Abstract
The training of a generation of healthcare professionals sensitive to the needs of the LGBTQ+ population is urgent. In Mexico, five million people identify as part of the LGBTQ+ population. Despite legal changes and the mandatory compliance that healthcare professionals must adhere to with protocols, the treatment of LGBTQ+ patients remains discriminatory. Efforts towards inclusion have been driven by governments through guidelines tailored to the contexts in which they are published, student demands through groups, and universities providing information on their official websites. However, these are only the first steps toward being able to provide informed and quality care to the LGBTQ+ population.
TopIntroduction
In Mexico, 5.1% of the population aged 15 and older, which is approximately five million people, identify as part of the LGBTQ+ population, according to the National Survey on Sexual and Gender Diversity (ENDISEG), the first survey of its kind in Mexico. The perception of rights and care for sexual diversity in the country has evolved inconsistently. Regarding health, the first legal reforms to include hormonal treatments and psychotherapy in the gender transition process for transgender individuals emerged in 2009. The strategy for recognition and visibility only began on May 17, 2014, when Mexico declared it as the national day against homophobia. Similarly, it wasn't until 2015 that the Supreme Court of Justice of the Nation (SCJN) stated that under no circumstances could anyone be denied or restricted access to a right based on their sexual orientation. This has also extended to healthcare rights, as recently, the registration of same-sex spouses or partners as beneficiaries was established in the Mexican Social Security Institute (IMSS) and the Institute of Security and Social Services for State Workers (ISSSTE) (National Institute of Statistics and Geography [INEGI], 2022). The objective of this chapter is to describe efforts towards the inclusion of a medical curriculum focused on the LGBTQ+ community from various perspectives.
Definition
The acronym LGBTI refers to: Lesbian, Gay, Bisexual, Trans, Intersex (CONAPRED, 2016). These initials can also be found as LGBTQ, where the Q refers to queer individuals who live and navigate their gender identity, gender expression, and sexual orientation fluidly. Reference can also be made to LGBTTTI, where the T distinguishes between transgender, transsexual, and cross-dressing individuals, terms that are becoming obsolete as they can represent discrimination, and the umbrella term “trans” is used instead. In some other acronyms, you may find the letter A for the Asexual community. In Canada, the term 2SLGBTQIA+ is used, where 2S refers to Two-Spirit individuals, who are Native Americans and do not adhere to gender binary norms (The University of British Columbia, 2023). Finally, it is common to write with a + at the end, which, for practicality, encompasses the rest of the diversities. For this document, the acronym LGBTQ+ will be used.
Panorama In Mexico
In 2017, Mexico's Ministry of Health launched the Protocol for Non-Discriminatory Access to Healthcare Services for LGBTQ+ Individuals (Secretaría de Salud, 2020). This protocol addresses a range of topics, including the legal framework, operational definitions, best clinical practices for the LGBTQ+ population, including children, and the hormonal regimen for transgender individuals who choose it. Despite legal changes and the mandatory compliance required by healthcare professionals with this protocol, there is a widespread lack of awareness. Some of the causes can be attributed to a lack of prior training in these topics, negative attitudes toward diversity, and cultural barriers. These issues result in delayed access to care and inadequate diagnoses. Medical education provides a significant opportunity for raising awareness of the LGBTQ+ population and their healthcare needs.
Discrimination against the LGBTQ+ population can take various forms, including not using the correct name and pronouns, making judgments, or omitting questions about sexual history during interviews or physical examinations, and assuming heterosexual coital relationships as the norm. This leads to inadequate diagnoses, ranging from not suspecting certain conditions, such as failing to conduct anal cytology and staining in individuals who engage in anal intercourse, to neglecting necessary tests, e.g., vaginal ultrasound in lesbian women (National LGBTQIA+ Health Education Center, 2018). It's important to mention that it's not just the absence of a diagnosis but also the attribution of one based on prejudice, as observed with HIV or monkeypox (ONUSIDA, 2022). The only diagnosis that could be reasonably attributed to the LGBTQ+ population is minority stress, which can lead to psychiatric disorders such as anxiety and depression.
Key Terms in this Chapter
Activists: Person who becomes politically involved in the defense or promotion of social, environmental, or political issues considered important by society.
Public Healthcare Services: System or set of services and resources provided and managed by the government ensure access to medical care and the well-being of the general population, such as, IMSS, ISSSTE, SEDENA, and the Navy.
LGBTQ+: Lesbian, Gay, Bisexual, Trans, Queer and the rest of the diversities.
Trans Umbrella: In order to avoid discrimination, the letter T is used to represent transgender, transsexual, and cross-dressing individuals.
Healthcare Professionals: Professionals responsible for providing clinical care, such as doctors, nurses, dentists, nutritionists, etc.
Curriculum: The plan that guides practice and acquisition of skills of the institution’s graduates.
Queer: Individuals who live and navigate their gender identity, gender expression, and sexual orientation fluidly.
Private Healthcare Services: Services available to individuals and families who choose to pay for them directly or through private health insurance plans, such as, pharmacy clinics or private hospitals.