Constructing a new epistemology of transgender persons: Impact of gender studies on mental health ideologies

International audienceThe depathologization in 2019 of transgender persons by the World Health Organization highlighted epistemological shifts at work at the confluence of sexuality, gender and mental health. If they are accompanied by changes in medical epistemology, they signal what Paul B. Preciado characterizes as the end of the paradigm of sexual difference. Based on the conceptual model developed by Norman Fairclough, we have identified the ideological frameworks in which these epistemic changes are taking place, illustrating in particular the impact of the means of knowledge production and interpretation. In this article, we argue that the development of gender studies has led to the existence of alternative epistemologies which, because of their political impact, have made it possible to support this depathologization process.La dépathologisation en 2019 des personnes transgenres par l’Organisation Mondiale de la Santé a permis de mettre en évidence les bouleversements épistémologiques à l’œuvre à la confluence entre sexualité, genre et santé mentale. S’ils s’accompagnent de changements de l’épistémologie médicale, ils annoncent ce que Paul B. Preciado caractérise comme la fin du paradigme de la différence sexuelle. En nous appuyant sur le cadre conceptuel développé par Norman Fairclough, nous avons procédé à une identification des cadres idéologiques dans lesquels s’opèrent ces changements épistémiques, en illustrant notamment l’impact des processus de production et d’interprétation des savoirs. Dans cet article, nous défendons que le développement des études de genre a amené l’existence d’épistémologies alternatives qui, de par leur impact politique, ont permis d’appuyer cette dépathologisation

: État des connaissances et perspectives

International audienceLes personnes transgenres représentent 0.3% à 4.5% des adultes et 1.2% à 8.4% des enfants et adolescents. Elles partagent un vécu d'exclusion sociale et de violences, des indicateurs, besoins et risques spécifiques. Certaines ont recours aux soins pour leur transition (modification de certaines caractéristiques corporelles visant à modifier leur expression de genre). Ensuite, des facteurs biologiques, comportementaux, sociaux, économiques et structurels les placent en situation de vulnérabilité vis-à-vis de risques de santé, notamment en santés sexuelle (plus spécifiquement VIH/SIDA), mentale (risque suicidaire) et addictologique. Enfin, elles font face à des difficultés documentées d'accès aux systèmes de santé imputables à leur inadaptation et à des pratiques discriminatoires de la part des professionnels de santé.Ces éléments font considérer qu'elles prennent leurs décisions de santé dans un objectif de survie immédiate et non de gestion des risques. Pour réduire ces iniquités de santé, il a été proposé d’associer directement les personnes et organisations communautaires à la réflexion sur cette problématique, afin de développer des solutions adaptées et applicables au contexte socio-culturel.La France produit peu de données sur leur santé et les systèmes de soins sont limités aux services spécialisés de santé mentale contrôlant l'accès aux interventions de transition. Leur incomplétude a été mise en avant par les associations, le Défenseur des Droits et récemment par la Délégation Interministérielle à la Lutte contre le Racisme, l'Antisémitisme et la Haine anti-LGBT.Elles forment donc une part importante de la population dont la santé est dégradée par des barrières systémiques d'accès aux soins et des besoins et des risques spécifiques non répondus.Face à l'impératif de transformation des systèmes de soins et de travail partenarial, cette communication présentera les données actuelles sur les déterminants et les besoins de santé, ainsi que des perspectives innovantes et basées sur des preuves concernant la participation des personnes concernées et la promotion de leur santé centrée sur ces populations

Déterminants, besoins de santé et promotion des personnes transgenres : état des connaissances et perspectives

International audienc

: Une analyse thématique de la littérature militante

National audienceINTRODUCTION. Alors que les personnes transgenres peuvent représenter près de 2% de la population (Zhang et al., 2020), les études épidémiologiques internationales mettent en évidence que cette population hétérogène, regroupant un ensemble varié d'identités et d'expressions de genre, partage un vécu spécifique d'exclusion sociale et de violences, ainsi que de mauvais indicateurs de santé et des besoins et risques spécifiques (Reisner et al., 2016). Les changements épistémiques récents accompagnant la dépsychopathologisation de la transidentité amènent une refonte des parcours de soins (Wylie et al., 2016) basée sur le modèle de la santé communautaire (Baleige, de la Chenelière, Dassonneville, & Martin, 2021). Cette étude a pour but de mettre en évidence des leviers d'actions permettant ces transformations. MÉTHODE. Nous avons réalisé une revue de la littérature militante visant à faire émerger les éléments scientifiques sous-tendant le discours politique. Les données incluses proviennent de documents issus des ressources communautaires européennes et ont été analysées sous la forme d’une analyse thématique venant soutenir la prise de décisions pratiques. RÉSULTATS. Les documents provenant de l'ensemble des parties prenantes ont été inclus dans l'analyse. Les données ont été extraites et classées en 23 thèmes permettant une modélisation rendant compte de cibles spécifiques d'action sur le système de santé mentale. DISCUSSION. Les résultats semblent transposables à un grand nombre de systèmes de soins occidentaux. L'amélioration de l'accès aux soins passerait par des modifications systémiques profondes de notre système social et par la montée en compétence des services de santé mentale. Les soins devraient être coordonnés par la santé primaire et les services devraient inclure des personnes paires dans leurs organisations

Risk reduction strategies for transgender people regarding sexually transmitted diseases and health promotion: a systematic review of activist literature

International audienceObjectivesTransgender people are a heterogeneous and growing population in visibility and numbers. They facedocumented difficulties in accessing health care systems, mainly based on the lack of training ofprofessionals and discrimination. In addition, the organization of health care systems is still largely basedon a psychiatric and pathologizing approach that reduces the possibilities of intervention and excludespeople from the health care system as well as research and policy-making. Multiple international studiesdocument a high prevalence of HIV and other sexually transmitted infections in this population. This workis based on field initiatives in health promotion and emphasizes the recognition of the expertise oforganizations and field actors with the aim of identifying applicable and acceptable approaches forintervention.MethodsWe conducted a systematic review of activist literature from European organizations and French localassociations. After analyzing the quality of the included documents, we performed a thematic analysisaiming at identifying the courses of action and strategies to be used for health promotion interventionsand campaigns.ResultsThe results highlight the multiplicity and expertise of associations in the field of harm reduction in sexualhealth. Transgender people face specific issues mainly related to social exclusion and inadequate healthcare systems. These issues are all the more important when people have a poor experience of medicalservices or exist outside of a heterosexual gender binarity.ConclusionsThe implementation of strategies to promote the health of transgender people regarding sexuallytransmitted diseases requires major epistemic and social changes. Individuals themselves seem bestequipped to deal with field challenges. Moreover, their concerns are in line with scientific data and policiespromoted by the World Health Organization. The major difficulty seems to be linked to Western caresystems and therefore associations should be put in a decision-making position for public health policies

Impact of gender transition on sexuality and diversity of practices: a qualitative analysis of reddit discussions

International audienceObjectivesTransgender people are a heterogeneous and growing population in visibility and numbers. There is littleresearch on their sexuality, especially outside of a heterosexual binary approach. The physical,psychological, and social changes associated with transition make knowledge developed about cisgenderpeople difficult to apply. Internet remains the preferred source to access information. In addition,transgender people face documented difficulties in accessing health care systems, including lack ofknowledge among professionals and discrimination. The objective of this study is to report on the diversityof practices and issues related to the impact of transition on sexuality. It is conducted in a participatorymanner, under the direction of a transgender person and in connection with the community.MethodsA quantitative content analysis was performed on a pool of most relevant threads and comments aboutthe topic "asktransgender" on Reddit. In accordance with the participatory approach, the relevant threadshave been selected by two researchers, one of whom is transgender. Corpus analysis techniques wereused to highlight the potential impacts of transition on sexuality and the diversity of practices. Secondly,the results were analyzed by gender and experience of transition.ResultsReddit is mostly used by transgender people asking for advice to other users about behavioral andhormonal impact of gender transition, as well as sexual practices outside of gender binarity. The resultsshow a significant gap between research evidence and the needs of those involved. Social exclusion andfear of violence appear as central aspects of actual or anticipated sexual experiences.ConclusionsThere is an important need to develop research and clinical approaches to support transgender people inmaintaining and developing positive sexuality. This field largely questions the established boundariesbetween normal and pathological and raises epistemic questions about the sexological approach and morebroadly about the Western social conception of gender and its impact on sexuality

Meeting Health Needs of Transgender and Gender Diverse People in Primary Care based on Free and Informed Consent

International audienceBACKGROUND. Transgender and gender diverse (TGD) individuals represent a heterogeneous and growing population. Unmet needs, epistemic changes and political activism are leading to a transformation of care delivery. The free and informed consent model based on primary care is widely promoted. General practitioners remain insufficiently trained and informed about TGD issues. To present a review of TGD health needs. To build common knowledge between consumers and professionals to face epistemic inconsistencies in science. To illustrate practical organizational changes.METHODS. This work lies at the con?uence of academic, experiential and ?eld knowledge. It is based on a review of recent scientific publications, a thematic synthesis of activist literature and a ?eld experiment in community care.OUTCOMES. Public health-based approaches share an epistemic proximity to arguments from the activist world, unlike specialized approaches, particularly in mental health, which lack ecological validity. Concrete examples of successful implementation also tend to reinforce this practical validity.DISCUSSION. Conceptualizing TGD people as a population at risk for systemic risks appears a better solution than hyperspecialized approaches based on diagnostic and prognostic assessment. Thus, transforming health care services towards primary care does not mean shifting tasks, but rather putting forward new practices and a new medical and paramedical stance in the service of self-determination and human rights

Impact of Depsychopathologization of Transgender and Gender Diverse Individuals in ICD-11 on Care Delivery: Looking at Trans Expertise through a Trans Lens

International audienceDepsychopathologization of transgender and gender diverse (TGD) individuals in theeleventh revision of the International Classification of Diseases (ICD-11) called for a shift in caredelivery models, based on free and informed consent. Public health policies face epistemic anddiscriminatory challenges and consensus built on evidence-based data is needed. TGD communitieswere consulted but did not actively participate in ICD-11 and the following public health debates.There is a need for TGD perspective—both in research and practice. This study draws on a peer-ledparticipatory approach and explores TGD participants’ recommendations based on unexploitedFrench data from ICD-11, in which 72 TGD gave feedback on public policies. Lexicometric analyseswere conducted using the ALCESTE method and resulted in a two-step double Descending Hier-archical Classification. Sex, gender, and health consumption were analyzed as secondary variables.The first classification highlighted five main topics: care pathways, training of professionals, access,literacy, and civil status change, developed into 12 targets in the second classification. While sex andgender appeared to have little impact on discourses, recommendations varied according to receivedcare. This study supports the growing scientific consensus of a public health approach to face TGDhealth challenges and emphasizes TGD individuals’ expertise

Promoting Access of Transgender and Gender Diverse People to Primary Care: A systematic review of activist literature

International audienceBACKGROUND. The visibility and number of the transgender and gender diverse (TGD) population is increasing. They presenttransdisciplinary needs and face systemic barriers to accessing care. Primary care is promoted as a neworganizational entry point for care pathways. Yet, a signi?cant number of TGD individuals report poor experiencesand avoid seeking help. The objective of this study is to highlight the ecological barriers and levers of access to primary health care forTGD people to improve practices.METHODS.We conducted a systematic review of activist literature from European organizations. Following quality analysis,we performed a thematic analysis aiming at identifying the courses of action and strategies to be used for healthpromotion.OUTCOMES. Results highlight the expertise of TGD organizations in identifying ecological problems and solutions.Discrimination appears as a central factor in access to care, as lack of training and information of professionals.These elements appear all the more important as TGD people evolve outside the norms of heterosexual genderbinarity.DISCUSSION. Building a common knowledge and information foundation appears to be a ?rst step towards promoting access tocare for TGD people, as well as developing professional and associative networks. Structural changes in caredelivery could easily alleviate some of the di?culties and also bene?t a large part of the cisgender population

Behaviors and challenges for transgender people accessing reproductive health: a systematic review of activist literature

International audienceObjectivesTransgender people are a heterogeneous and growing population in visibility and numbers. They facedocumented difficulties in accessing health care systems, mainly based on the lack of training ofprofessionals and discrimination. These barriers are particularly apparent in the field of reproductive healthand are hampered by heteronormative and cisnormative public and legislative policies. These difficultieslimit the ability of transgender people to reproduce and have a significant impact on transition journeyswith consequences for psychological and social well-being. In addition, the multiplicity of legislativeframeworks and practices increases the social and economic disparities that have already been identifiedas important determinants of transgender health and well-being. The purpose of this study is to report onfield realities and strategies adopted by individuals to preserve their fertility.MethodsWe conducted a systematic review of activist literature from European organizations and French localassociations. After analyzing the quality of the included documents, we conducted an exploratoryqualitative analysis and modeling putting into dialogue the challenges at the French and Europeanlevels. Secondly, the results were analyzed by gender and experience of transition.ResultsThe French system does not allow for adequate access to reproductive health, but associations have beenable to put in place workaround strategies that remain insufficient in relation to needs. The disparity oflegislative frameworks and practices at the European level contributes to both the slowing down of accessand the development of complex and inappropriate strategies that increase population gaps.ConclusionsThe current organization of the health system traps transgender people in a paradox between dependenceand lack of appropriate response. There is an urgent need to put in place adapted and human rights-basedpathways, both in terms of practices and public policies and legislation. The expertise of the associationsappears essential for their development