (4)
3% (1)
Gay
Lesbian
Bisexual
Heterosexual
Queer
Not sure/Other
12% (4)
25% (8)
12% (4)
34% (11)
3% (1)
12% (4)
3% (1)
13% (4)
7% (2)
37% (11)
13% (4)
27% (8)
Spanish nationality
Permanent permit of
residence
Without permit of residence
Other
97% (31)
3% (1)
97% (28)
0
Married/leg recogn.
partnership
Widow/separated/ divorced
Single
Cohabiting with partner
Not cohabiting with partner
Other
12% (4)
0
16% (5)
44% (14)
9% (3)
12% (4)
6% (2)
52% (15)
14% (4)
24% (7)
10% (3)
Same sex
Different sex
64% (7)
36% (4)
55% (6)
45% (5)
Yes
No
9% (3)
91% (29)
0
97% (29)
No. Not finished primary
Completed primary
Secondary
Technical
Universitary
Post-degree
Other
6%
9%
22%
28%
25%
6%
3%
(2)
(3)
(7)
(9)
(8)
(2)
(1)
0%
21%
17%
17%
31%
10%
3%
Full time student
Full time employee
Part time employee
Unemployed, registered
Unemployed, unregistered
Pensioner (health/disability)
Retiree
Migrant irregular situation
Submerged economy
I’d rather not answer
Other
28%
22%
3%
16%
9%
0%
3%
0%
9%
3%
6%
(9)
(7)
(1)
(5)
(3)
(0)
(1)
(0)
(3)
(3)
(2)
21% (6)
28% (8)
0% (0)
28% (8)
7% (2)
0% (0)
0% (0)
3% (1)
7% (2)
0% 0)
7% (2)
35% (11)
3% (1)
6% (2)
3% (1)
6% (2)
0% (0)
3% (1)
3% (1)
0% (0)
3% (1)
35%(11)
44% (12)
4% (1)
4% (1)
15% (4)
7% (2)
0% (0)
0% (0)
4% (1)
0% (0)
0% (0)
22% (6)
Sexual Orientation
Administrative
situation
0
0
Civil Status
Sex of partner
Children at home
Education level
Labour situation
Monthly income
<550 €
551 - 800 €
801 - 1050 €
1051 – 1300 €
1301 – 1550 €
1551 – 1850 €
1851 – 2250 €
2251 – 2700 €
2701 – 3450 €
<3450€
I’d rather not answer
3%
3%
(1)
(1)
(0)
(6)
(5)
(5)
(9)
(3)
(1)
Respondents whose monthly average income is under 550 € are mostly full time students
(40%) or unemployed persons either registered or not under the National Employment
Institute (31%). This is valid for both cisgender and transgender respondents.
2. Perceived health and social support. Mental health.
Overall, the vast majority of respondents considered that they had a very good (28%) or good
(55%) health status in the previous year. 14% of respondents reported a regular health status
in the last 12 months, while just a small percentage reported a bad (2%) or very bad (1%)
health.
We don’t appreciate relevant differences between cisgender men and women. Transgender
women perceived health status is also similar to cisgender men’s and women’s except for a
slightly higher percentage of trans women who perceived their health in the previous year as
being bad (3%). Transgender men declared higher rates of very good perceived health (38%)
but also of bad (7%) or very bad (3%) health. The groups for which the fork between regular
and very bad is wider are bisexual women, transgender men and transgender women. Figure 3
shows perceived health status for gay, lesbian, bisexual and transgender men and women.
Perceived health status for unemployed respondents and pensioners was slightly worse. 22%
declared having had regular health in the past twelve months, 4% bad and 2% very bad. In the
case of respondents older than 50, the perception was also slightly worse when compared to
the media. Only 18% declared having had a very good health status, with 61% reporting it to
have been good and 18% regular.
transgender men
38%
bisexual men
41%
19%
gay men
10%
69%
29%
7% 3%
6% 6%
56%
14% 1%
very good
good
regular
transgender women
22%
59%
16%
3%
bad
very bad
bisexual women
25%
lesbian women
49%
27%
0%
10%
22%
53%
20%
30%
40%
50%
60%
70%
80%
2%
14%
2% 1%
90%
100%
Fig. 3. Perceived health status
We assessed mental health asking survey respondents about recent feelings of sadness and
depression. Three quarters of respondents reported having felt sad or depressed one or more
days in the last month. Almost one third (31%) felt sad or depressed for 1-2 days while 24% felt
sad or depressed for 3 to 7 days.
The percentage of those who responded negatively to the question is significantly higher for
cisgender men (29%), than for cisgender women (22%). Among transgender respondents, 19%
of women and 17% of men had not recently felt sad or depressed. Transgender women,
however, scored higher than any other subgroup in sadness and depressive feelings for longer
than 21 days (9%).
Results were slightly worse for bisexual women and men compared to lesbian women and gay
men respectively. Thus, depressing or sad thoughts for 8 to 15 days were more prevalent for
bisexual women (14%) and men (19%) than for lesbians (7%) and gay men (10%). Figure 4
shows differences for LBT women and GBT men.
transgender men
17%
bisexual men
28%
12%
24%
19%
10%
38%
14%
19%
3%
6% 6%
no
gay men
30%
28%
21%
10% 4%5%
1 - 2 days
3 - 7 days
8 - 15 days
transgender women
19%
28%
28%
3% 12%
9%
16 - 21 days
21 - 31 days
bisexual women
14%
lesbian women
36%
25%
0%
10%
32%
36%
20%
30%
40%
14% 2%
27%
50%
60%
70%
80%
NS
7% 2%
90% 100%
Figure 4. Feelings of sadness or depression in the previous month
Depressive and sad thoughts were also more prevalent among unemployed and retired LGBT
respondents compared to the media, with only 19% declaring not having feel depressed in the
last month against 43% for the global sample.
It is also worth noting that 15% of our survey respondents stated having ever had suicidal
ideas in the previous year. The percentage of respondents with suicidal ideas is slightly higher
for men (15%) than women (12%). Looking at sexual orientation, bisexual people had higher
rates of suicide thoughts, specially bisexual men, for whom over one third of respondents
(38%) responded affirmatively. However, as we anticipated, we need to take into account the
small representation and size of bisexual men in our sample. Suicidal ideation seems to be
especially prevalent among people who identified themselves as transgender women. While
accounting only for 9% of those who had suicide ideas in the last twelve months, 28% of
transgender women responded affirmatively to this question. Figure 5 shows the distribution
of suicidal ideation for our six subgroups.
When filtered by employment status, we see that rate of suicidal ideas in the previous 12
mohts rises up to 25% for unemployed and retired respondents. No significant age differences
were appreciated.
transgender men
14%
79%
bisexual men
7%
38%
gay men
56%
14%
6%
84%
2%
Yes
No
transgender women
28%
bisexual women
62%
15%
lesbian women
80%
11%
0%
9%
5%
88%
10%
20%
30%
40%
50%
NS
1%
60%
70%
80%
90%
100%
Fig 5. Have you seriously thought of committing suicide in the last 12 months?
We introduced a question in our survey to assess lack of food in the previous four weeks as an
indicator to the level of resources. Next figure shows how overall about 90% of respondents
were not deprived of food.
a complete day without eating
96%
1% 1% 2%
never in the last 4 weeks
went hungry to bed due to lack of food
91%
6%
1% 1%
sometimes
often
I'd rather not answer
not enough food at home
80%
88%
85%
Fig 6. Lack of food and hunger in the last 4 weeks.
7%
90%
3%
95%
2%
100%
We asked our respondents about perceived social support in different fields such as labour
and education or the neighbourhood of residence. We also inquired about perceived support
from partners, friends and family members. The majority of respondents acknowledged having
social support at all mentioned fields and from all groups of persons. Fig. 7 shows the extent of
perceived support for the whole group of respondents.
Partner
63%
Friends
4%
33%
91%
6% 3%
Yes
Family
80%
16%
4%
No
Don't have
Neighbourhood
48%
Workplace / School
31%
60%
0%
10%
20%
30%
20%
19%
40%
50%
60%
70%
21%
80%
90%
100%
Fig. 7. Perceived social support
We highlight that neighbourhood was perceived as the less supportive environment where
almost one of every three respondents answered negatively. Universities and high schools, as
well as the workplace were perceived as supportive for 6 of every ten respondents.
Family support was reported by 80% of respondents, ten points below support obtained from
friends. Putting aside the 33% of respondents that stated not having a partner, 94% said that
they felt they had enough support from their partners.
However the rates of obtained social support were significantly lower for transgender
individuals in all categories except for partner support, when compared to cisgender men and
women as can be seen in figures 8 to 10.
Partner
47%
3%
Friends
51%
81%
12%
7%
Yes
Family
73%
23%
4%
No
Don't have
Neighbourhood
41%
Workplace / School
40%
0%
10%
20%
40%
19%
24%
30%
40%
50%
36%
60%
70%
80%
90%
100%
Fig. 8. Perceived social support. Transgender respondents
Partner
73%
Friends
4%
23%
94%
3%2%
Yes
Family
82%
15%
3%
No
Don't have
Neighbourhood
51%
Workplace / School
29%
68%
0%
10%
20%
30%
40%
Fig. 9. Perceived social support. Cisgender women
20%
15%
50%
60%
70%
80%
16%
90%
100%
Partner
58%
Friends
4%
38%
89%
7%
3%
Yes
Family
80%
16%
4%
No
Don't have
Neighbourhood
47%
Workplace / School
31%
58%
0%
10%
20%
30%
21%
20%
40%
50%
60%
70%
22%
80%
90%
100%
Fig. 10. Perceived social support. Cisgender men
We could also appreciate differences between men and women, with men reporting lower
rates of perceived support at the workplace or neighbourhood. It is also worth noting that the
rate of bisexual men who stated not receiving enough support from their friends is 31%
compared to 7% for the global of men. There were no significant differences between lesbian
and bisexual women.
3. Right to health care and use of health services.
Our sample consists mainly of respondents with access to public health care (96%), which is a
significant bias taking into account the original aims of our study1. Besides, within the
remaining 4% we found a large proportion of civil servants with private health insurance
provided by the Administration or people who reported having access to public health care in
a different region, where they are registered as residents. This reduces the number of people
not covered either by public or private healthcare to three individuals. Furthermore, 21% of
respondents declared having an additional private medical insurance policy.
While finding no significant differences by sex (22% of women against 19% of men), gender
identity (21% of cisgender people. 22% of transgender) or sexual orientation except for
bisexual men (6% of respondents against 23% of lesbian women; 21% of gay men; 20% of
bisexual women), we noticed that the percentage of married people with private medical
insurance was higher (38%) than for the overall sample.
79% of respondents needed to visit a health care centre in the last twelve months. This rate
rose to 83% for unemployed and retired respondents. None of them stated access barriers in
that/those occasion/s. In 59% of the occasions the health problem was not related to the list
1
We wanted to assess whether and how the changes introduced by the Government in 2012 were
affecting migrant LGBT people in accessing health care.
proposed in the survey questionnaire. Of those listed, anxiety (17%) and HIV (12%) were the
most reported health problems. These two health problems were slightly more prevalent for
unemployed and retired respondents (20% anxiety and 14% HIV infection).
9% of respondents reported that the problem they had sought health care for was depression
(15% in the case of retired and unemployed) and an additional 9% reported
asthma/emphysema /chronic bronchitis.
350
302
300
250
200
150
100
50
87
62
49
13
33
5
0
1
7
49
19 12
2
2
0
0
9
13
4
19
4
26
4
7
Fig 11. Health related problems for which you have sought health care in the last 12 months
4. Visibility and concealment of gender identity/sexual orientation patients to
health practitioners.
We asked our respondents whether the health professionals they had been in contact with,
knew about their gender identity or their sexual orientation, both in primary health care (PHC)
settings and specialized health care (SHC) services.
The response was affirmative for 43% of respondents in relation with general practitioners and
other health professionals at PHC settings. In the case of professionals at SHC services, 36% of
respondents answered affirmatively, which suggest lower visibility or trust for disclosure.
However results differ when compared by gender identity and sex as shown in table 3.
Visibility of transgender respondents to both PHC and SHC professionals was higher.
Yes
No
NS
NP
WOMEN
PHC
SHC
72%
59%
19%
19%
09%
12%
3%
TRANSGENDER
MEN
PHC
SHC
66%
59%
28%
24%
07%
07%
10%
MEN AND WOMEN
PHC
SHC
62%
53%
27%
23%
10%
11%
10%
CISGENDER
WOMEN
MEN
PHC
SHC
PHC
SHC
45%
39%
48%
29%
36%
34%
31%
34%
19%
15%
21%
23%
12%
12%
Table 3. Visibility of gender identity / sexual orientation to health professionals
PHC: Primary healthcare settings. SHC: Specialized health services. NS: Not sure. NP: I am not currently a
patient at any specialized health service.
Thus, in PHC settings we appreciated that transgender women are more visible (72%) when
compared to transgender men (66%), lesbian and bisexual women (45%) and gay and bisexual
men (48%). Visibility is also significantly higher in SHC settings for trans patients than for LGB
cisgender men and women. This result makes sense, since sexual orientation can easily be
concealed while, in many occasions, non-conforming gender identity can’t be. Even when the
difference in terms of visibility to general practitioners and other PHC professionals is not
significant between LB women and GB men, the percentage of visible women is only slightly
lower, which contradicts the discourse of much higher concealment of sexuality for lesbian
and bisexual women. This is much more evident in the case of specialized health care, where
the situation is actually reversed with higher visibility for lesbian and bisexual women.
80%
72%
70%
66%
59%
60%
50%
45%
59%
48%
T women
39%
40%
T men
29%
30%
LB women
GB men
20%
10%
0%
PHC
SHC
Fig 12. Rates of visible LGBT patients to their health professionals in primary (PHC) and specialized
health care (SHC)
When health professionals in PHC knew the gender identity or sexual orientation of our
respondents it was mainly because respondents themselves told them (85%). In 6% of cases,
practitioners discovered the respondent’s gender identity or sexual orientation because the
information was available in another patient health file. 3% stated that someone else (a
relative or acquaintance) had disclosed the respondent’s gender identity or sexual orientation
to health professionals. Most of the responses contained under the category “other” (5%) do
actually go deeper in how they disclosed themselves rather than offering another different
explanation. However, we found eloquent quotes such as “I didn’t have to, it was a health
service for LGBT people”, or a plain “I’m a transgender person. It is evident to everyone”.
With respect to whether LGBT patients feel at ease coming out to health professionals, 42%
responded affirmatively and 28% negatively. 30% said that sometimes they did not feel at
ease. These rates are different for transgender people, who felt less at ease (32% responded
affirmatively and 34% negatively, the remaining 34% marked “sometimes”). GB men felt much
more at ease (47% responded affirmatively and 25% negatively) than LB women (38%
affirmative, 29% negative).
In the case of transgender people, even if their visibility was higher, the rate of active
disclosure of their gender identity is actually lower (67%). In 20% of the cases their general
practitioners found out about their gender identity in another medical reports. The reasons
mentioned by transgender respondents for not to disclosing to general practitioners were “I
don’t think it is relevant” (41%); “I haven’t had the occasion to tell him/her” (44%); “I’m afraid
of being discriminated against if they find out” (30%).
In 90% of cases, visible lesbian and bisexual women had actively disclosed themselves. This
rate was slightly higher than gay and bisexual men (86%). Only in 3% of LB women cases and
5% of GB men cases, this information was available to the PHC professional through medical
reports of the patient.
The reasons of LB women for not disclosing their sexualities to health professionals were “I
don’t think it’s relevant” (52%); “I haven’t had the occasion to tell him/her” (55%); “I am afraid
that they would tell my relatives” (4%, 7), “I’m afraid of being discriminated against if they find
out” (11%, 18).
In the case of GB men, the most mentioned reason was “I don’t think it is relevant” (66%);
followed by “I haven’t had the occasion to tell him/her” (57%, 89) and “I’m afraid of being
discriminated against if they found out” (9%, 14). A small 3% (4) feared that GP would tell their
relatives if they found out”
Only one woman and two men stated that they positively knew that other LGBT patients had
been discriminated against by their GP.
When we move to the area of specialized health care, we found that for those transgender
men and women whose doctors and/or nurses were aware of their gender identity, the main
reason was, once more, that they told them themselves (41%). However, awareness is largely
related to the health professional speciality: in 31% of cases these were health professionals
related to their transition process. Information about their gender identity was available in
other medical reports in 21% of the cases. Amongst reasons of transgender respondents for
not coming out to health professionals in SHC we found: “I don’t think it is relevant” (35%), “I
haven’t had the occasion to tell him/her” (38%); “I am afraid of being discriminated against if
they knew (27%)” A significant 27% responded “other”. When explained, reasons were mainly
variations for “I don’t think it is relevant” or “I fear discrimination”.
As with PHC, the reason why LB women and GB men were visible to health professionals in
SHC was mostly because they told them themselves (91% and 84% respectively). This again
poses the question whether LB women disclose more their sexual orientation or not as
literature and discourse suggest. In the case of GB men, information about their sexual
orientation was available to the health professional in medical records largely in relation with
sexual transmitted infections (STI) background.
Mentioned reasons by LB women and GB men respectively for concealing sexual orientation
were: “I don’t think it is relevant” (61%; 69%); “I haven’t had the occasion to tell him/her”
(47%; 56%), “I am afraid that they would tell my relatives” (3%, 2%), “I am afraid of being
discriminated against if they find out” (12%, 8%). 4 respondents stated that they knew
positively that other patients have been discriminated by his/her SHC doctor/nurse.
Apart from higher rates of fear of discrimination for transgender respondents, we appreciate
in figures 13 and 14 that they perceived their gender identity to be more relevant for the care
they seek for. To this respect, cisgender men question more such relevance compared to
women, especially when it comes to SHC.
70%
66%
60%
55%
52%
57%
50%
44%
41%
40%
T men and women
LB women
30%
30%
GB men
20%
11%
10%
9%
4% 3%
0
0%
Not relevant
No occasion yet
Fear discrimination Fear they tell family
Fig. 13. Reasons for not telling GP and other PHC professionals about sexual orientation/gender
identity
80%
69%
70%
61%
60%
56%
47%
50%
40%
35%
T men and women
38%
LB women
27%
30%
GB men
27%
20%
12%
8%
10%
7% 6%
0%
Not relevant
No occasion yet
Fear discrimination
Other
Fig. 14. Reasons for not telling SHC professionals about sexual orientation/gender identity
5. Experiences of discrimination in health care.
Overall, 80% of our survey respondents stated not having ever been discriminated within the
Spanish Health Care System. 7% believed they have been discriminated against within the last
12 months due to their sexual orientation or gender identity. An additional 14% stated having
been discriminated for this reason more than one year ago.
However, 41% of transgender respondents, -double rate than for the global survey
respondents-, stated that they had suffered discrimination. In fact, 23% said that they had
been discriminated in the previous 12 months, and 23% prior to that, with obviously some
respondents responding affirmatively to both.
80% of lesbian women and 86% of GB men had not felt discriminated. This shows how women
felt they were discriminated against due to their sexual orientation slightly more frequently
than men.
As figure 15 shows, the setting where discrimination took place more often was a PHC centre
(39%), followed by hospital services (30%) and SHC services (21%). Emergency services were
mentioned by 14% of those who had ever been discriminated.
For 38% of respondents the experience of discrimination has influenced the decision to avoid
using the service where the discrimination took place if they needed it afterwards. A significant
30% mentioned this to be not completely but partly true. Finally, for one third this experience
had not influenced the use they make of the health care service at all.
Other
10%
NGO facilities
2%
Dentist
2%
Private mental health
5%
Workplace HS
1%
Insurance company services
8%
Private doctor
5%
Sexual health service
5%
Family planning
6%
Local health service
5%
Emergencies
4%
Hospital admission
7%
SHC centre
21%
Hospital consultation
30%
PHC centre
39%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Fig 15. Health care setting where sexual orientation or gender identity based discrimination took place
Our survey included an invitation to respondents to inform about concrete experiences of
discrimination within the health system with the aim to use them as examples for trainings
and to illustrate our report. Overall, we have compiled 135 stories in which the respondents
were either victims or witness to discrimination based on sexual orientation or gender identity.
This accounts for 19,7% of the total valid questionnaires.
8%
2%
13%
36%
Gay men
Bisexual men
transgender men
Lesbian women
35%
Bisexual women
4%
transgender women
Other
2%
Fig. 16. Distribution of reported stories of discrimination according to sexual orientation and gender
identity
Many of the stories reported by women relate to assumption of heterosexuality in
gynecological units or during medical anamnesis, which was also reported by cisgender men.
A significant part of the stories had to do with assumptions made by health professionals
about the individual sexual activity in relation to risk of HIV or STI infection. These stories go
both ways, resulting in proposition of unnecessary prevention measures and medical test for
gay and bisexual men as well as transgender women, and denial to lesbian women.
Lesbian and bisexual women also report lack of adequate HIV and STI prevention activities and
programs within the health system but they also criticize absence of preventive activities
conducted by NGO. Women complained that, in the eyes of many health professionals, having
sex with women equals to have no sex at all. Also, some women complained about the use of
medical material during gynecological exploration, inadequate for women who do not practice
penetration.
A large part of women also go deeper into discriminatory stories in accessing assisted
reproductive techniques under the public system schemes. Protocols and health promotion
materials applied or delivered to pregnant women do not contemplate the possibility that the
partner was another woman.
Another frequently denounced situation is also registered here as a concrete story. We refer
to not admittance of an unmarried or unregistered partner of the same sex as the companion
during hospitalization or at the medical consultation with the excuse that she or he is not a
direct patient’s relative.
In some cases the discriminatory situation is more directly related to HIV infection rather than
sexual orientation or gender identity. To this respect, we had the testimony of a witness to
violation of medical confidentiality in the waiting room to a medical consultation where a
nurse disclosed the HIV status of a gay man to other patients by a nurse. We also highlight the
testimony of a health professional working in the emergency unit of a big hospital, who had
been witness of discriminatory speech and prejudice against people with HIV coming from
other health professionals, before his own HIV positive status was accidentally made known to
them.
Also, many gay men report direct or indirect discrimination as blood donors. In Spain it is not
forbidden that gay men donate blood. However, in practice, many gay and bisexual men are
rejected as donors even if they have no blood-born disease or infection. Also many GB men
but some LB women as well received judgmental commentaries related to their sexual life,
sexual partners, friends or lifestyles. Another way in which health professionals can be
perceived as agents of discrimination occurs when they whisper and joke with colleagues in
face of LGTB patients.
Another story related to HIV status reflects a frequent situation in our country, where
interventions and medical test to people with HIV are postponed to the last place in the day
list, even if the intervention is not invasive, with the excuse that the operating or testing room
needs to be sterilized. One respondent related how he had to wait for hours to get an
abdominal scan even when he had been appointed much earlier and he had no skin injuries.
The same respondent explains also how he had to wait for hours to be fed after he had been
hospitalized in an intensive care unit after a car accident since he couldn’t fend for himself and
no health professional wanted to take care of feeding him due to his HIV status.
HIV positive respondents reported both direct and perceived discrimination at the dentist.
Transgender respondents reported frequent refusal from the part of health professionals to
name or treat them according to his or her physical appearance and/or gender identity.
Furthermore, one respondent related how she was about to be forced to use the male section
of the X-Ray room for a scan she had to have at the beginning of her transitioning process until
a doctor and a nurse (both female) interceded and allowed her to use the female section
instead.
A third situation reported by a transgender respondent relates to isolation to a one-patient
room during hospitalization, so that she did not have to share room either with women or
men. Finally another transgender person relates how the GP refused to request a hormone
profile test for the patient, under hormonal therapy, claiming conscientious objection.
Transgender patients also complained about lack of sensitiveness towards sexual diversity
from speech therapists.
With respect to our survey, one respondent felt that the questionnaire was itself
discriminatory since, being a transsexual woman she was not asked about mammography,
assisted reproductive techniques or cervical smear. She had also sent a message to our
Facebook profile to complain about this. We contacted her and explained why cisgender
women were asked about these aspects and transgender men as well (except for assisted
reproductive techniques) rather than transgender women, since we were (possibly naively)
assuming that transgender women that had undergone reassignment surgery were in closer
contact with gynecological services. One of the aims of our survey was to determine whether
people who were assigned as women at birth were accessing these services or not and
whether access was discriminatory.
Another woman complained that the terminology “second mother” included in question 29
was itself discriminatory towards the non-expecting mother.
Finally, another respondent complained that the questionnaire was not adequate for
intersexual respondents.
6. Perceptions about health professionals’ competence and training in LGBT issues.
Respondents were asked about their perceptions on competences and training about LBGT
issues of health professionals with whom they were in contact. Almost half the sample had a
positive perception, perceiving their training and competences to be good (32%) or very good
(12%). 27% thought that health professionals had no competence at all on LBGT issues and a
remarkable 26% of respondents were not sure whether they were competent and trained or
not.
7% of LG women thought that health professionals were very well trained and 26% thought
they were well trained. 35% thought they had no competence at all regarding LGBT issues,
while 28% were not sure. GB men mostly thought that heath professionals training and
competences were very good (18%) or good (36%). Only 15% believed that it was not good and
28% were not sure. Amongst transgender respondents, the rate of uncertainty about
competence and training of health professionals is the lowest, with just 10%. Their opinions
are, thus, more polarized between 47% believing that health professionals training is not good
at all and 39% believing it to be good (34%) or very good (5%).
GLOBAL
12%
T men and women 5%
32%
26%
34%
10%
27%
47%
4%
4%
very good
good
not sure
GB men
LB women
18%
7%
0%
36%
26%
20%
28%
28%
40%
15% 3%
35%
60%
80%
not at all
not in contact with HP
4%
100%
Fig 17. Perceptions about training and competences of health professionals (HP) about LGBT topics.
7. Relevant health topics
Survey respondents were asked to choose from a list of health topics those five which,
according to their opinion, were more important or should be taken into account more
seriously. They were then asked to order them.
Overall, the topic more frequently chosen was HIV infection. However this is not the case for
the three subgroups of population (LB women, GB men and T men and women) and the mean
position conceded to HIV infection varies from group to group.
For lesbian and bisexual women, the top 5 topics were 1) HIV infection (1,87), 2) Impact of
labour and school harassment (3,20), 3) Improvement of health professionals’ competence on
LGBT issues (2,94), 4) Equal access to health care (2,67), and 5) other STI including HPV (2,57).
For gay and bisexual men, these were 1) HIV infection (1,44), 2) other STI including HPV (2,41),
3) Impact of labour and school harassment (3,43), 4) equal access to health care (3,07) and
mental health (3,53).
Transgender men said the most relevant topics were: 1) Improvement of health professionals’
competence on LGBT issues (2,91), 2) equal access to health care (2,05), 3) Impact of labour
and school harassment (3,72), 4) health care for elderly LGBT people (3,69) and other STI
including HPV (2,36).
Finally, transgender women said the most relevant topics were 1) equal access to health care
(2,42) 2) Improvement of health professionals’ competence on LGBT issues (2,36) 3) HIV
infection (1,81) 4) Impact of labour and school harassment (3,47) and 5) health care for elderly
LGBT people (3,50).
8. Preventive behaviour in relation to HIV infection and other STI
Respondents were first asked about the number of sexual partners in the last month. We
observed evident differences between cisgender and transgender respondents, as well as
between men and women. While nearly half the transgender respondents did not have sexual
partners in the last month (52% transgender men, 46% transgender women), the rate for
cisgender men and women without a sexual partner in the last month was respectively 26%
and 36%.
100%
7%
2%
6%
90%
3%
3%
9%
80%
26%
6%
rather not say
70%
60%
17%
31%
57%
31%
21 to 50
11 to 20
50%
39%
6 to 10
40%
2 to 5
30%
20%
over 50
47%
52%
One
None
36%
26%
10%
0%
cisgender LB women
cisgender GB men
T women
T men
Fig 18. Number of sexual partners in the last month.
8.1. HIV prevention and testing practices of lesbian and bisexual women.
The set of questions related to prevention practices of lesbian and bisexual women with
respect to HIV infection and other STI showed the following results.
30% of women had never used sex toys for vaginal or anal penetration. Among those who had
ever used them, 74% did not use a condom the last time they shared a toy with another
person. 6% of respondents had never practiced fingering. Among those who did, the practical
totality (97%) had not used any kind of protection (condom or latex glove) the last time they
practiced fingering. Finally, 87% of respondents had never used any kind of protective barrier
to give oral sex to another woman. Fig. 19 shows use frequency of barriers for the 13% of
respondents that had ever used them. We highlight that 69% stated using barriers very rarely.
Those who explained further the occasions in which they used them under the category
“other” (9%) stated that they used them “when starting a relationship” or “when she’s not my
steady partner” mostly. The materials used were a dental dam (53%), a split-open condom
(56%) or plastic wrap (16%).
very rarely
sometimes
frequency
69%
12%
6% 3% 9%
frequently
always
other
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Fig 19. Frequency of use of latex barriers for oral sex among women
43% of respondents had never had sexual intercourse with a man. Among those who had, 76%
used a condom the last time they had sexual intercourse with a man. Reasons for not using a
condom in this last occasion were I thought it was safe (39%), neither my partner or I had HIV
(21%), I didn’t have a condom at hand (12%), I prefer sex without condoms (3%), I can’t afford
paying for them (3%). 21% offered a completely different reason including: my partner didn’t
want to use them; I was using other contraceptive method, I asked him to have regular STI
tests, or we were drunk.
With regard to HIV prevention and education activities, 56% of lesbian and bisexual women
stated that they had at least once attended a workshop or informative talk. For the 42% that
never attended this kind of activity, the main reason was I never had the chance (65%). Other
reasons stated were I consider I know everything I need to know about HIV (12%), I am not
interested in this kind of workshops or talks (5%), nobody organize this kind of activities in my
city (5%). An extra 12% added another different reason, among which we find I don’t think I
am at risk of HIV because I am a lesbian, or I pick information at my primary health care centre.
It is worth noting that no respondent stated not having ever participated in a workshop or
informative talk because she was discriminated due to her sexual orientation. However,
among women who have ever attended a workshop or a talk, 11% had felt discriminated
against due to their sexual orientation. An additional 7% of them are not sure whether they
were discriminated or not. Additionally as we mentioned above in chapter 5, lesbian and
bisexual women criticized the absence of preventive activities organized by NGO
4 of every 10 LB women had taken an HIV test at least once in their lifetime. The practical
totality of them did not feel discriminated of judged because their sexual orientation at the
HIV service where they were tested. However a small 4% did feel discriminated against. These
discriminatory situations took place mostly within a primary health care centre. In terms of
discriminatory attitudes of health care professionals, we highlight a small 2% of responses that
stated that they were denied an HIV test because the professional thought that she was not at
risk due to her sexual orientation rather than her sexual practices. However, main reasons for
not taking a HIV test were I consider I have not been at risk of getting HIV (73%), I never
thought about it (28%); and I don’t know where to get an anonymous and free HIV test. Among
the 9% who did not chose any of the given possibilities and marked “other” instead, a
significant majority of responses state that they get their HIV results as blood donors.
All LB women who had ever had an HIV test obtained a negative result in their last test, which
implies that no lesbian or bisexual woman with HIV answered our survey.
8.2. HIV and STI prevention testing and practices among gay and bisexual men.
53% of participant gay and bisexual men in our survey said they had used a condom the last
time they had intercourse. 40% did not use it, while 6% had never had anal intercourse.
Among men with HIV the rate of those who did not use a condom is lower than average (30%).
Among respondents who did not use a condom the last time (N=125), 79% did not use it with a
regular partner, while 20% had unprotected anal sex with an occasional sexual partner. 82% of
them have a negative HIV status, and 17% positive. Fig. 20 show what were the reasons for not
using condom.
Why didn't you use a condom the last time you had anal sex?
60
52%
50
40
30
22%
20
14%
10
10%
10%
6%
4%
2%
1%
Other
I can't affor paying
for condoms
I prefer
condomless sex
My partner had
HIV but his VL is
undetectable
I have HIV buy my
VL is undetectable
We both had HIV
Neither of us had
HIV
I considered the
sexual practice
had no risk
I dind't have one
at hand
0
Fig 20. Reasons for not using a condom the last time I had anal intercourse (gay and bisexual men).
In the case of men with HIV most frequent reasons for not using a condom were I have HIV but
my viral load is undetectable (56%) and both my partner and I have HIV (22%).
14% of men had ever received money, food or drugs in exchange for sex. Of these men,
(N=40), 26% had exchanged sex for money, food or drugs in the last twelve months. All of
them had received money, food or drugs in Spain, while 5% had also sold sex in a different
country. Among migrant cisgender male sex workers, none had sold sex in their country of
origin.
With regard to HIV prevention and education activities, 59% of gay and bisexual men stated
that they had attended a workshop or informative talk at least once, a percentage only slightly
higher than women (56%). However this rate is surprisingly higher (75%) for those men who
did not use a condom the last time they had anal sex. For the 34% that had never attended this
kind of activity, the main reason was I never had the chance (53%). Other reasons collected
were I consider I know everything I need to know about HIV (11%), I am not interested in this
kind of workshops or talks (11%), nobody organizes this kind of activities in my city (11%) and I
don’t trust the organizations giving these workshops or talks in my city (5%).
Among men who had ever attended a workshop or a talk, 6% felt discriminated against due to
their sexual orientation, a lower percentage compared to women (11%). Nevertheless, the
percentage of GB men who felt discriminated while having an HIV test because their sexual
orientation is higher than for LB women (12% against 4%).
The rate of men who had ever had an HIV test is also higher than women, as foreseeable. 82%
of gay or bisexual men had ever had an HIV test in their lifetime. The rate for those who did
not use a condom the last time they had anal sex is similar, even slightly higher (84%). Reasons
for not taking an HIV test included I didn’t thought about it (24%), I consider I have not been at
risk of getting HIV (66%), If I had HIV I’d rather not know (2%), I fear that results are not
confidential (10%) I don’t know where to get an anonymous and free HIV test (24%), I can’t
afford paying for it (5%), I fear opinions if they know I am taking an HIV test (5%), I fear that my
parents or relatives would be informed (7%), I fear my partner’s reaction if the result was
positive (7%).
12% of respondents reported having felt discriminated while taking an HIV test. Health
services where the situation felt as discriminatory took place were PHC centre (58%), SHC
centre, including GUM clinics (29%) or a pharmacy (3%). Other service mentioned was the
workplace medical services.
Among gay and bisexual men who answered our survey, the result of the latest HIV test was
positive for 24% of respondents. 2% had not received the results. Among the sub-group of
men who did not use a condom the last time they had anal sex, self-declared HIV prevention
prevalence is lower, 17%.
All of men with HIV declared having visited a specialist on HIV in the last year. Of these, 15%
stated having felt discriminated against by their doctors by reason of their sexual orientation.
8.3. Support groups for gay and bisexual men with HIV
65% of gay and bisexual men with HIV had never participated in a support group for people
with HIV. Among those who had used a support group, 82% chose the face-to-face modality.
74% of these support groups users had never felt discriminated by facilitators or by other users
because of their sexual orientation. However, 17% said they were not sure. 2 respondents said
they had felt discriminated specifically in a support group conducted by a LGBT organization
due to their sexual orientation, which shows the extent of intra-community stigma and
discrimination.
2%
5%
29%
never
65%
face-to-face
internet
both face-to-face & internet
Fig. 21. Use of support groups for people with HIV
We included in our questionnaire a question targeted to people with HIV in relation with the
frequency of visit to the dentist, since it has been used in other surveys as an indicator for
discrimination against people with HIV. In our survey, 77% of gay and bisexual men with HIV
had visited the dentist in the previous year. Among reasons for not going to the dentist, the
most frequent was I can’t afford it (53%) and I didn’t think it was necessary given my oral
health status (33%). Fear of being discriminated because of the HIV status was less frequent
(7%). Fear of being discriminated because of the sexual orientation as a reason for not visiting
the dentist was not mentioned by anyone.
8.4. Transgender women and men and HIV/STI prevention practices
We asked transgender men2 about their preventive practices regarding their past or current
use of sex toys. 40% of them had never practiced penetration with sex toys. Among the
remaining 60%, one half had used a condom the last time they shared a sex toy with another
person.
14% of transgender men in our survey had never practiced fingering. Among those who had,
89% did not use any kind of protective measure (glove, condom, etc). Protective measures for
oral sex were not widespread either: only 16% had ever used barrier methods for oral sex with
a woman, with only one respondent admitting to have always used them. 43% of transgender
men who had ever used them had done it occasionally; 29% did it very rarely and 14%
frequently.
2
Please, keep in mind that for analysis purposes we refer as “transgender men” all respondents who
were assigned as female at birth but whose gender identity is different that female. Likewise, all
individuals whose assigned sex at birth was male but whose gender identity is different that male are
considered as “transgender women”. We acknowledge that this choice is reductionist to binary
conception of sex and does not reflect the diversity of gender identities.
21% of transgender men and women had not practiced penis penetration, either insertive or
receptive. Condom use rate in the last sexual relationship with penetration was 63,7%.
However 15,5% of respondents chose not to answer this question. The percentage of condom
use on that last occasion decreased to 55,5% for transgender women. In the case of
transgender men, 52% have never had sexual intercourse, and the rate of condom use the last
time among those who used it rises to 85%.
Reasons for not using a condom the last time they had intercourse were I thought it was safe
(42%), neither my partner or I had HIV (25%), I didn’t have a condom at hand (25%), I prefer sex
without condoms (8%).
Contrary to most studies about transgender people and HIV, that focus so much in transgender
sex work, in our survey only 7 transgender individuals, six women and one men had ever
received money, food or drugs in exchange for sex, and only one of the women admitted to
have exchanged sex in the previous 12 year. They account for just 12% of our sample of
transgender individuals.
52% of our transgender sample admitted to have ever taken an HIV test, and 41% had not. The
remaining 7% were either not sure or preferred not to tell. 18% of transgender people who
had taken an HIV test felt discriminated at the HIV testing site, a percentage higher than GB
men (12%) and LB women (4%).
There were also differences between trans men and women in perceived discrimination
related to HIV testing. Except for pharmacies, every possible testing site category was
mentioned at least once as the place where the discriminatory situation took place, including
NGO.
GB men
88%
LB women
12%
96%
4%
No
Yes
T men
79%
T women
21%
89%
0%
10%
20%
30%
40%
11%
50%
60%
70%
80%
90%
100%
Fig 22. Have you ever felt discrimination in an HIV testing site because of your sexual orientation or
gender identity?
Reasons for never haven taken an HIV test include I didn’t thought about it (21%), I consider I
have not been at risk of getting HIV (79%), I don’t know where to get an anonymous and free
HIV test (3%), I can’t afford paying for it (3%), I fear opinions if they know I am taking an HIV
test (3%), I fear that my parents or relatives would be informed (3%), I fear my partner’s
reaction if the result was positive (3%).
Among transgender respondents who had ever had an HIV test, there were only two cases of
HIV infection –two women- (5%), and 5% preferred not to tell the result of their latest HIV test.
Both respondents with HIV infection had seen a specialist in the last year and one of them
stated having felt discriminated against by her specialist due to her gender identity.
9. Experiences and practices regarding gynecological consultation
Both lesbian/bisexual women and transgender persons who were assigned as women at birth
and whose gender identity is not female were asked about their preventive practices in
relation with visit to gynecological consultation.
84% of them had visited the gynecologist at least once. The rate of transgender individuals
here is significantly lower (66% against 85% among cisgender women) Asked about the last
time they visited the gynecologist for a reason not related to pregnancy or delivery, 52%
admitted to have done so in the last twelve months, while 33% did it between one and three
years ago. 13% have not visited the gynecologist in the last three years.
Respondents who had not visited the gynecologist were eminently young in both cases
(cisgender and transgender); overall, 80% have between 18 and 29 years.
Lesbian and bisexual
women (N=44)
Transgender individuals
assigned as female at
birth (N=10)
77%
16%
7%
90%
75%
18%
20%
Age
18-29
30-39
40-49
50-65
Sexual orientation
Lesbian
Bisexual
Heterosexual
Queer
Other
Finished studies
Incomplete primary
Completed primary
Complete secondary
Technical studies
University degree
Post-degree
Other
Income
< 550 €
551-800 €
801-1050 €
1051-1300 €
1301-1500 €
1501-1850 €
>1851 €
Rather not say
2%
5%
5%
7%
27%
25%
25%
9%
2%
10%
60%
20%
30%
30%
20%
10%
10%
39%
14%
7%
7%
5%
2%
40%
27%
50%
10%
Table 4. Socio-demographic characteristics of respondents who had never visited the gynecologist.
Women and transgender individuals who were assigned as women at birth and who are older
than 40 (N= 59 and N=5 respectively) were asked whether they had ever had a mammography.
In the case of women, 68% had at least one mammography in their lifetime. In 55% of the
cases the last mammography was covered under the social security schemes and 38% by a
private insurance policy. Cited reasons for never having had a mammography were I didn’t
need it yet because of my age (63%) I didn’t need it because of my health status (37%). One
respondent stated she didn’t had it because I fear being judged by health professionals for
being lesbian/bisexual (5%). Table 5 shows antecedents and symptoms associated to breast
cancer. Only one women in this age group had been diagnosed with breast cancer. Overall,
three women (1%) in our whole sample were diagnosed with breast cancer.
Breast cancer family background
Yes
No
Don’t know
27%
61%
2%
Symptomatology related to breast cancer
Mass or protuberance
Breast swelling, total or partial
Irritation of fissure in breast skin
Breast or nipple pain
Nipple contraction or retraction
Reddening or skin removal
Nipple secretion
None of these
15%
14%
3%
25%
0%
3%
5%
58%
Table 5. Family background and symptomatology related to breast cancer in lesbian/bisexual women
73% of lesbian and bisexual women had a cervical smear, but just 56% of them had it in the
previous year. In 60% of cases the last cervical smear was covered by the public health system.
31% of women had the last cervical smear it covered by a private insurance policy. 9% paid for
the test in a private clinic.
When asked for the reason why they had not had a smear test, most frequent answers
included I didn’t need it yet because of my age (46%) and I didn’t need it because of my health
status (51%).
Nevertheless, even if 76% of these women who had never had a smear were within the age
range of 18-29, 17% of them were over 30 years, and 7% between 40 and 49 years. 74% of
these women identified themselves as lesbians and 19% as bisexuals. 46% of them declared
that their monthly incomes were under 550 €. 56% of women who had never had a cervical
smear had never visited a gynecologist either.
Figure 23 illustrate the frequency of proposed reasons for never had taken a cervical smear.
Under the category “other”, reasons such as “I have been waiting for three years for an
appointment”, or “I feel shame” were included. For the rest, answers in this category are
mostly variations for “my doctor considered it was not necessary because of my sexual
practices/sexual orientation” categories.
It is worth mentioning that even if fear of anticipated discrimination from health professionals
was a reason for 6% of women, no actual previous discriminatory situation from the
gynecologist or another health professional was registered as a motive for never having a
cervical smear.
60%
51%
50%
46%
40%
30%
20%
17%
8%
10%
2%
2%
6%
2%
0%
Not needed
(Age)
Not needed
(Health
status)
Lack
resources
Can't affor gynecologist gynecologist afraid being
work leave
said not
said not discriminated
needed
needed
(sexual
(sexual
practices) orientation)
Other
Fig 23. Reasons for not having a cervical smear (N=72)
Among the five transgender over 40 who were assigned as female at birth, three had ever had
a mammography in their lifetime. In all three cases it was covered by the social security. In two
cases, there was a family background of breast cancer and related symptoms. However, no
transgender man (N=38) had ever been diagnosed with breast cancer.
57% of transgender individuals had had a cervical smear at least once in their lifetimes.
However, only 44% of smears were made in the previous year, and 38% were made more than
two years ago. In 69% of cases, the last cervical smear was covered by the public health
system. Reasons for not having a cervical smear include I didn’t need it yet because of my age
and I didn’t need it because of my health status. However most the 12 respondents who
haven’t had a cervical smear gave another reason including Nobody told me I needed to have
one, I don’t know what a cervical smear is or I am a transgender man and had an
hysterhectomy before I could even had one.
LB women
56%
27%
16%
1%
<12 months
12-24 months
>24 months
don't remember
Transgender
44%
0%
20%
12%
40%
38%
60%
80%
6%
100%
Fig. 24. Time since the last smear test
10. Use of assisted reproductive techniques (ART)
Almost half of cisgender participant women in our survey had never thought about using ART
for getting pregnant. 43% had discussed with a female partner about using them. An additional
8% thought about using ART to get pregnant as a single woman.
Among respondents who had ever thought about using ART either as a couple of women or as
a single woman, 68% had never actually followed a treatment with ART. 23% of respondents
had used them to become pregnant themselves (either single or in couple) and 13% of
respondents stated that their partners had used them so that she would become the nonexpecting mother. Within the group of women who had used ART, 51% had undergone
treatment for the last time in the previous year, 18% between one and two years ago, and 31%
more than two years ago.
In this last occasion the technique used for 22% of women was in vitro fertilization, partner’s
egg cell donation for 13% and insemination for 58%. Additionally, 9% mentioned mixed
techniques and one respondent mentioned donated embryo transference.
The coverage for the last ART treatment was private in 80% of cases. Women who had public
coverage for their treatment were registered in Valencia, Andalusia, Balearic Island and Canary
Island regions.
11% of women felt that they had been discriminated by health professionals the last time they
used ART. In these cases the coverage for the treatment was always private and took place in
Madrid, Balearic Islands, Andalusia and Valencia. This fact superposes to the actual
discrimination by the public health system (rather than health professionals) about which
women in the survey were not specifically questioned, but which is reflected in the
experiences of discrimination narrated by respondents.
When asked about reasons for not using a treatment with ART, 37% did actually chose “other”,
where almost all responses were either “it is too soon for me/us”, “I am/we are too young” or
“the economic situation is bad and I/we’d rather wait”.
40%
37%
34%
35%
30%
25%
20%
14%
15%
10%
6%
5%
7%
6%
2%
0%
I am already a I don't wish to Me and/or my
No public
Not covered by I'd rather not
mother
have a child partner do not coverage in my my private
answer
wish to have a
region
insurance
child
policy
Other
Fig. 25. Reasons for not using ART
11. Gender Units and health coverage for transition treatments
Gender Identity Disorder Units (UTIG) or Gender Units as the transgender community prefers
to name them are comprehensive health care services for transgender people, available in
some Spanish regions. They include endocrinology, psychiatry, psychology, gynecology,
urology, plastic surgery and services and cover diagnosis, treatment, surgery and post-surgery
care.
52% of respondents said that there was a gender unit in their region of residence. 24% said
there was not, and 24% said they didn’t know. A small minority of transgender respondents
who said there was no gender unit in the region, were living in cities where one such unit does
actually exist. Likewise, a couple of respondents who said there was a gender unit in the region
where they lived, were residents in regions where these units do not exist. This adds to the
lack of awareness of these services by potential clients.
As for the province of residence, 31% of respondents said there was a gender unit in the
province where they lived, 17% did not know whether a gender unit existed or not, and 52%
said that there was no gender unit in the province of residence.
Among respondents who did not know about the existence of a gender unit, 69% were
individuals whose gender identity is different to the one assigned at birth but who do not
identify as men or women. Also the rate of transgender women who did not know about the
existence of gender units is higher than transgender men. Respondents who were not aware
about the existence of gender units in their regions of residence were from the Basque
Country, Castilla y León, Castilla-La Mancha, Valencia, Madrid, Canary Islands, Madrid and
Catalonia. As mentioned, in some of these regions there are actually Gender Units.
51% of transgender respondents (54% men of transgender men and 44% of transgender
women) are not using the services of a gender unit. 40% (34% of men and 47% of women) are
using them in the same Region where they live and 9% (10% of transgender men and 9% in the
case of women) in a different region.
Among proposed reasons for not being a client of a gender unit, the most signaled was “other”
(52%) which includes different reasoning against sexual and gender binary conceptions
proposed by health professionals within these services. Other frequent reasons included the
not existence of these units in their residence area (16%) or not knowing if they existed (26%).
Fear of being discriminated was mentioned by 10% of respondents and actual previous
discrimination as a reason for not using a gender unit was given by 3% as a reason.
Almost half the gender unit clients used private transportation for arriving to the unit and
average time to destination was between one and two hours for 44%, one hour or less for 38%
and more than two hours for 19% of clients. No differences between men and women were
appreciable.
As for valuation of different aspects of these units, 62,5% declared that the location was
regular or good, easiness to obtain an appointment was valued as bad or regular by 56%,
health assistance was valued as being good, very good, or excellent by 72%, and 57%
considered that, globally, the units were regular or good. Figure 26 illustrates how clients of
gender units had a better opinion of the health assistance provided than of administrative
formalities to obtain an appointment or their geographical situation.
overall
16%
assistance
9%
19%
16%
38%
31%
19%
16%
9%
25%
3%
bad
regular
good
appointment
25%
31%
19%
12%
12%
very good
excellent
no answer
location
9%
0%
38%
10%
20%
30%
25%
40%
Fig 26. Valuation of gender units by clients.
50%
60%
16%
70%
80%
12%
90%
100%
14% of transgender respondents considered they had suffered discrimination as clients within
a gender unit due to their non-conforming gender identity, and 18% were not sure whether
they had been discriminated or not. They amounted to 17 cases in different provinces
pertaining the regions of Andalusia (4 cases), Canary Islands (3 cases) Madrid (3 cases), Aragon
(2 cases), Catalonia (2 cases), Castile and Leon (1 case) and Aragon (1 case). Many of these
discrimination cases were originated by refusal of transgender people to be labeled into binary
constructions of “man” and “woman” and the standardized models proposed by health
professionals of what the “result” of the transition process should be. Thus, many transgender
people who were not willing to undergo genital surgery felt discriminated. We could also
notice that three quarters of these cases of discrimination were against women rather than
men.
Despite the existence or not of gender units in specific regions, different specialized health
services are provided to transgender clients in the health system. We asked about the
availability of these services within the public system, as well as the use and valuation that our
respondents made of them.
Psychological or psychiatric services were reported to be positively available in the region of
residence in 67% of cases. Endocrine services for hormonal therapy were acknowledged to be
available in 61% of cases. Surgery for increase (breast implants), reduction or removal
(mastectomy) of breast was included in the available service portfolio in the region in 30% of
cases, as well as reassignment surgery. However it is worth noticing that 36% of respondents
said they were not sure about the health services available to them. Different services, such as
speech therapy or body hair removal, were rarely signaled in questionnaires. In the case of
speech therapy only respondents living in Madrid and Castile and Leon said this specialized
health service was available and publicly covered.
Figure 27 shows the rate of respondents that used these services and how were they valued.
We observe the tendency to have an opinion either too good or too bad about services such as
surgery related to breast volume (implants or mastectomy) or reassignment.
Opinions about other more widespread services such psychology/psychiatry or endocrine are
more evenly distributed (we must keep in mind that a diagnose of gender identity disorder is
mandatory to access any further transitioning health service).
Reassignment Surgery
Breast Surgery
3%2% 5%
90%
3% 5% 3%
89%
bad
regular
Speech Therapy
4% 3%
good
97%
very good
excellent
Endocrine
3%
Psychology / Psychiatry
7%
15%
0%
10%
15%
11%
20%
16%
13%
16%
30%
10%
40%
50%
did not use
46%
13%
60%
34%
70%
80%
90% 100%
Fig. 27. Use and opinion about different health services for transgender people.
PART II
AVAILABILITY OF HEALTH SERVICES IN SPAIN
We collected information from six different regions. However, we managed to get complete
information from all three categories from just four of them for both collection periods.
While Andalusia increases its punctuation, and Catalonia sees no changes, all other regions
obtained a lower global score in 2014, which suggest how the services and strategies put in
force to protect LGTB health have worsened since 2008.
The range for different sections of the set of questionnaires is:
a)
b)
c)
d)
General: 0-6
HIV: -1 – 14
Transgender health services: 0 – 13
Assisted reproductive services and gynaecological attention: 0- 8
Thus, the possible score goes from -1 to 41
Madrid.
From 2008 to 2014 Madrid lost 5 points. 2 of them were lost in indicator 1 for failing to
guarantee health care for all population regardless the administrative situation. While the
ranking in the last group of indicators increase due to improvement of inclusion of lesbian and
bisexual women realities in socio-sanitary forms, the attention given to HIV policies and
strategies has worsened in 2014 when the region scored under 20
GENERAL
2008
2014
4
2
2008
9
HIV
2014
5
TRANSGENDER
2008
2014
7
7
ART AND GYNEC
2008
2014
3
4
GLOBAL
2008
2014
23
18
Questionnaires were answered by:
-
Ramón Aguirre. Coordinator of health Promotion Unit at the Regional Health Ministry
Mario Blázquez. Technical HIV staff. COGAM
MADRID
Has the region government set a protocol to guarantee public and comprehensive health coverage to all population regardless the insured status of
individuals?
Has the administration offered training on LGBT issues to health professionals?
Is there any specific service (health or social services) at the regional or local level where LGBT people can get mental health support (psychological
counseling, etc.)?
Is there a regional strategic plan or action plan on HIV in force?
SI
x
2008
NO
2014
SI NO
x
x
x
X
X
x
X
If it exists, does the strategic plan mention MSM population (including MSW) as a key target group?
X
X
If it exists, does the strategic plan mention transgender people (excluding TSW) as a key target group?
X
X
Is there any specific health budget allocated to HIV prevention and/or testing specific programs and activities?
X
Has the government launched a specific call for grants to fund HIV prevention projects and was there an administrative decision?
X
Have specific HIV prevention projects or programs targeted to LGBT people –MSM, TSW, MSW- been funded?
X
X
Is there any public specific service (clinic, primary health care centre, hospitals) for HIV and STI testing that guarantees anonymity and
confidenciality?
Is treatment for diagnosed STI offered free of charge in public testing services?
X
X
X
X
Are there early diagnose programs through rapid HIV test specifically targeted to LGBT people (NGO or other)
X
X
Do NGO distribute both condoms and lubricant in cruising areas, sex bars, etc. at least twice a month?
X
Is there any support group for LGBT people with HIV at the public social services or health services level?
X
X
Is there any support group at the NGO level for LGBT people with HIV?
X
X
Is there in the region any kind of ordinance prosecuting or punishing sex workers or clients?
X
X
x
x
X
Is there at the region level any kind of institutional declaration or agreement including measures against HIV related discrimination?
Has any training been offered to health professionals in relation with LGBT vulnerability to HIV?
Is there any legislation or protocol forbidding in a specific way discrimination against LGBT people with HIV with regard to access to HIV related health
services?
Is there any centre or specific health care unit for transgender people?
x
X
X
X
x
X
X
X
Is there any comprehensive law on transgender issues at the region level?
x
X
If it exists does in include measures for public coverage of health care under the social security schemes?
X
X
Is psychological follow up included in publicly covered health services?
X
X
Is endocrine and hormone therapy included in publicly covered health services?
X
X
Is reassignment surgery included in publicly covered health services?
X
X
Is it possible to have surgery procedures within the same region?
X
X
In order to obtain health care in the region, is it possible to get by without a gender disorder diagnose?
x
X
Has the Region authorities given any institutional declaration in favor of non pathologization?
X
X
Are there organizations providing care, information and support to transgender people?
X
X
Are there organizations providing health care to uninsured transgender persons?
x
x
Has any training been offered to health professionals of primary health care services about transgender realities?
x
X
Is there any legislation or protocol forbidding in a specific way discrimination against transgender people with regard to health care?
X
X
Is there any kind of gynecologic protocol inclusive of lesbian and bisexual women realities?
X
Has any training been offered to health professionals on sexual and reproductive health of lesbian and bisexual women?
X
Does the regional health system include public coverage of assisted reproductive techniques for single women and couples of women?
Do protocols on assisted reproduction contemplate the possibility that the partner is another woman?
X
X
x
X
X
x
Is transfer of egg cells from the partner (ROPA Method) included within publicly covered assisted reproduction techniques?
x
X
Is there any kind of legislation or protocol explicitly forbidding discrimination of LB women in coverage of assisted reproductive techniques?
Do registry forms of sociosanitary information at primary health care level include the realities of LGBT families?
X
x
x
Is there any support group, organization o information service to LGBT families?
X
x
x
Catalonia
No changes were reported overtime
GENERAL
2008
2014
2
2
HIV
2008
2014
12
12
TRANSGENDER
2008
2014
8
8
ART AND GYNEC
2008
2014
1
1
Questionnaires were asked by
-
William Mejias. HIV testing technical staff. Gais Positius
Andreu Segura. Regional Health Ministry
Ana Martínez. General Practitioner.
GLOBAL
2008
2014
23
23
CATALONIA
Has the region government set a protocol to guarantee public and comprehensive health coverage to all population regardless the insured status of
individuals?
Has the administration offered training on LGBT issues to health professionals?
SI
x
2008
NO
2014
SI NO
X
X
x
x
X
Is there any specific service (health or social services) at the regional or local level where LGBT people can get mental health support (psychological
counseling, etc.)?
Is there a regional strategic plan or action plan on HIV in force?
X
X
If it exists, does the strategic plan mention MSM population (including MSW) as a key target group?
X
X
If it exists, does the strategic plan mention transgender people (excluding TSW) as a key target group?
X
X
Is there any specific health budget allocated to HIV prevention and/or testing specific programs and activities?
X
X
Has the government launched a specific call for grants to fund HIV prevention projects and was there an administrative decision?
X
X
Have specific HIV prevention projects or programs targeted to LGBT people –MSM, TSW, MSW- been funded?
X
X
Is there any public specific service (clinic, primary health care centre, hospitals) for HIV and STI testing that guarantees anonymity and
confidenciality?
Is treatment for diagnosed STI offered free of charge in public testing services?
X
X
X
X
Are there early diagnose programs through rapid HIV test specifically targeted to LGBT people (NGO or other)
X
X
Do NGO distribute both condoms and lubricant in cruising areas, sex bars, etc. at least twice a month?
X
X
Is there any support group for LGBT people with HIV at the public social services or health services level?
x
X
Is there any support group at the NGO level for LGBT people with HIV?
X
X
Is there in the region any kind of ordinance prosecuting or punishing sex workers or clients?
X
X
Is there at the region level any kind of institutional declaration or agreement including measures against HIV related discrimination?
X
Has any training been offered to health professionals in relation with LGBT vulnerability to HIV?
Is there any legislation or protocol forbidding in a specific way discrimination against LGBT people with HIV with regard to access to HIV related health
services?
Is there any centre or specific health care unit for transgender people?
X
X
X
X
X
X
X
Is there any comprehensive law on transgender issues at the region level?
x
X
If it exists does in include measures for public coverage of health care under the social security schemes?
X
x
Is psychological follow up included in publicly covered health services?
x
X
Is endocrine and hormone therapy included in publicly covered health services?
X
X
Is reassignment surgery included in publicly covered health services?
X
X
Is it possible to have surgery procedures within the same region?
x
x
In order to obtain health care in the region, is it possible to get by without a gender disorder diagnose?
X
X
Has the Region authorities given any institutional declaration in favor of non pathologization?
X
X
Are there organizations providing care, information and support to transgender people?
X
X
Are there organizations providing health care to uninsured transgender persons?
x
x
Has any training been offered to health professionals of primary health care services about transgender realities?
x
X
Is there any legislation or protocol forbidding in a specific way discrimination against transgender people with regard to health care?
X
X
Is there any kind of gynecologic protocol inclusive of lesbian and bisexual women realities?
x
X
Has any training been offered to health professionals on sexual and reproductive health of lesbian and bisexual women?
X
x
Does the regional health system include public coverage of assisted reproductive techniques for single women and couples of women?
Do protocols on assisted reproduction contemplate the possibility that the partner is another woman?
x
X
X
x
Is transfer of egg cells from the partner (ROPA Method) included within publicly covered assisted reproduction techniques?
x
X
Is there any kind of legislation or protocol explicitly forbidding discrimination of LB women in coverage of assisted reproductive techniques?
Do registry forms of socio-sanitary information at primary health care level include the realities of LGBT families?
X
x
x
X
Is there any support group, organization o information service to LGBT families?
x
X
Andalusia
Andalusia increased its score, thanks mainly to the recent entry of the law on transgender
issues, which improves health protection and services for transgender people in the region.
GENERAL
2008
2014
6
6
HIV
2008
2014
12
12
TRANSGENDER
2008
2014
8
13
ART AND GYNEC
2008
2014
4
4
GLOBAL
2008
2014
30
35
Questionnaires were filled and sent back by:
-
José María Sánchez Bursón. Regional Health Ministry
Pilar Baraza Cano. Responsible for the Migrant Section of the Regional Health Ministry
and Chief of Patient Claims
ANDALUSIA
Has the region government set a protocol to guarantee public and comprehensive health coverage to all population regardless the insured status of
individuals?
Has the administration offered training on LGBT issues to health professionals?
SI
x
2008
NO
2014
SI NO
X
X
x
Is there any specific service (health or social services) at the regional or local level where LGBT people can get mental health support (psychological
counseling, etc.)?
Is there a regional strategic plan or action plan on HIV in force?
x
X
x
X
If it exists, does the strategic plan mention MSM population (including MSW) as a key target group?
x
X
If it exists, does the strategic plan mention transgender people (excluding TSW) as a key target group?
x
X
Is there any specific health budget allocated to HIV prevention and/or testing specific programs and activities?
x
X
Has the government launched a specific call for grants to fund HIV prevention projects and was there an administrative decision?
x
X
Have specific HIV prevention projects or programs targeted to LGBT people –MSM, TSW, MSW- been funded?
x
X
Is there any public specific service (clinic, primary health care centre, hospitals) for HIV and STI testing that guarantees anonymity and
confidenciality?
Is treatment for diagnosed STI offered free of charge in public testing services?
x
X
x
X
Are there early diagnose programs through rapid HIV test specifically targeted to LGBT people (NGO or other)
x
X
Do NGO distribute both condoms and lubricant in cruising areas, sex bars, etc. at least twice a month?
X
X
Is there any support group for LGBT people with HIV at the public social services or health services level?
X
X
Is there any support group at the NGO level for LGBT people with HIV?
X
X
Is there in the region any kind of ordinance prosecuting or punishing sex workers or clients?
X
X
Is there at the region level any kind of institutional declaration or agreement including measures against HIV related discrimination?
X
X
Has any training been offered to health professionals in relation with LGBT vulnerability to HIV?
X
X
Is there any legislation or protocol forbidding in a specific way discrimination against LGBT people with HIV with regard to access to HIV related health
services?
Is there any centre or specific health care unit for transgender people?
X
X
X
X
Is there any comprehensive law on transgender issues at the region level?
X
X
If it exists does in include measures for public coverage of health care under the social security schemes?
X
X
Is psychological follow up included in publicly covered health services?
X
X
Is endocrine and hormone therapy included in publicly covered health services?
X
X
Is reassignment surgery included in publicly covered health services?
X
X
Is it possible to have surgery procedures within the same region?
X
X
In order to obtain health care in the region, is it possible to get by without a gender disorder diagnose?
X
X
Has the Region authorities given any institutional declaration in favor of non pathologization?
X
X
Are there organizations providing care, information and support to transgender people?
X
X
Are there organizations providing health care to uninsured transgender persons?
x
X
Has any training been offered to health professionals of primary health care services about transgender realities?
Is there any legislation or protocol forbidding in a specific way discrimination against transgender people with regard to health care?
X
X
X
X
Is there any kind of gynecologic protocol inclusive of lesbian and bisexual women realities?
Has any training been offered to health professionals on sexual and reproductive health of lesbian and bisexual women?
Does the regional health system include public coverage of assisted reproductive techniques for single women and couples of women?
Do protocols on assisted reproduction contemplate the possibility that the partner is another woman?
X
X
X
X
Is transfer of egg cells from the partner (ROPA Method) included within publicly covered assisted reproduction techniques?
X
X
Is there any kind of legislation or protocol explicitly forbidding discrimination of LB women in coverage of assisted reproductive techniques?
Do registry forms of socio-sanitary information at primary health care level include the realities of LGBT families?
X
X
Is there any support group, organization o information service to LGBT families?
Valencia
Valencia is the worst scoring region, both in 2008 and 2014 and the one that has seen the most dramatic
decrease over the period. The region has seen a severe series of budgetary cuts affecting HIV prevention
programs and activities for LGBT health promotion and protection. It has also been one of the regions
that have more seriously implemented the royal decree excluding non regular migrant population from
health care.
GENERAL
2008
2014
2
0
HIV
2008
2014
10
5
TRANSGENDER
2008
2014
6
6
ART AND GYNEC
2008
2014
3
1
GLOBAL
2008
2014
21
12
Questionnaires were sent back by:
-
Julia Talavera and Marina valiente. Health and HIV technical staff from Col·lectiu Lambda
José Tomás Mateo García. University of Valencia.
Carlos Álvarez Dardet. University of Alicant
VALENCIA
Has the region government set a protocol to guarantee public and comprehensive health coverage to all population regardless the insured status of
individuals?
Has the administration offered training on LGBT issues to health professionals?
Is there any specific service (health or social services) at the regional or local level where LGBT people can get mental health support (psychological
counseling, etc.)?
Is there a regional strategic plan or action plan on HIV in force?
SI
x
2008
NO
2014
SI NO
x
X
X
X
X
X
X
If it exists, does the strategic plan mention MSM population (including MSW) as a key target group?
X
X
If it exists, does the strategic plan mention transgender people (excluding TSW) as a key target group?
X
X
Is there any specific health budget allocated to HIV prevention and/or testing specific programs and activities?
X
X
Has the government launched a specific call for grants to fund HIV prevention projects and was there an administrative decision?
X
X
Have specific HIV prevention projects or programs targeted to LGBT people –MSM, TSW, MSW- been funded?
X
X
Is there any public specific service (clinic, primary health care centre, hospitals) for HIV and STI testing that guarantees anonymity and
confidenciality?
Is treatment for diagnosed STI offered free of charge in public testing services?
X
X
X
X
Are there early diagnose programs through rapid HIV test specifically targeted to LGBT people (NGO or other)
X
X
Do NGO distribute both condoms and lubricant in cruising areas, sex bars, etc. at least twice a month?
X
X
Is there any support group for LGBT people with HIV at the public social services or health services level?
Is there any support group at the NGO level for LGBT people with HIV?
Is there in the region any kind of ordinance prosecuting or punishing sex workers or clients?
X
X
X
X
x
X
Is there at the region level any kind of institutional declaration or agreement including measures against HIV related discrimination?
X
X
Has any training been offered to health professionals in relation with LGBT vulnerability to HIV?
X
X
Is there any legislation or protocol forbidding in a specific way discrimination against LGBT people with HIV with regard to access to HIV related health
services?
Is there any centre or specific health care unit for transgender people?
x
X
X
X
Is there any comprehensive law on transgender issues at the region level?
x
X
If it exists does in include measures for public coverage of health care under the social security schemes?
X
X
Is psychological follow up included in publicly covered health services?
X
X
Is endocrine and hormone therapy included in publicly covered health services?
X
x
Is reassignment surgery included in publicly covered health services?
X
X
Is it possible to have surgery procedures within the same region?
X
X
In order to obtain health care in the region, is it possible to get by without a gender disorder diagnose?
x
X
Has the Region authorities given any institutional declaration in favor of non pathologization?
X
X
Are there organizations providing care, information and support to transgender people?
X
X
Are there organizations providing health care to uninsured transgender persons?
X
X
Has any training been offered to health professionals of primary health care services about transgender realities?
x
X
Is there any legislation or protocol forbiding in a specific way discrimination against transgender people with regard to health care?
X
x
Is there any kind of gynecologic protocol inclusive of lesbian and bisexual women realities?
X
x
Has any training been offered to health professionals on sexual and reproductive health of lesbian and bisexual women?
X
X
Does the regional health system include public coverage of assisted reproductive techniques for single women and couples of women?
Do protocols on assisted reproduction contemplate the possibility that the partner is another woman?
X
X
X
X
Is transfer of egg cells from the partner (ROPA Method) included within publicly covered assisted reproduction techniques?
x
X
Is there any kind of legislation or protocol explicitly forbidding discrimination of LB women in coverage of assisted reproductive techniques?
Do registry forms of socio-sanitary information at primary health care level include the realities of LGBT families?
X
x
x
X
Is there any support group, organization o information service to LGBT families?
X
X
Acknowledgements
With our most felt gratitude to all those LGBTI community members who answered the
questionnaire and anyone who has collaborated to its dissemination in any way.
Alejandro Ballesteros , Raúl Noales, Fuencisla Gasca, and Pilar Tornero (FELGTB Staff)
Santiago Redondo Bueno (FELGTB responsible for health and HIV issues)
Isabel Gómez (FELGTB responsible for equality)
Boris Balanetkii-Schlütter and Sophie Aujean (ILGA-Europe), for their guidance and support
throughout the whole project.
Begoña Merino, Pilar Campos and Ana Gil (Health Promotion Unit. Ministerio de Sanidad,
Servicios Sociales e Igualdad)
Region Questionnaire respondents: Ramón Aguirre, Mario Blázquez (Cogam), Marina Valiente
and Julia Talavera (Cogam), José Tomás Mateos García, Uge Sangil (Algarabía), José María
Sánchez, Pilar Baraza, Ana Martínez, Willian Mejías (Gais Positius), Gloria Guerra and Andreu
Segura
Encuesta: Discriminación y barreras en la atención sanitaria a personas LGTBI
Pág. 1.- Bienvenidxs...
-----------------------------------------------------------------------------------Gracias por participar en nuestra encuesta. Esta investigación forma parte de un
programa de ILGA-Europe (Equality for lesbian, gay, bisexual, trans and intersex people
in Europe http://www.ilga-europe.org/), financiado por la Unión Europea para mejorar
el acceso de las personas LGTBI a la atención y los servicios sanitarios. Para poder
establecer diferencias geográficas y de otro tipo, hemos optado por seleccionar tres
temas que afectan particularmente a distintos grupos dentro de nuestra población. En
primer lugar, el VIH del que hay una alta incidencia en hombres gays y bisexuales y en
mujeres trans. En segundo lugar, la cobertura de tratamientos de reproducción asistida
para mujeres solteras y parejas de mujeres, así como la atención ginecológica y el
seguimiento de protocolos preventivos. Por último, la cobertura sanitaria de distintos
aspectos relacionados con el proceso transexualizador.Desde FELGTB, la Federación
Estatal de Lesbianas, Gais, Transexuales y Bisexuales (http://www.felgtb.org) te
garantizamos el anonimato y la confidencialidad de la información que nos
proporciones. Te rogamos que no escribas nada que permita identificarte (nombre,
dirección de correo, teléfono) en las preguntas de respuesta abierta.
Pág. 2.- Bienvenidxs...
-----------------------------------------------------------------------------------Ten en cuenta que esta encuesta va dirigida únicamente a:
Personas
LGTBI.Mayores de 18 años, Que residen en España Por favor, contesta a todas las
preguntas de la manera más exacta y completa posible.Si tienes alguna pregunta, no
dudes en contactarnos en [email protected] Los resultados de la encuesta estarán
disponibles a partir de marzo de 2015 en www.felgtb.org Si no eres una persona LGTBI
pero te identificas con nuestra causa y deseas compartir tu opinión sobre cómo mejorar
la atención sanitaria a nuestra población estaremos encantados de recibir tu mensaje en
[email protected] Gracias y un cordial saludo.FELGTB
Preg.1.- Confirmo que he leído y comprendo la información anterior y que he tenido la
oportunidad de preguntar por correo electrónico las dudas que me hayan surgido antes
de comenzar a rellenar la encuesta. Entiendo que mi participación es voluntaria y que
tengo la libertad de dejar de rellenar la encuesta en cualquier momento, sin dar
explicaciones y sin que ello conlleve ninguna penalización
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Consiento en participar en este estudio
No deseo participar en este estudio (* Continuar en la pág.:38)
Pág. 3.- País de residencia
-----------------------------------------------------------------------------------Preg.2.- ¿En qué país resides actualmente?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
España (* Continuar en la pág.:4)
Otro (* Continuar en la pág.:38)
Pág. 4.- País de nacimiento y provincia de residencia
-----------------------------------------------------------------------------------Preg.3.- ¿En qué provincia resides actualmente?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Álava
Albacete
Alicante/Alacant
Almería
Asturias
Ávila
Badajoz
Baleares
Barcelona
Burgos
Cáceres
Cádiz
Cantabria
Castellón
Ceuta
Ciudad Real
Córdoba
Cuenca
Girona
Granada
Guadalajara
Guipúzcoa
Huelva
Huesca
Jaén
La Coruña
La Rioja
Las Palmas
León
Lérida
Lugo
Madrid
Málaga
Melilla
Murcia
Navarra
Orense
Palencia
Pontevedra
Salamanca
Santa Cruz de Tenerife
Segovia
Sevilla
Soria
Tarragona
Teruel
Toledo
Valencia
Valladolid
Vizcaya
Zamora
Zaragoza
Preg.4.- ¿En qué país naciste?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
España
Otro país de la Unión Europea
Otro país que no forma parte de la Unión Europea
Actualmente estás residiendo o piensas residir en España…
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿En qué país naciste?" : "Otro país de la Unión Europea" de la página
"País de nacimiento y provincia de residencia" o además
han contestado a "¿En qué país naciste?" : "Otro país que no forma parte de la Unión
Europea" de la página "País de nacimiento y provincia de residencia".)
Durante seis meses o más tiempo
Menos de seis meses (* Continuar en la pág.:38)
Pág. 5.- Edad
-----------------------------------------------------------------------------------Preg.5.- Indica cuál es tu edad (años que cumpliste en tu último cumpleaños)
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
< 18 (* Continuar en la pág.:38)
18 - 29
30 - 39
40 - 49
50 - 65
> 65
Pág. 6.- Orientación sexual e identidad de género
-----------------------------------------------------------------------------------Preg.6.- ¿Qué sexo te asignaron cuando naciste?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Hombre
Mujer
Intersexual / otro
Preg.7.- ¿Te identificas en la actualidad, o te has identificado alguna vez como persona
con disconformidad de género (transexual, transgénero, trans o persona con género
variante)?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Sí, me asignaron género de hombre al nacer, y actualmente mi identidad de género
es de mujer
Sí, me asignaron género de hombre al nacer, y actualmente mi identidad de género
es otra
Sí, me asignaron género de mujer al nacer, y actualmente mi identidad de género es
de hombre
Sí, me asignaron género de mujer al nacer, y actualmente mi identidad de género es
otra
No
NS/NC
Preg.8.- De las siguientes categorías ¿cuál describe mejor tu orientación sexual?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Lesbiana / mujer homosexual
Gay / hombre homosexual
Bisexual
Heterosexual
Queer
No estoy seguro/a
Otro (Por favor
especifique)_______________________________________________________
Esta encuesta no va dirigida a personas heterosexuales que no se identifiquen como
trans. Por eso te pedimos confirmar antes de continuar la encuesta. ¿Te identificas en la
actualidad o te has identificado alguna vez como persona con disconformidad de género
(transexual, transgénero, trans o persona con género variante)?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "De las siguientes categorías ¿cuál describe mejor tu orientación
sexual?" : "Heterosexual" de la página "Orientación sexual e identidad de género".)
Sí
No (* Continuar en la pág.:38)
Pág. 7.- Situación administrativa
-----------------------------------------------------------------------------------Preg.9.- ¿Cuál de estas situaciones te describe mejor?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Tengo nacionalidad española
Tengo nacionalidad de un país que pertenece a la Unión Europea
Tengo un permiso de residencia permanente en España
Tengo un permiso de residencia temporal en España
He solicitado un permiso de residencia pero aún no me lo han concedido
Tengo un visado de turista para estar temporalmente en España
Tengo un visado o un permiso de estudiante para estar temporalmente en España
Soy solicitante de asilo
Tengo estatus de refugiado/a
NS/NC
Otro (Por favor
especifique)_______________________________________________________
Preg.10.- Actualmente estás... (señala la que más se adecúe a tu situación)
(* Marque una sola opción)
Casado/a o en una relación de pareja reconocida legalmente.
Soltero/a pero previamente has estado casado/a o con pareja reconocida
legalmente (viudo/a, separado/a, divorciado/a)
Soltero/a, y nunca has tenido una pareja reconocida legalmente.
En una relación de pareja estable y vives con ella.
En una relación de pareja estable pero no vives con ella.
Otro (Por favor
especifique)_______________________________________________________
Tu pareja estable es...
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "Actualmente estás... (señala la que más se adecúe a tu situación)" :
"Casado/a o en una relación de pareja reconocida legalmente." de la página "Situación
administrativa" o además
han contestado a "Actualmente estás... (señala la que más se adecúe a tu situación)" :
"En una relación de pareja estable y vives con ella." de la página "Situación
administrativa" o además
han contestado a "Actualmente estás... (señala la que más se adecúe a tu situación)" :
"En una relación de pareja estable pero no vives con ella." de la página "Situación
administrativa".)
Alguien de tu mismo sexo
Alguien del sexo contrario al tuyo
Otro (Por favor
especifique)_______________________________________________________
Preg.11.- ¿Tienes algún hijo o hija a tu cargo en tu hogar?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Si
No
Pág. 8.- Estado de salud
-----------------------------------------------------------------------------------Preg.12.- En general ¿cómo dirías que ha sido tu estado de salud en los últimos 12
meses?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Muy bueno
Bueno
Regular
Malo
Muy malo
NS/NC
Pág. 9.- Estado de salud
-----------------------------------------------------------------------------------Preg.13.- En el último mes ¿cuántos días aproximadamente te has sentido deprimido/a?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
No me he sentido triste ni deprimido/a en el último mes
1 - 2 días
3 - 7 días
8 - 15 días
16 - 21 días
21 - 31 días
NS/NC
Preg.14.- En los últimos doce meses ¿has pensado seriamente alguna vez en el suicidio?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Si
No
NS/NC
Pág. 10.- Derecho a la atención sanitaria
-----------------------------------------------------------------------------------Preg.15.- Actualmente, ¿tienes derecho a la atención sanitaria pública de manera
gratuita en la ciudad en la que vives?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Si
Sí, a través del seguro de mi cónyuge
Sí, tengo un seguro médico de estudiante
No
No lo sé / no estoy seguro/a / prefiero no contestar
¿Por qué no tienes derecho a la atención sanitaria?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "Actualmente, ¿tienes derecho a la atención sanitaria pública de
manera gratuita en la ciudad en la que vives?" : "No" de la página "Derecho a la atención
sanitaria".)
Estoy desempleado/a y no estoy asegurado/a
Soy inmigrante y no tengo permiso de residencia
No lo sé / prefiero no contestar
Otro (Por favor
especifique)_______________________________________________________
Preg.16.- ¿Tienes un seguro médico privado?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Si
No
Prefiero no contestar
Pág. 11.- Utilización servicios sanitarios últimos doce meses
-----------------------------------------------------------------------------------Preg.17.- En los últimos doce meses ¿has tenido la necesidad de ir a un centro de salud
por algún motivo de salud?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Si
No
Si has necesitado ir a un centro de salud en los últimos doce meses ¿has podido hacerlo?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Si
No
En esa ocasión ¿tu problema de salud estaba relacionado con alguno de la siguiente
lista? Señala todos los que sea necesario.
(* Esta pregunta es obligatoria )
(* Contestar solo si :
han contestado a "En los últimos doce meses ¿has tenido la necesidad de ir a un centro
de salud por algún motivo de salud?" : "Si" de la página "Utilización servicios sanitarios
últimos doce meses".)
Asma/enfisema/bronquitis crónica/EPOC
Diabetes
Enfermedad coronaria / infarto de miocardio
Infarto cerebral
Hepatitis vírica B ó C
VIH o sida
Otra infección de transmisión sexual distinta al VIH
Virus del Papiloma Humano (VPH)
Hipertensión (tensión arterial alta)
Tuberculosis
Cáncer de mama
Cáncer de útero
Cáncer de próstata
Algún otro tipo de cáncer
Ansiedad
Depresión
Trastorno del comportamiento alimentario
Abuso de sustancias / alcohol
Tratamiento de reproducción asistida.
Interrupción voluntaria del embarazo o píldora anticonceptiva
Tratamiento hormonal relacionado con mi proceso transexualizador
Intervenciones quirúrgicas relacionadas con mi proceso transexualizador
Otras intervenciones sanitarias relacionadas con mi proceso transexualizador
Otro (Por favor
especifique)_______________________________________________________
¿Cuáles consideras que fueron las razones por las que no fuiste a un centro de salud en
esa ocasión?
(* Esta pregunta es obligatoria )
(* Contestar solo si :
han contestado a "Si has necesitado ir a un centro de salud en los últimos doce meses
¿has podido hacerlo?" : "No" de la página "Utilización servicios sanitarios últimos doce
meses".)
No sé si tengo derecho a la atención sanitaria gratuita y no puedo permitirme pagar
por recibirla.
No tengo tarjeta sanitaria
Estoy en situación irregular y tenía miedo de que me deportaran.
La lista de espera era muy larga.
No podía permitirme tomarme el día libre en el trabajo.
El centro sanitario al que debía ir está muy lejos de donde vivo.
Pensaba que mejoraría sin necesidad de ir al médico
No sabía a qué centro sanitario ir para el problema de salud que tenía
Tenía miedo de que me juzgaran por ser gay/lesbiana/bisexual/transexual
Anteriormente me han discriminado en ese centro de salud por ser
gay/lesbiana/bisexual/transexual
Otro (Por favor
especifique)_______________________________________________________
Pág. 12.- Experiencia en atención primaria
-----------------------------------------------------------------------------------Las siguientes preguntas son sobre tu experiencia en los centros de atención primaria,
con tu médico/a de familia o de cabecera. Y a continuación, te preguntaremos sobre tu
experiencia en hospitales o centros de especialidades médicas.
Preg.18.- Entre el personal sanitario que te atiende en tu centro de salud ¿sabe alguien
que eres una persona LGTBI?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Si
No
No estoy seguro/a
No procede- no tengo derecho a la atención primaria (* Continuar en la pág.:13)
¿Cómo ha(n) sabido que eres una persona LGTBI?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "Entre el personal sanitario que te atiende en tu centro de salud
¿sabe alguien que eres una persona LGTBI?" : "Si" de la página "Experiencia en atención
primaria".)
Se lo he dicho yo
la información estaba en otros informes médicos
Lo saben a través de personas que conozco o familiariares
Otro (Por favor
especifique)_______________________________________________________
¿Cuáles son los motivos por los que no lo sabe(n) o crees que no lo sabe(n)? Marca
todos los que sea necesario
(* Esta pregunta es obligatoria )
(* Contestar solo si :
han contestado a "Entre el personal sanitario que te atiende en tu centro de salud
¿sabe alguien que eres una persona LGTBI?" : "No" de la página "Experiencia en
atención primaria" o además
han contestado a "Entre el personal sanitario que te atiende en tu centro de salud
¿sabe alguien que eres una persona LGTBI?" : "No estoy seguro/a" de la página
"Experiencia en atención primaria".)
Porque no lo considero relevante
Porque no he tenido ocasión de comentarlo
Porque temo que se lo diga(n) a mis familiares
Porque temo ser discriminado/a si se entera(n)
Porque me consta que otros pacientes LGTBI han sido discriminados/as por los/las
profesionales de la salud que me atienden
Otro (Por favor
especifique)_______________________________________________________
Pág. 13.- Experiencia en atención especializada
-----------------------------------------------------------------------------------Preg.19.- Cuando visitas al especialista, ¿saben que eres una persona LGTBI?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Si
No
No estoy seguro/a
Actualmente no soy paciente de ningún centro de especialidades sanitarias
No procede- no tengo derecho a la asistencia sanitaria
¿Cómo han sabido que eres una persona LGTBI?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "Cuando visitas al especialista, ¿saben que eres una persona LGTBI?" :
"Si" de la página "Experiencia en atención especializada".)
Se lo he dicho yo
La información estaba en otros informes médicos
Se han enterado a través de personas que conozco o familiares
El motivo porque el que voy al hospital (o centro de especialidades) está relacionado
con mi identidad sexual o de género.
Otro (Por favor
especifique)_______________________________________________________
¿Cuáles son los motivos por los que no saben, o crees que no lo sabe(n)? Marca todas las
que sea necesario
(* Esta pregunta es obligatoria )
(* Contestar solo si :
han contestado a "Cuando visitas al especialista, ¿saben que eres una persona LGTBI?" :
"No" de la página "Experiencia en atención especializada" o además
han contestado a "Cuando visitas al especialista, ¿saben que eres una persona LGTBI?" :
"No estoy seguro/a" de la página "Experiencia en atención especializada".)
Porque no lo considero relevante
Porque no he tenido ocasión de comentarlo
Porque temo que se lo digan a mis familiares
Porque temo ser discriminado/a si se entera(n)
Porque me consta que otros pacientes LGTBI han sido discriminados/as por los/las
profesionales que me atienden
Otro (Por favor
especifique)_______________________________________________________
Pág. 14.- Experiencias de discriminación
-----------------------------------------------------------------------------------Preg.20.- En alguna ocasión ¿crees haber sido discriminado/a en un centro sanitario en
España a causa de orientación sexual o identidad de género? Puedes marcar las dos
primeras opciones si es tu caso.
Si, en los últimos 12 meses
Si, hace más de 12 meses
No
¿En qué tipo de centro sanitario crees haber sido discriminado/a a causa de tu
orientación sexual o identidad de género?Puedes señalar tantos como sea necesario.
(* Esta pregunta es obligatoria )
(* Contestar solo si :
han contestado a "En alguna ocasión ¿crees haber sido discriminado/a en un centro
sanitario en España a causa de orientación sexual o identidad de género? Puedes marcar
las dos primeras opciones si es tu caso." : "Si, en los últimos 12 meses" de la página
"Experiencias de discriminación" o además
han contestado a "En alguna ocasión ¿crees haber sido discriminado/a en un centro
sanitario en España a causa de orientación sexual o identidad de género? Puedes marcar
las dos primeras opciones si es tu caso." : "Si, hace más de 12 meses" de la página
"Experiencias de discriminación".)
En el centro de salud/atención primaria
En la consulta con un especialista en el Hospital (incluidas consultas externas)
En la consulta con un médico especialista en un Centro de Especialidades
Durante un ingreso en el Hospital
En el Servicio de Urgencias (Hospital o centro de salud)
En el Centro Municipal de Salud
En un Centro de Planificación Familiar
En un centro de Salud Sexual
En la consulta de un médico particular/privado/de pago
En la consulta de un médico de una sociedad aseguradora/mutua
En el servicio médico de la empresa en la que trabajo o he trabajado
En la consulta privada de Salud Mental/Psicología
En el Dentista
En una ONG que presta servicios sanitarios (prueba del VIH, asesoramiento
psicológico, etc.)
Otro (Por favor
especifique)_______________________________________________________
¿Consideras que esta experiencia ha influido en que sigas utilizando estos servicios con
normalidad o cuando los has necesitado?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "En alguna ocasión ¿crees haber sido discriminado/a en un centro
sanitario en España a causa de orientación sexual o identidad de género? Puedes marcar
las dos primeras opciones si es tu caso." : "Si, en los últimos 12 meses" de la página
"Experiencias de discriminación" o además
han contestado a "En alguna ocasión ¿crees haber sido discriminado/a en un centro
sanitario en España a causa de orientación sexual o identidad de género? Puedes marcar
las dos primeras opciones si es tu caso." : "Si, hace más de 12 meses" de la página
"Experiencias de discriminación".)
Si
No
Sólo en parte
Opcional:Si tienes una experiencia de discriminación que quieras compartir, nos gustaría
saber más sobre ella para poder emplear tu caso en la mejorar de la atención sanitaria a
la población LGTBI. Recuerda no indicar tu nombre ni ningún otro dato que pueda
identificarte.
(* Contestar solo si :
han contestado a "En alguna ocasión ¿crees haber sido discriminado/a en un centro
sanitario en España a causa de orientación sexual o identidad de género? Puedes marcar
las dos primeras opciones si es tu caso." : "Si, en los últimos 12 meses" de la página
"Experiencias de discriminación" o además
han contestado a "En alguna ocasión ¿crees haber sido discriminado/a en un centro
sanitario en España a causa de orientación sexual o identidad de género? Puedes marcar
las dos primeras opciones si es tu caso." : "Si, hace más de 12 meses" de la página
"Experiencias de discriminación".)
________________________________________________________________________
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Pág. 15.- Formación del personal sanitario en temas LGBT
-----------------------------------------------------------------------------------Preg.21.- En conjunto, ¿consideras que el personal sanitario que te atiende tiene
formación suficiente sobre la salud de las personas LGTBI?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
En general, creo que tienen mucha formación
En general, creo que tienen algo de formación
En general, creo que no tienen formación en absoluto
No estoy seguro/a
Actualmente, no hay profesionales sanitarios que me atiendan
Preg.22.- Opcional:¿Sobre qué temas relacionados con la salud LGTBI consideras
importante mejorar la formación del personal sanitario?
________________________________________________________________________
____________
________________________________________________________________________
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________________________________________________________________________
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________________________________________________________________________
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________________________________________________________________________
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________________________________________________________________________
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Preg.23.- ¿Te sientes cómodo/a descubriendo tu orientación sexual/identidad de género
cuando acudes a un centro sanitario?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Si
No
A veces
Pág. 16.- Opinión sobre temas de salud relevantes
-----------------------------------------------------------------------------------Preg.24.- Desde tu punto de vista, ¿cuáles de estos temas son más importantes o a los
que hay que prestar más atención? Puedes elegir hasta cinco.
VIH y sida
Otras ITS incluyendo el VPH (virus del papiloma humano)
Consumo de sustancias ilegales
Tabaquismo
Alcoholismo
Acceso igualitario a la atención sanitaria
Alimentación saludable
Ejercicio físico
Mejora de la formación de profesionales de la salud acerca de las personas LGBTI
Salud mental
Obesidad / consecuencias en la salud del sobrepeso
Acoso escolar / acoso laboral
Ideación e intento de suicidio
Atención a personas LGBTI mayores
Otro (Por favor
especifique)_______________________________________________________
Pág. 17.- Prevención y VIH
-----------------------------------------------------------------------------------Las siguientes preguntas tienen que ver con tus prácticas sexuales y tus
comportamientos preventivos frente al VIH, otras infecciones de transmisión sexual, y
tus experiencias con los servicios de diagnóstico y prevención. Te recordamos que toda
la información que nos proporciones es completamente confidencial
Preg.25.- En el último mes ¿aproximadamente con cuántas personas diferentes has
tenido relaciones sexuales?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Ninguna
1
2-5
6 - 10
11 - 20
21 - 50
Más de 50
Prefiero no decirlo
La última vez que compartiste un juguete sexual para la penetración anal o vaginal
¿utilizaste preservativo?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿Qué sexo te asignaron cuando naciste?" : "Mujer" de la página
"Orientación sexual e identidad de género".)
Si
No
Nunca he practicado la penetración con juguetes sexuales
Prefiero no decirlo
La última vez que practicaste la penetración vaginal o anal con dedos con otra persona,
¿utilizaste algún tipo de protección (preservativo, guantes, etc.)?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿Qué sexo te asignaron cuando naciste?" : "Mujer" de la página
"Orientación sexual e identidad de género".)
Si
No
Nunca he practicado la penetración con dedos con otra persona
Prefiero no contestar
¿En alguna ocasión has utilizado algún tipo de barrera protectora para practicar sexo
oral con una mujer?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿Qué sexo te asignaron cuando naciste?" : "Mujer" de la página
"Orientación sexual e identidad de género".)
Si
No
NS/NC
¿Qué tipo de barreras protectoras has utilizado?
(* Esta pregunta es obligatoria )
(* Contestar solo si :
han contestado a "¿En alguna ocasión has utilizado algún tipo de barrera protectora
para practicar sexo oral con una mujer?" : "Si" de la página "Prevención y VIH".)
Barreras de latex (dental dam)
Preservativos abiertos
Plástico de envolver alimentos
NS/NC
Otro (Por favor
especifique)_______________________________________________________
¿Con qué frecuencia utilizas o has utilizado este tipo de barreras para practicar sexo oral
con una mujer?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿En alguna ocasión has utilizado algún tipo de barrera protectora
para practicar sexo oral con una mujer?" : "Si" de la página "Prevención y VIH".)
Muy rara vez
A veces
Con frecuencia
Casi siempre
Siempre
Otro (Por favor
especifique)_______________________________________________________
Preg.26.- Las siguientes preguntas se refieren a penetración con pene, excluyendo por
tanto penetración con dedos o juguetes sexuales.La última vez que practicaste sexo con
penetración (anal o vaginal) ¿utilizaste condón?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Si
No
Nunca he practicado sexo con penetración (* Continuar en la pág.:20)
Prefiero no decirlo
La última vez que practicaste la penetración, anal o vaginal, fue con...
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "Las siguientes preguntas se refieren a penetración con pene,
excluyendo por tanto penetración con dedos o juguetes sexuales.La última vez que
practicaste sexo con penetración (anal o vaginal) ¿utilizaste condón?" : "Si" de la página
"Prevención y VIH" o además
han contestado a "Las siguientes preguntas se refieren a penetración con pene,
excluyendo por tanto penetración con dedos o juguetes sexuales.La última vez que
practicaste sexo con penetración (anal o vaginal) ¿utilizaste condón?" : "No" de la
página "Prevención y VIH" o además
han contestado a "Las siguientes preguntas se refieren a penetración con pene,
excluyendo por tanto penetración con dedos o juguetes sexuales.La última vez que
practicaste sexo con penetración (anal o vaginal) ¿utilizaste condón?" : "Prefiero no
decirlo" de la página "Prevención y VIH".)
Tu pareja habitual, o estable
Una pareja sexual ocasional
Un/a trabajador/a del sexo
Un cliente
Prefiero no decirlo
¿Por qué no utilizaste condón en tu última relación de penetración?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "Las siguientes preguntas se refieren a penetración con pene,
excluyendo por tanto penetración con dedos o juguetes sexuales.La última vez que
practicaste sexo con penetración (anal o vaginal) ¿utilizaste condón?" : "No" de la
página "Prevención y VIH".)
No tenía uno a mano
Consideré que la práctica sexual no implicaba riesgo
Ni yo ni mi pareja sexual teníamos VIH
Tanto yo como mi pareja sexual teníamos VIH
Tengo VIH pero mi carga viral es indetectable
Mi pareja tiene VIH pero su carga viral es indetectable
Prefiero el sexo sin condón
No puedo permitirme pagar por los condones
Otro (Por favor
especifique)_______________________________________________________
Pág. 18.- trabajo sexual
-----------------------------------------------------------------------------------Preg.27.- ¿En alguna ocasión has recibido dinero, comida o drogas a cambio de practicar
sexo con alguien?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Si
No (* Continuar en la pág.:21)
Prefiero no contestar (* Continuar en la pág.:21)
¿Cuándo fue la última vez que recibiste dinero, comida o drogas por practicar sexo con
alguien?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿En alguna ocasión has recibido dinero, comida o drogas a cambio de
practicar sexo con alguien?" : "Si" de la página "trabajo sexual".)
En los últimos 12 meses
Hace más de 12 meses
Prefiero no contestar
¿En qué país o países has practicado sexo con alguien a cambio de recibir dinero, comida
o drogas? Puedes marcar tantas opciones como sea necesario
(* Esta pregunta es obligatoria )
(* Contestar solo si :
han contestado a "¿En alguna ocasión has recibido dinero, comida o drogas a cambio de
practicar sexo con alguien?" : "Si" de la página "trabajo sexual" o además
han contestado a "¿En alguna ocasión has recibido dinero, comida o drogas a cambio de
practicar sexo con alguien?" : "Si" de la página "trabajo sexual".)
En España
En mi país de origen
En otro país en el que he residido o al que he viajado
Prefiero no contestar
Pág. 19.- Disponibilidad de material preventivo
-----------------------------------------------------------------------------------ATENCIÓN: Si no ves preguntas en esta página, dale a CONTINUAR
¿En los últimos doce meses has recibido preservativos y lubricantes de forma gratuita?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿En alguna ocasión has recibido dinero, comida o drogas a cambio de
practicar sexo con alguien?" : "Si" de la página "trabajo sexual" y además
han contestado a "¿Cuándo fue la última vez que recibiste dinero, comida o drogas por
practicar sexo con alguien?" : "En los últimos 12 meses" de la página "trabajo sexual".)
Si, preservativos y lubricantes
Sí, preservativos
Sí, lubricantes
No
NS/NC
Aproximadamente, ¿cuántos preservativos gratuitos has recibido en los últimos doce
meses?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿En alguna ocasión has recibido dinero, comida o drogas a cambio de
practicar sexo con alguien?" : "Si" de la página "trabajo sexual" y además
han contestado a "¿Cuándo fue la última vez que recibiste dinero, comida o drogas por
practicar sexo con alguien?" : "En los últimos 12 meses" de la página "trabajo sexual" y
además
han contestado a "¿En los últimos doce meses has recibido preservativos y lubricantes
de forma gratuita?" : "Si, preservativos y lubricantes" de la página "Disponibilidad de
material preventivo" o además
han contestado a "¿En los últimos doce meses has recibido preservativos y lubricantes
de forma gratuita?" : "Sí, preservativos" de la página "Disponibilidad de material
preventivo".)
Menos de cinco
Entre cinco y diez
Entre once y veinte
Más de veinte
Aproximadamente ¿cuántos lubricantes gratuitos has recibido en los últimos doce
meses?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿En alguna ocasión has recibido dinero, comida o drogas a cambio de
practicar sexo con alguien?" : "Si" de la página "trabajo sexual" y además
han contestado a "¿Cuándo fue la última vez que recibiste dinero, comida o drogas por
practicar sexo con alguien?" : "En los últimos 12 meses" de la página "trabajo sexual" y
además
han contestado a "¿En los últimos doce meses has recibido preservativos y lubricantes
de forma gratuita?" : "Si, preservativos y lubricantes" de la página "Disponibilidad de
material preventivo" o además
han contestado a "¿En los últimos doce meses has recibido preservativos y lubricantes
de forma gratuita?" : "Sí, lubricantes" de la página "Disponibilidad de material
preventivo".)
Menos de cinco
Entre cinco y diez
Entre once y veinte
Más de veinte
¿Donde los recogiste, o quién te los entregó? Marca todas las que sea necesario
(* Esta pregunta es obligatoria )
(* Contestar solo si :
han contestado a "¿En alguna ocasión has recibido dinero, comida o drogas a cambio de
practicar sexo con alguien?" : "Si" de la página "trabajo sexual" y además
han contestado a "¿Cuándo fue la última vez que recibiste dinero, comida o drogas por
practicar sexo con alguien?" : "En los últimos 12 meses" de la página "trabajo sexual" y
además
han contestado a "¿En los últimos doce meses has recibido preservativos y lubricantes
de forma gratuita?" : "Si, preservativos y lubricantes" de la página "Disponibilidad de
material preventivo" o además
han contestado a "¿En los últimos doce meses has recibido preservativos y lubricantes
de forma gratuita?" : "Sí, preservativos" de la página "Disponibilidad de material
preventivo" o además
han contestado a "¿En los últimos doce meses has recibido preservativos y lubricantes
de forma gratuita?" : "Sí, lubricantes" de la página "Disponibilidad de material
preventivo".)
Los recogí en un centro de salud
Los recogí en un centro de planificación familiar
Me los entregó un profesional de la salud (médico/a, enfermero/a)
Me los dio un/a educador/a de una ONG en la calle, en un bar o discoteca
Los recogí yo mismo/a en la sede de una ONG
Otro (Por favor
especifique)_______________________________________________________
¿Tienes dinero suficiente para gastar en condones cada vez que los necesitas?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Si
No
Pág. 20.- Actividades de prevención
-----------------------------------------------------------------------------------Preg.28.- En alguna ocasión has participado en algún taller o charla informativa sobre
prevención del VIH?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Si
No
No estoy seguro/a (* Continuar en la pág.:21)
¿Por qué no has participado nunca en actividades de este tipo? Marca todas las que sea
necesario
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "En alguna ocasión has participado en algún taller o charla
informativa sobre prevención del VIH?" : "No" de la página "Actividades de
prevención".)
Nunca he tenido la oportunidad
No tengo interés en participar en este tipo de talleres o charlas
Considero que sé todo lo que tengo que saber acerca del VIH
En mi ciudad nadie organiza este tipo de talleres o charlas
No confío en las asociaciones que organizan este tipo de talleres o charlas en mi
ciudad
Otro (Por favor
especifique)_______________________________________________________
¿En alguna ocasión has sentido al participar en un taller o charla informativa sobre
prevención de VIH que eras discriminado/a por tu orientación sexual o identidad de
género?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "En alguna ocasión has participado en algún taller o charla
informativa sobre prevención del VIH?" : "Si" de la página "Actividades de prevención".)
Si
No
No estoy seguro/a
Pág. 21.- prueba del VIH
-----------------------------------------------------------------------------------Preg.29.- ¿En alguna ocasión te has hecho la prueba del VIH?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Si
No (* Continuar en la pág.:25)
No lo sé (* Continuar en la pág.:25)
Prefiero no decirlo (* Continuar en la pág.:25)
¿En alguna ocasión te has sentido discriminado/a o juzgado/a por tu orientación sexual
o identidad de género en el centro en el que te has hecho la prueba del VIH?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿En alguna ocasión te has hecho la prueba del VIH?" : "Si" de la
página "prueba del VIH".)
Si
No
¿En qué lugar en el que te hiciste la prueba tuvo lugar esas situación?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿En alguna ocasión te has sentido discriminado/a o juzgado/a por tu
orientación sexual o identidad de género en el centro en el que te has hecho la prueba
del VIH?" : "Si" de la página "prueba del VIH".)
En mi centro de salud
En un centro sanitario especializado (centro de salud joven, centro de infecciones de
transmisión sexual, hospital, etc.)
En una ONG
En una farmacia
En un laboratorio privado
Otro (Por favor
especifique)_______________________________________________________
¿En qué país tuvo lugar esa situación?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿En alguna ocasión te has sentido discriminado/a o juzgado/a por tu
orientación sexual o identidad de género en el centro en el que te has hecho la prueba
del VIH?" : "Si" de la página "prueba del VIH".)
España
Otro país
En España y en otro país
¿Por qué no te has hecho nunca la prueba del VIH?Marca tantas opciones como
consideres necesario
(* Esta pregunta es obligatoria )
(* Contestar solo si :
han contestado a "¿En alguna ocasión te has hecho la prueba del VIH?" : "No" de la
página "prueba del VIH".)
Nunca he pensado en ello
Considero que no he corrido riesgo de infectarme por el VIH
Cuando pensé en hacérmela me dijeron que debido a mi orientación
sexual/identidad de género no era necesario que me la hiciera
Si tengo VIH prefiero no saberlo
Tengo miedo de que los resultados no sean confidenciales
No sé dónde hacerme la prueba anónima y gratuita en mi ciudad
No tengo dinero para pagar por hacerme la prueba
Tengo miedo de la opinión de los demás si se enteran de que me he hecho la prueba
Tengo miedo de que el personal sanitario informe a mis padres o familiares sobre el
resultado de la prueba
Tengo miedo a la reacción de mi pareja si el resultado es positivo.
Otro (Por favor
especifique)_______________________________________________________
Pág. 22.- Resultado última prueba de VIH
-----------------------------------------------------------------------------------¿Cuál fue el resultado de tu última prueba de VIH?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿En alguna ocasión te has hecho la prueba del VIH?" : "Si" de la
página "prueba del VIH".)
Positivo (estoy infectado/a por el VIH)
Negativo (no estoy infectado/a por el VIH) (* Continuar en la pág.:25)
No recogí el resultado (* Continuar en la pág.:25)
Prefiero no decirlo (* Continuar en la pág.:25)
En los últimos doce meses ¿has visto en España a un/a doctor/a especialista en VIH?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿Cuál fue el resultado de tu última prueba de VIH?" : "Positivo (estoy
infectado/a por el VIH)" de la página "Resultado última prueba de VIH".)
No
Si
Prefiero no decirlo
¿Por qué no has visto a un/a doctor/a especialista en VIH? Marca todas las que
consideres necesario
(* Esta pregunta es obligatoria )
(* Contestar solo si :
han contestado a "En los últimos doce meses ¿has visto en España a un/a doctor/a
especialista en VIH?" : "No" de la página "Resultado última prueba de VIH".)
No puedo permitirme pagarlo
No puedo permitirme tomar un día libre para ir al médico
El hospital está muy lejos de donde vivo
No tengo derecho a la atención sanitaria
Por mi estado de salud, no he necesitado ir
Tengo miedo a que la gente me vea y descubra que tengo VIH
Tengo miedo a que me juzguen por ser gay/bisexual/transexual
Me he sentido discriminado por ser gay/bisexual/transexual
Otro (Por favor
especifique)_______________________________________________________
¿En alguna ocasión te has sentido discriminado/a o juzgado/a por tu orientación sexual
o identidad de género por los doctores/as especialistas en VIH que te han atendido en
España?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "En los últimos doce meses ¿has visto en España a un/a doctor/a
especialista en VIH?" : "Si" de la página "Resultado última prueba de VIH".)
Si
No
Pág. 23.- grupos de ayuda mutua
-----------------------------------------------------------------------------------¿Has participado alguna vez en un grupo de ayuda mutua o soporte emocional para
personas con VIH?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿Cuál fue el resultado de tu última prueba de VIH?" : "Positivo (estoy
infectado/a por el VIH)" de la página "Resultado última prueba de VIH".)
No
Sí, presencial
Sí, a través de internet
Sí, tanto presencial como por internet
¿Por qué no has participado en un grupo de ayuda mutua? Marca todas las opciones que
consideres necesarias
(* Esta pregunta es obligatoria )
(* Contestar solo si :
han contestado a "¿Has participado alguna vez en un grupo de ayuda mutua o soporte
emocional para personas con VIH?" : "No" de la página "grupos de ayuda mutua".)
No tengo interés / no necesito participar en este tipo de grupos
No hay ningún grupo de este tipo en mi ciudad
No conozco ninguna asociación que organice este tipo de grupos
Los horarios no me van bien
Tengo miedo de que alguien me vea y descubran que tengo VIH
No confío en quienes organizan este tipo de grupos en mi ciudad
Quienes participan en este tipo de grupos no tienen nada que ver conmigo
NS/NC
¿En alguna ocasión te has sentido discriminado/a o juzgado/a por tu orientación sexual
o identidad de género en un grupo de ayuda mutua o soporte emocional para personas
con VIH?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿Has participado alguna vez en un grupo de ayuda mutua o soporte
emocional para personas con VIH?" : "Sí, presencial" de la página "grupos de ayuda
mutua" o además
han contestado a "¿Has participado alguna vez en un grupo de ayuda mutua o soporte
emocional para personas con VIH?" : "Sí, a través de internet" de la página "grupos de
ayuda mutua" o además
han contestado a "¿Has participado alguna vez en un grupo de ayuda mutua o soporte
emocional para personas con VIH?" : "Sí, tanto presencial como por internet" de la
página "grupos de ayuda mutua".)
Si
No
No estoy seguro/a
¿Dónde ocurrió esta situación en la que te sentiste discriminado/a? Señala tantas
opciones como sea necesario
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿En alguna ocasión te has sentido discriminado/a o juzgado/a por tu
orientación sexual o identidad de género en un grupo de ayuda mutua o soporte
emocional para personas con VIH?" : "Si" de la página "grupos de ayuda mutua".)
En un grupo de ayuda mutua de una ONG que trabaja en VIH
En un grupo de ayuda mutua de una ONG de personas LGBT
En un grupo de ayuda mutua online
En un grupo de ayuda mutua de un centro sanitario o de servicios sociales
Otro (Por favor
especifique)_______________________________________________________
¿En qué país tuvo lugar esta situación de discriminación?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿En alguna ocasión te has sentido discriminado/a o juzgado/a por tu
orientación sexual o identidad de género en un grupo de ayuda mutua o soporte
emocional para personas con VIH?" : "Si" de la página "grupos de ayuda mutua".)
España
Otro país
España y otro país
Pág. 24.- Visita dentista
-----------------------------------------------------------------------------------En los últimos doce meses has visitado a tu dentista para hacerte una revisión o una
limpieza bucal?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿Cuál fue el resultado de tu última prueba de VIH?" : "Positivo (estoy
infectado/a por el VIH)" de la página "Resultado última prueba de VIH".)
Si
No
¿Cuál es el motivo por el que no has visitado a tu dentista? Señala todas las que
convenga
(* Esta pregunta es obligatoria )
(* Contestar solo si :
han contestado a "En los últimos doce meses has visitado a tu dentista para hacerte una
revisión o una limpieza bucal?" : "No" de la página "Visita dentista".)
No puedo permitirme pagarlo
Me resulta desagradable ir al dentista y lo pospongo
Por mi estado de salud bucal, no he necesitado ir
Tengo miedo a que el dentista me discrimine por tener VIH
Tengo miedo a que el dentista me discrimine por ser gay/bisexual/transexual
Ya me he sentido discriminado en otras ocasiones por el dentista por ser
gay/lesbiana/transexual/bisexual o por tener VIH
Otro (Por favor
especifique)_______________________________________________________
Pág. 25.- Consulta ginecológica
-----------------------------------------------------------------------------------Las siguientes preguntas tienen que ver con tu opinión y/o experiencia respecto a las/los
profesionales de la ginecología.NOTA: Si no ves preguntas en esta página, dále a
CONTINUAR
¿Has acudido en alguna ocasión a una consulta ginecológica?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿Qué sexo te asignaron cuando naciste?" : "Mujer" de la página
"Orientación sexual e identidad de género".)
Si
No
¿Cuándo has efectuado la última visita a una consulta de ginecología por algún motivo
distinto a los relacionados con el embarazo o el parto?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿Has acudido en alguna ocasión a una consulta ginecológica?" : "Si"
de la página "Consulta ginecológica".)
Hace menos de 12 meses
Entre 1 y 3 años
Hace más de 3 años
Nunca he ido por motivos diferentes al embarazo o parto
Prefiero no contestar
Pág. 26.- Mamografía
-----------------------------------------------------------------------------------NOTA: Si no ves preguntas en esta página, dále a CONTINUAR
¿En alguna ocasión te has hecho una mamografía?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿Qué sexo te asignaron cuando naciste?" : "Mujer" de la página
"Orientación sexual e identidad de género" y además
han contestado a "Indica cuál es tu edad (años que cumpliste en tu último
cumpleaños)" : "40 - 49" de la página "Edad" o además
han contestado a "¿Qué sexo te asignaron cuando naciste?" : "Mujer" de la página
"Orientación sexual e identidad de género" y además
han contestado a "Indica cuál es tu edad (años que cumpliste en tu último
cumpleaños)" : "50 - 65" de la página "Edad" o además
han contestado a "Indica cuál es tu edad (años que cumpliste en tu último
cumpleaños)" : "> 65" de la página "Edad" y además
han contestado a "¿Qué sexo te asignaron cuando naciste?" : "Mujer" de la página
"Orientación sexual e identidad de género".)
Sí
No
No lo sé
Tu última mamografía fue
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Hace menos de un año
Hace 1 - 2 años
Hace 3 -5 años
Hace más de cinco años
Tu última mamografía estuvo cubierta por...
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿En alguna ocasión te has hecho una mamografía?" : "Sí" de la
página "Mamografía".)
El sistema sanitario público
Mi seguro de salud privado
Otro (Por favor
especifique)_______________________________________________________
¿Cuáles son los motivos por los que no te has hecho nunca una mamografia? Señala
todas las opciones que sea necesario
(* Esta pregunta es obligatoria )
(* Contestar solo si :
han contestado a "¿En alguna ocasión te has hecho una mamografía?" : "No" de la
página "Mamografía".)
Por mi edad, aún no lo he necesitado
Por mi estado de salud, no he necesitado hacérmela
No puedo permitirme pagar por hacérmela
No puedo permitirme tomar un día libre en el trabajo para hacérmela
Tengo miedo a que el personal sanitario me juzgue o me discrimine por ser
lesbiana/bisexual/trans
Otro (Por favor
especifique)_______________________________________________________
¿Has recibido en tu domicilio alguna carta para acudir a una unidad de exploración
mamográfica?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Sí, hace menos de un año
Sí, hace entre uno y dos años
Sí, hace entre tres y cinco años
Sí, hace más de cinco años
No
NS/NC
Pág. 27.- Diagnóstico y factores de riesgo cáncer de mama
-----------------------------------------------------------------------------------ATENCIÓN: Si no ves preguntas en esta página, dále a CONTINUAR
¿Hay antecedentes de cáncer de mama entre tus familiares?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿Qué sexo te asignaron cuando naciste?" : "Mujer" de la página
"Orientación sexual e identidad de género" y además
han contestado a "Indica cuál es tu edad (años que cumpliste en tu último
cumpleaños)" : "40 - 49" de la página "Edad" o además
han contestado a "¿Qué sexo te asignaron cuando naciste?" : "Mujer" de la página
"Orientación sexual e identidad de género" y además
han contestado a "Indica cuál es tu edad (años que cumpliste en tu último
cumpleaños)" : "50 - 65" de la página "Edad" o además
han contestado a "Indica cuál es tu edad (años que cumpliste en tu último
cumpleaños)" : "> 65" de la página "Edad" y además
han contestado a "¿Qué sexo te asignaron cuando naciste?" : "Mujer" de la página
"Orientación sexual e identidad de género".)
Si
No
NS/NC
¿En alguna ocasión has tenido alguno de los siguientes síntomas?
(* Esta pregunta es obligatoria )
(* Contestar solo si :
han contestado a "¿Qué sexo te asignaron cuando naciste?" : "Mujer" de la página
"Orientación sexual e identidad de género" y además
han contestado a "Indica cuál es tu edad (años que cumpliste en tu último
cumpleaños)" : "40 - 49" de la página "Edad" o además
han contestado a "¿Qué sexo te asignaron cuando naciste?" : "Mujer" de la página
"Orientación sexual e identidad de género" y además
han contestado a "Indica cuál es tu edad (años que cumpliste en tu último
cumpleaños)" : "50 - 65" de la página "Edad" o además
han contestado a "Indica cuál es tu edad (años que cumpliste en tu último
cumpleaños)" : "> 65" de la página "Edad" y además
han contestado a "¿Qué sexo te asignaron cuando naciste?" : "Mujer" de la página
"Orientación sexual e identidad de género".)
Masa o protuberancia en el seno
Hinchazón de parte o de todo el seno
Irritación o hendiduras en la piel del seno
Dolor en el seno o en el pezón
Contracción o retracción de los pezones
Enrojecimiento, descamación de la piel, del seno o del pezón
Secrección del pezón que no sea leche materna
Ninguno de estos
¿Has sido diagnosticada en alguna ocasión por un/a profesional sanitario/a de cáncer de
mama?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "Indica cuál es tu edad (años que cumpliste en tu último
cumpleaños)" : "40 - 49" de la página "Edad" y además
han contestado a "Indica cuál es tu edad (años que cumpliste en tu último
cumpleaños)" : "50 - 65" de la página "Edad" o además
han contestado a "Indica cuál es tu edad (años que cumpliste en tu último
cumpleaños)" : "> 65" de la página "Edad" o además
han contestado a "¿Qué sexo te asignaron cuando naciste?" : "Mujer" de la página
"Orientación sexual e identidad de género".)
Si
No
Prefiero no contestar
Pág. 28.- Citología
-----------------------------------------------------------------------------------ATENCIÓN: Si no ves preguntas en esta página, dále a CONTINUAR
¿En alguna ocasión te has hecho una citología o prueba Papanicolau?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿Qué sexo te asignaron cuando naciste?" : "Mujer" de la página
"Orientación sexual e identidad de género".)
Si
No
NS/NC
¿Cuáles son los motivos por los cuales no te has hecho nunca una citología? Señala todas
las respuestas que sea necesario
(* Esta pregunta es obligatoria )
(* Contestar solo si :
han contestado a "¿En alguna ocasión te has hecho una citología o prueba
Papanicolau?" : "No" de la página "Citología".)
Por mi edad, no he necesitado hacérmela
Por mi estado de salud, no he necesitado hacérmela
No puedo permitirme pagarla
No puedo permitirme tomar un día libre en el trabajo para hacérmela
Mi ginecóloga/o me ha dicho que no es necesario hacérmela debido a mis prácticas
sexuales
Mi ginecóloga/o me ha dicho que no es necesario hacérmela debido a mi orientación
sexual/identidad de género
Tengo miedo de que mi ginecólogo/a me discrimine por ser lesbiana/bisexual/trans
Me he sentido discriminada en el pasado por mi ginecólogo/a por ser
lesbiana/bisexual/trans
Otro (Por favor
especifique)_______________________________________________________
Te hiciste tu última citología
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿En alguna ocasión te has hecho una citología o prueba
Papanicolau?" : "Si" de la página "Citología".)
En los últimos 12 meses
Hace entre 12 y 24 meses
Hace más de 24 meses
No lo recuerdo
Tu última citología estuvo cubierta por...
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿En alguna ocasión te has hecho una citología o prueba
Papanicolau?" : "Si" de la página "Citología".)
El sistema sanitario público
Mi seguro de salud privado
Otro (Por favor
especifique)_______________________________________________________
Pág. 29.- Reproducción asistida
-----------------------------------------------------------------------------------Las siguientes preguntas tienen que ver con tu experiencia respecto a la reproducción
asistidaATENCIÓN: Si no ves preguntas en esta página, dale a CONTINUAR
En alguna ocasión HAS PENSADO EN seguir un tratamiento de reproducción asistida para
quedarte embarazada tú o tu pareja?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿Qué sexo te asignaron cuando naciste?" : "Mujer" de la página
"Orientación sexual e identidad de género" y además
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "No" de la página "Orientación sexual e identidad de género".)
Sí, he pensado seguirlo yo sola para quedarme embarazada
Sí, mi pareja (otra mujer) o yo hemos pensado seguirlo para ser madres
No
¿En alguna ocasión tú o tu pareja habéis seguido un tratamiento de reproducción
asistida? Si es tu caso puedes marcar las dos primeras
(* Esta pregunta es obligatoria )
(* Contestar solo si :
han contestado a "En alguna ocasión HAS PENSADO EN seguir un tratamiento de
reproducción asistida para quedarte embarazada tú o tu pareja?" : "Sí, he pensado
seguirlo yo sola para quedarme embarazada" de la página "Reproducción asistida" o
además
han contestado a "En alguna ocasión HAS PENSADO EN seguir un tratamiento de
reproducción asistida para quedarte embarazada tú o tu pareja?" : "Sí, mi pareja (otra
mujer) o yo hemos pensado seguirlo para ser madres" de la página "Reproducción
asistida".)
Sí, lo he seguido yo para quedarme embarazada
Sí lo ha seguido mi pareja para quedarse embarazada y que yo sea la segunda madre
No
¿Cuáles son los motivos por los que no has pensado emplear o no has empleado
técnicas de reproducción asistida? Puedes marcar todas las respuestas que sea
necesario
(* Esta pregunta es obligatoria )
(* Contestar solo si :
han contestado a "¿En alguna ocasión tú o tu pareja habéis seguido un tratamiento de
reproducción asistida? Si es tu caso puedes marcar las dos primeras" : "No" de la página
"Reproducción asistida" o además
han contestado a "En alguna ocasión HAS PENSADO EN seguir un tratamiento de
reproducción asistida para quedarte embarazada tú o tu pareja?" : "No" de la página
"Reproducción asistida".)
Ya soy madre
No deseo ser madre
Mi pareja y/o yo no deseamos ser madres
En mi comunidad autónoma no hay cobertura pública para la reproducción asistida
para mujeres solteras o parejas de mujeres
Mi/nuestro seguro privado no cubre la reproducción asistida para mujeres solteras o
para parejas de mujeres
Prefiero no contestar
Otro (Por favor
especifique)_______________________________________________________
Pág. 30.- Empleo de servicios de reproducción asistida
------------------------------------------------------------------------------------
ATENCIÓN: Si no ves preguntas en esta página, dale a CONTINUAR
¿Cuándo ha sido la última vez que has empleado / habéis empleado métodos de
reproducción asistida?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿En alguna ocasión tú o tu pareja habéis seguido un tratamiento de
reproducción asistida? Si es tu caso puedes marcar las dos primeras" : "Sí, lo he seguido
yo para quedarme embarazada" de la página "Reproducción asistida" o además
han contestado a "¿En alguna ocasión tú o tu pareja habéis seguido un tratamiento de
reproducción asistida? Si es tu caso puedes marcar las dos primeras" : "Sí lo ha seguido
mi pareja para quedarse embarazada y que yo sea la segunda madre" de la página
"Reproducción asistida".)
En los últimos 12 meses
Hace entre 1 y 2 años
Hace más de 2 años
En esa ocasión ¿qué técnica empleasteis?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿En alguna ocasión tú o tu pareja habéis seguido un tratamiento de
reproducción asistida? Si es tu caso puedes marcar las dos primeras" : "Sí, lo he seguido
yo para quedarme embarazada" de la página "Reproducción asistida" o además
han contestado a "¿En alguna ocasión tú o tu pareja habéis seguido un tratamiento de
reproducción asistida? Si es tu caso puedes marcar las dos primeras" : "Sí lo ha seguido
mi pareja para quedarse embarazada y que yo sea la segunda madre" de la página
"Reproducción asistida".)
Fecundación in vitro
Fecundación in vitro a través del método ROPA (recepción de ovocitos de la pareja; o
cesión de óvulos de la pareja)
Inseminación artificial
NS/NC
Otro (Por favor
especifique)_______________________________________________________
En esa última ocasión, la cobertura del tratamiento para ti o para tu pareja fue...
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿En alguna ocasión tú o tu pareja habéis seguido un tratamiento de
reproducción asistida? Si es tu caso puedes marcar las dos primeras" : "Sí, lo he seguido
yo para quedarme embarazada" de la página "Reproducción asistida" o además
han contestado a "¿En alguna ocasión tú o tu pareja habéis seguido un tratamiento de
reproducción asistida? Si es tu caso puedes marcar las dos primeras" : "Sí lo ha seguido
mi pareja para quedarse embarazada y que yo sea la segunda madre" de la página
"Reproducción asistida".)
Pública
Privada
Otro (Por favor
especifique)_______________________________________________________
¿En esa última ocasión te sentiste / os sentisteis discriminada/as por parte del personal
sanitario que te atendió / os atendió a causa de tu/vuestra orientación sexual o
identidad de género?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿En alguna ocasión tú o tu pareja habéis seguido un tratamiento de
reproducción asistida? Si es tu caso puedes marcar las dos primeras" : "Sí, lo he seguido
yo para quedarme embarazada" de la página "Reproducción asistida" o además
han contestado a "¿En alguna ocasión tú o tu pareja habéis seguido un tratamiento de
reproducción asistida? Si es tu caso puedes marcar las dos primeras" : "Sí lo ha seguido
mi pareja para quedarse embarazada y que yo sea la segunda madre" de la página
"Reproducción asistida".)
Si
No
No revelé mi orientación sexual/identidad de género
Prefiero no contestar
Pág. 31.- Unidades de Género
-----------------------------------------------------------------------------------Las siguientes preguntas se dirigen únicamente a personas trans y tienen que ver con su
experiencia y utilización de servicios sanitarios relacionados con su proceso de
tránsitoATENCIÓN: Si no ves preguntas en esta página, dale a CONTINUAR
En la COMUNIDAD AUTÓNOMA en la que vives ¿existe una unidad de género u otro
centro en el que puedas recibir de manera integral la atención sanitaria que podrías
necesitar para tu proceso transexualizador?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de hombre al nacer, y actualmente mi
identidad de género es de mujer" de la página "Orientación sexual e identidad de
género" o además
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de hombre al nacer, y actualmente mi
identidad de género es otra" de la página "Orientación sexual e identidad de género" o
además
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de mujer al nacer, y actualmente mi
identidad de género es de hombre" de la página "Orientación sexual e identidad de
género" o además
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de mujer al nacer, y actualmente mi
identidad de género es otra" de la página "Orientación sexual e identidad de género".)
Si
No
No lo sé
¿Existe alguna unidad de género en la CIUDAD en la que vives?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de hombre al nacer, y actualmente mi
identidad de género es de mujer" de la página "Orientación sexual e identidad de
género" o además
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de hombre al nacer, y actualmente mi
identidad de género es otra" de la página "Orientación sexual e identidad de género" o
además
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de mujer al nacer, y actualmente mi
identidad de género es de hombre" de la página "Orientación sexual e identidad de
género".)
Si
No
No lo sé
Pág. 32.- Uso y experiencias en las unidades de género
-----------------------------------------------------------------------------------Las siguientes preguntas se dirigen únicamente a personas trans y tienen que ver con su
experiencia y utilización de servicios sanitarios relacionados con su proceso de
tránsitoATENCIÓN: Si no ves preguntas en esta página, dale a CONTINUAR
En la actualidad, ¿acudes a una unidad de género?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de hombre al nacer, y actualmente mi
identidad de género es de mujer" de la página "Orientación sexual e identidad de
género" o además
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de hombre al nacer, y actualmente mi
identidad de género es otra" de la página "Orientación sexual e identidad de género" o
además
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de mujer al nacer, y actualmente mi
identidad de género es de hombre" de la página "Orientación sexual e identidad de
género" o además
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de mujer al nacer, y actualmente mi
identidad de género es otra" de la página "Orientación sexual e identidad de género".)
Sí, en la Comunidad Autónoma en la que vivo
Sí, pero en otra Comunidad Autónoma
No
¿Por qué motivos no acudes actualmente a una unidad de género? Señala todas las
respuestas que sea necesario
(* Esta pregunta es obligatoria )
(* Contestar solo si :
han contestado a "En la actualidad, ¿acudes a una unidad de género?" : "No" de la
página "Uso y experiencias en las unidades de género".)
No sé si existe una unidad de género donde vivo
No existe una unidad de género donde vivo
No tengo un diagnóstico o informe psiquiátrico/psicológico
No tengo derecho a la atención sanitaria pública
No puedo permitirme pagar por ir a recibir atención sanitaria
No tengo tiempo o medios para desplazarme hasta la unidad de género que me
corresponde
Tengo miedo a ser discriminada/o por ser trans
Me he sentido discriminada/o en el pasado en la unidad de género
Otro (Por favor
especifique)_______________________________________________________
¿Qué métodos de transporte tienes que utilizar para llegar a la unidad de género que te
corresponde?
(* Esta pregunta es obligatoria )
(* Contestar solo si :
han contestado a "En la actualidad, ¿acudes a una unidad de género?" : "Sí, en la
Comunidad Autónoma en la que vivo" de la página "Uso y experiencias en las unidades
de género" o además
han contestado a "En la actualidad, ¿acudes a una unidad de género?" : "Sí, pero en
otra Comunidad Autónoma" de la página "Uso y experiencias en las unidades de
género".)
Caminando
Coche
Autobús
Metro
Tren
Otro (Por favor
especifique)_______________________________________________________
De media, ¿cuánto tiempo empleas en llegar a esta unidad de género desde tu hogar?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "En la actualidad, ¿acudes a una unidad de género?" : "Sí, en la
Comunidad Autónoma en la que vivo" de la página "Uso y experiencias en las unidades
de género" o además
han contestado a "En la actualidad, ¿acudes a una unidad de género?" : "Sí, pero en
otra Comunidad Autónoma" de la página "Uso y experiencias en las unidades de
género".)
Menos de una hora
Entre una y dos horas
Más de dos horas
Pág. 33.- Valoración de unidades de género y servicios sanitarios a personas trans
-----------------------------------------------------------------------------------Las siguientes preguntas se dirigen únicamente a personas trans y tienen que ver con su
experiencia y utilización de servicios sanitarios relacionados con su proceso de
tránsitoATENCIÓN: Si no ves preguntas en esta página, dale a CONTINUAR
De acuerdo a tu experiencia, ¿como calificarías este centro?
(* Esta pregunta es obligatoria )
(* Marque una sola opción por fila)
(* Contestar solo si :
han contestado a "En la actualidad, ¿acudes a una unidad de género?" : "Sí, en la
Comunidad Autónoma en la que vivo" de la página "Uso y experiencias en las unidades
de género" o además
han contestado a "En la actualidad, ¿acudes a una unidad de género?" : "Sí, pero en
otra Comunidad Autónoma" de la página "Uso y experiencias en las unidades de
género".)
Malo
Localización (situación
geográfica)
Facilidad para obtener
cita
Atención recibida
Valoración global
Regular
Bueno
Muy
bueno
Prefiero
Excelente no
contestar
Pág. 34.- discriminacion unidades género
-----------------------------------------------------------------------------------Las siguientes preguntas se dirigen únicamente a personas trans y tienen que ver con su
experiencia y utilización de servicios sanitarios relacionados con su proceso de
tránsitoATENCIÓN: Si no ves preguntas en esta página, dale a CONTINUAR
En alguna ocasión has sentido discriminación en una unidad de género por algún
aspecto relacionado con tu identidad de género o tu orientación sexual?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
(* Contestar solo si :
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de hombre al nacer, y actualmente mi
identidad de género es de mujer" de la página "Orientación sexual e identidad de
género" o además
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de hombre al nacer, y actualmente mi
identidad de género es otra" de la página "Orientación sexual e identidad de género" o
además
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de mujer al nacer, y actualmente mi
identidad de género es de hombre" de la página "Orientación sexual e identidad de
género".)
Si
No
No estoy segura/o
Pág. 35.- Servicios sanitarios para personas trans disponibles en la comunidad autónoma
-----------------------------------------------------------------------------------Las siguientes preguntas se dirigen únicamente a personas trans y tienen que ver con su
experiencia y utilización de servicios sanitarios relacionados con su proceso de
tránsitoATENCIÓN: Si no ves preguntas en esta página, dale a CONTINUAR
Ya sea en una unidad de género o de forma descentralizada en distintos centros
sanitarios, ¿Cuáles de los siguientes servicios tienes cubiertos por el sistema sanitario
público en tu comunidad autónoma? Señala tantas respuestas como sea necesario
(* Esta pregunta es obligatoria )
(* Contestar solo si :
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de hombre al nacer, y actualmente mi
identidad de género es de mujer" de la página "Orientación sexual e identidad de
género" o además
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de hombre al nacer, y actualmente mi
identidad de género es otra" de la página "Orientación sexual e identidad de género" o
además
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de mujer al nacer, y actualmente mi
identidad de género es de hombre" de la página "Orientación sexual e identidad de
género" o además
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de mujer al nacer, y actualmente mi
identidad de género es otra" de la página "Orientación sexual e identidad de género".)
Atención psicológica/psiquiátrica
Endocrinología / tratamiento hormonal
Foniatría
Cirugías de aumento/reducción/eliminación de mamas
Tratamiento de eliminación de vello
Cirugía de resignación
No estoy seguro/a
Otro (Por favor
especifique)_______________________________________________________
De aquellos que has utilizado alguna vez, ¿qué valoración haces? Si no los has utilizado,
marca la última opción de cada fila "no lo he usado"
(* Esta pregunta es obligatoria )
(* Marque una sola opción por fila)
(* Contestar solo si :
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de hombre al nacer, y actualmente mi
identidad de género es de mujer" de la página "Orientación sexual e identidad de
género" o además
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de hombre al nacer, y actualmente mi
identidad de género es otra" de la página "Orientación sexual e identidad de género" o
además
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de mujer al nacer, y actualmente mi
identidad de género es de hombre" de la página "Orientación sexual e identidad de
género" o además
han contestado a "¿Te identificas en la actualidad, o te has identificado alguna vez
como persona con disconformidad de género (transexual, transgénero, trans o persona
con género variante)?" : "Sí, me asignaron género de mujer al nacer, y actualmente mi
identidad de género es otra" de la página "Orientación sexual e identidad de género".)
Malo
Regular
Bueno
Muy
bueno
No lo
Excelente he
usado
Atención
psicológica/psiquiátrica
Endocrinología / tratamiento
hormonal
Foniatría
Cirugías de
aumento/reducción/eliminación
de mamas
Tratamiento de eliminación de
vello
Cirugía de resignación
Pág. 36.- experiencia de discriminación
-----------------------------------------------------------------------------------Preg.30.- Si tienes una experiencia de discriminación que quieras compartir sobre
cualquiera de los aspectos tratados en esta encuesta, nos gustaría saber más sobre ella
para poder emplear tu caso en la mejorar de la atención sanitaria a la población LGTBI.
Recuerda no indicar tu nombre ni ningún otro dato que pueda identificarte.
________________________________________________________________________
____________
________________________________________________________________________
____________
________________________________________________________________________
____________
________________________________________________________________________
____________
________________________________________________________________________
____________
________________________________________________________________________
____________
________________________________________________________________________
____________
________________________________________________________________________
____________
________________________________________________________________________
____________
________________________________________________________________________
____________
Pág. 37.- Algunas preguntas finales...
-----------------------------------------------------------------------------------¡Ya casi hemos terminado! Tan solo cinco preguntas más, acerca de tus características
socio-demográficas, que nos ayudaran a entender e interpretar mejor tus respuestas a
las preguntas anteriores. Recuerda que todos tus datos son anónimos.
Preg.31.- ¿Cual es el nivel de estudios más alto que has finalizado? Por favor, selecciona:
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Sin estudios o estudios primarios incompletos (EGB,ESO)
Estudios primarios completos (EGB, ESO)
Secundarios (Bachiller, BUP, COU, LOGSE)
Técnico (Formación profesional de grado medio o superior)
Universitarios (Diplomatura, Licenciatura, Grado)
Estudios de Postgrado
Otro (Por favor
especifique)_______________________________________________________
Preg.32.- ¿Cual de las siguientes situaciones se ajusta más a tu situación actual?
(* Esta pregunta es obligatoria )
(* Marque una sola opción)
Estudiante a jornada completa
Trabajador/a jornada completa
Trabajador/a a tiempo parcial
Desempleado/a e inscrito como demandante de empleo
Desempleado/a pero no inscrito como demandante de empleo
Perceptor/a de pensión por discapacidad o enfermedad
Jubilado/a
Soy inmigrante y no dispongo de permiso de trabajo
Realizo trabajos que no cotizan a la seguridad social/economía sumergida
Prefiero no contestar
Otro (Por favor
especifique)_______________________________________________________
Preg.33.- ¿Cuáles son aproximadamente tus ingresos mensuales, descontando las
retenciones por impuestos, cotizaciones sociales, etc.?
(* Marque una sola opción)
550 euros o menos
De 551 a 800
De 801 a 1.050
De 1051 a 1.300
De 1.301 a 1.550
De 1.551 a 1.850
De 1.851 a 2.250
De 2.251 a 2.700
De 2.701 a 3.450
Más de 3.450
Prefiero no contestar
Preg.34.- En las últimas cuatro semanas:
(* Esta pregunta es obligatoria )
(* Marque una sola opción por fila)
Nunca en las 4
últimas
semanas
En alguna ocasión no
hubo suficiente
comida en tu hogar
por falta de recursos
económicos
Te fuiste a la cama
con hambre porque
no había suficiente
comida
Has estado un día
completo sin comer
nada porque no había
suficiente comida
A veces
A menudo
Prefiero no
contestar
Preg.35.- En general, ¿sientes que tienes suficiente apoyo social...
(* Marque una sola opción por fila)
SI
NO
No tengo / No
procede
En el trabajo o centro
donde estudias?
En tu barrio o
vecindario?
De tu familia?
De tus amigos?
De tu pareja?
Pág. 38.- FIN DE LA ENCUESTA.
-----------------------------------------------------------------------------------Muchas gracias por tu tiempo y por tu participación en nuestra encuesta… Recuerda que
si necesitas atención personalizada o quieres comentar algún aspecto relacionado con
esta encuesta o los temas abordados, puedes contactarnos a través de nuestra página
web www.felgtb.org o al correo [email protected]

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