Inés Arístegui

Factors associated with healthcare avoidance among transgender women in Argentina

IntroductionTransgender (TG) women in many settings continue to contend with barriers to healthcare, including experiences of stigma and discrimination. Argentina has a universal health care system and laws designed to promote healthcare access among TG women. However, little is known about barriers to healthcare access among TG women in this setting. The aim of this study was to explore individual, social-structural and environmental factors associated with healthcare avoidance among TG women in Argentina.MethodsData were derived from a 2013 nation-wide, cross-sectional study involving TG women in Argentina. We assessed the prevalence and factors associated with avoiding healthcare using multivariable logistic regression.ResultsAmong 452 TG women included in the study, 184 (40.7%) reported that they avoided seeking healthcare because of their transgender identity. In multivariable analysis, factors positively associated with avoiding seeking healthcare were: having been exposed to police violence (adjusted odd ratio [aOR] = 2.20; 95% CI: 1.26 - 3.83), internalized stigma (aOR = 1.60, 95% CI: 1.02-2.51), having experienced discrimination by healthcare workers (aOR = 3.36: 95% CI: 1.25 - 5.70) or patients (aOR = 2.57; 95% CI: 1.58 - 4.17), and currently living in the Buenos Aires metropolitan area (aOR = 2.32; 95% CI: 1.44 - 3.76). In contrast, TG women with extended health insurance were less likely to report avoiding healthcare (aOR = 0.49; 95% CI: 0.26 - 0.93).ConclusionsA high proportion of TG women in our sample reported avoiding healthcare. Avoiding healthcare was associated with stigma and discrimination in healthcare settings, as well as police violence experiences. Although further research is warranted, these finding suggests that socio-structural interventions tailored TG women needs are needed to improve access to healthcare among this population.

Prevalence and Correlates of Lifetime Suicide Attempts Among Transgender Persons in Argentina

ABSTRACT This study examined the lifetime prevalence and correlates of attempted suicide among transgender persons in Argentina. Data were derived from a nation-wide, cross-sectional survey conducted in 2013. We assessed individual, social, and structural correlates of reporting a history of attempting suicide using logistic regression. Among 482 participants, the median age was 30, 91% identified as transwomen, and 32% resided in the Buenos Aires metropolitan area. A lifetime suicide attempt was reported by 159 (33%), among whom the median age at first attempt was 17. In a multivariate model, internalized stigma was positively associated with a history of suicidal behavior, while participants with stable housing had reduced odds of prior suicide attempt(s). These findings suggest that reducing stigma and mitigating structural vulnerabilities (through, for example, the enactment and enforcement of laws that prohibit discrimination based on gender identity to ensure equitable access to housing) could be effective targets for intervention to reduce suicide attempts among transgender individuals in Argentina.

Towards full citizenship: correlates of engagement with the gender identity law among transwomen in Argentina.

Introduction In May 2012, Argentina passed its “Gender Identity” Law, which aimed to address the legal invisibility, discrimination and marginalization that transgender individuals have historically faced. The aim of this study was to explore factors associated with engagement with the Gender Identity Law among transwomen living in Argentina. Methods Data were derived from a 2013 nationwide, cross-sectional study involving transwomen in Argentina. Using multivariate logistic regression, we assessed the prevalence and factors associated with acquiring a gender-congruent identity card within the first 18 months of enactment of the Gender Identity Law. Results Among 452 transwomen, 260 (57.5%) reported that they had obtained a new gender-congruent identity card. In multivariate analysis, factors positively associated with acquiring a new ID were: previously experiencing discrimination by healthcare workers (adjusted odd ratio [aOR] = 2.01, 95% CI: 1.27–3.20); having engaged in transition procedures (aOR = 3.06, 95% CI: 1.58–5.93); and having a job other than sex work (aOR = 1.81, 95% CI: 1.06–3.10). Foreign born transwomen were less likely to have obtained a new ID (aOR = 0.14, 95% CI: 0.06–0.33). Conclusions More than half of transwomen in our sample acquired a new gender-congruent ID within the first 18 months of enactment of the Gender Identity Law. However, access to and uptake of this right has been heterogeneous. In particular, our findings suggest that the most empowered transwomen may have been among the first to take advantage of this right. Although educational level, housing conditions, HIV status and sex work were not associated with the outcome, foreign-born status was a strong negative correlate of new ID acquisition. Therefore, additional efforts should be made in order to ensure that benefits of this founding policy reach all transwomen in Argentina.

Motivational Interviewing among HIV Health Care Providers: Challenges and Opportunities to Enhance Engagement and Retention in Care in Buenos Aires, Argentina.

In Argentina, providers’ response to motivational interviewing (MI) to improve engagement and retention in care among challenging patients with HIV was evaluated. Twelve HIV care physicians participated, and their video recordings pre- and post-MI training were also obtained. One week post-training, 11 of the 12 participants were committed to using MI strategies during consult session. Of the 12 participants, 9 demonstrated appropriate utilization of MI techniques and change in HIV education provided during consultation (Z = −2.375, P = .018). Motivational interviewing appears to be a viable strategy to enhance engagement and retention in challenging HIV-positive patients.

Impact of the Gender Identity Law in Argentinean transgender women

ABSTRACT Background: In May 2012, collective efforts led to the enactment of a Gender Identity Law in Argentina. This is a particularly progressive law, based on human rights principles, as it is the first in the world to recognize a persons gender identity without any preconditions. However, studies that evaluate its impact on the transgender community (positive outcomes as well as barriers to implementation) have been scant. Thus, the following study investigated the impact of the implementation of the Argentinean Gender Identity Law on the living conditions, plus it explored stigma and discrimination (S&D) experiences of transgender women. Method: Two focus groups, with 20 transgender women, were conducted. Recordings were transcribed and a thematic analysis of the transcripts was performed according to the following categories: general perceived impact of the Law, work and education, security and civil rights, health services, and perceived differences among regions and provinces. Results: After the Laws enactment, participants mostly perceived positive changes, in general, and in particular domains such as education, health care, work, security, and civil rights. A general empowering effect on the community can be inferred. However, barriers to full implementation were identified, both internal and subjective (age, internalized stigma) and external (lack of trained professionals and public servants, reluctance to implementation in conservative provinces). Discussion: This study provides the first evaluation of the implementation and impact of the Gender Identity Law in Argentina from the point of view of transgender women. The empowering effect and the improvements achieved provide preliminary information on the importance of adopting this type of policy. Additionally, the barriers to be overcome and recommendations for the future are discussed.

Resources to cope with stigma related to HIV status, gender identity, and sexual orientation in gay men and transgender women

The stigma related to HIV status, gender identity, and sexual orientation has negative implications for the quality of life of individuals. A qualitative study was conducted to explore the resources that these stigmatized groups recognize as tools to cope with stigma and maintain their psychological well-being. Four focus groups were conducted with gay men and transgender women divided by HIV status. A thematic analysis revealed that individual, interpersonal, and institutional resources are commonly recognized as coping resources. This article discusses the importance of enhancing self-acceptance, social support, and a legal framework that legitimizes these groups as right holders.

Implementation and uptake of the Conexiones y Opciones en la Argentina intervention: feasibility and acceptability.

ABSTRACT Challenging HIV-infected patients, those neither adherent nor actively engaged in care, represent an important opportunity for intervention if the HIV epidemic is to be contained. This pilot study assessed the feasibility and acceptability of an adapted patient adherence intervention and a motivational interview-based provider intervention in urban Buenos Aires, Argentina, in order to optimize health benefits in challenging HIV-infected patients. To maximize implementation and uptake of both strategies, interventions were adapted to the local setting. Qualitative data and a short quantitative assessment from patients, staff, fellows, residents and physicians (n = 84) were examined to establish the feasibility and acceptability of offering patient and provider evidence-based interventions in both public and private health-care settings. Results identified key themes on provision of information, use of specialized communication techniques and group support in the utilization of the interventions. Both providers (n = 12) and patients (n = 120) endorsed the acceptability and value of the interventions, and the feasibility of their delivery. Findings support the use of both intervention modalities with challenging patients in diverse urban health-care settings.

Social Suffering and an Approach to Professionals’ Burnout

Individual and social problems require the assistance of professionals who are accustomed to work with “suffering” on daily basis. Psychologists, physicians, and social workers step into this role helping alleviate the suffering and improve the quality of life of their patients and clients. But, inevitably, they experience suffering as they address others’ problems. Their own well-being and quality of life may be reduced by their work in helping. We interviewed Argentinean professionals about their experience of patient, personal, and suffering conditions in order to determine the level of transference and turn to the practice of Yoga as a possible physical and psychological approach to mediating suffering. As such professionals work to improve their clients’ quality of life, they must be provided the tools to preserve their own.

Cultural Competences of International Students: Its Role on Successful Sociocultural and Psychological Adaptation

This chapter addresses the study of cultural competences involved in the successful adaptation of a particular group of migrants: international students. Cultural competences are skills that people display when facing cultural diversity and have been found to predict job performance and academic achievement of those who have to interact in different contexts other than their own. This chapter aims to respond three questions that students consider when studying abroad: ‘What should I do to have a successful life?’, ‘How prepared are members of the host culture to receive me?’, and, ‘Who are the most successful international students?’ The first segment introduces the role of acculturative strategies of Latin American international students in Argentina in order to predict psychological adjustment (life satisfaction) and sociocultural adaptation. The second section presents local students perceptions and attitudes towards international peers and multiculturalism. The last section describes sociodemographic, cultural and psychological predictors of psychological adjustment, sociocultural adaptation and academic achievement, as well as the relationship between character strengths and cultural and academic adjustment. Finally, the role of cultural competences sensitivity and cultural intelligences as cultural competences is explained. Results demonstrate the importance of cultural variables in positive adaption to culture.