lgbt people and discrimination in the area of healt in spain
Transcripción
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".) ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ 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? ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ 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]