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  • 1.
    Anyango, Cartrine
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Nkulu Kalengayi, Faustine
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Linander, Ida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    "A One-size-fit-all model is not good"?: Ambivalent perceptions and experiences of African immigrant parents towards Swedsih sexual and reproductive health services for young people2020In: BMC Research Notes, E-ISSN 1756-0500, Vol. 13, article id 449Article in journal (Refereed)
    Abstract [en]

    Objective: Parents have a key role regarding young people’s access to sexual and reproductive health services, thus their perceptions go a long way towards promoting or discouraging young people from using such services. Research has revealed that immigrant young people in Sweden access these essential services to a lesser extent than their native peers, and that they perceive their parents as unsupportive of such visits. This pilot study’s objective was to explore immigrant parents’ perceptions and experiences of the sexual and reproductive health services provided by Swedish youth clinics.

    Results: Two categories were developed from the data analysis: (i) Youth clinics are well-known (to some) and appreciated (to a certain extent), and (ii) Parents feel left out from youth clinics and that the clinics have taken over parental responsibility. This study presents an ambivalent scenario connected to immigrant parents’ experiences and perceptions of having neither a space nor a voice within the existing youth clinic model. Parents expressed the desire for the youth clinics to recognise their cultural backgrounds, norms, and beliefs while providing sexual and reproductive health services to their children.

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  • 2.
    Berg, Linda
    et al.
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Linander, Ida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Hypogonadism: Diagnosis, Masculinity, and Capital in Narratives about Testosterone deficiency2023In: Norma, ISSN 1890-2138, E-ISSN 1890-2146, Vol. 18, no 1, p. 5-20Article in journal (Refereed)
    Abstract [en]

    For centuries, male hypogonadism has been defined as a clinical syndrome caused by the inability to produce physiological concentrations of testosterone and/or normal amount of sperm. In 2020, an information campaign started in Sweden with the ambition of increasing knowledge about hypogonadism and (lack of) testosterone, targeting both men and healthcare providers. In this study, we take a closer look at media discussions in Sweden on hypogonadism over the period 2018–2021. Through feminist thinking on biomedicalisation, we analyse the media material about the phenomena and issues being raised regarding masculinity, age and health in contemporary neoliberal and biocapital times. For some people, hypogonadism is a severe condition, but we can also see that the diagnosis becomes a response to a wide range of symptoms, expanding the realm for diagnostic practices and tying into normative ideas about age, time and lacking or fading masculinity. The media narratives about hypogonadism not only reflect cultural norms regarding masculinity and the plasticity of diagnoses but also create desires, needs and markets.

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  • 3.
    Goicolea, Isabel
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Bäckström, Hanna
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Lauri, Marcus
    Mid Sweden University, Östersund, Sweden.
    Carbin, Maria
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Linander, Ida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Daring to ask about violence?: a critical examination of social services’ policies on asking about gender-based violence2023In: Journal of Gender-Based Violence, ISSN 2398-6808, Vol. 7, no 3, p. 467-482Article in journal (Refereed)
    Abstract [en]

    This article critically analyses the assumptions and effects of the ‘daring to ask approach’ to gender based violence (GBV), as expressed in the policies that govern social services’ work in Sweden. We show how GBV is constituted as a sensitive issue connected with shame and as something that will not be brought up spontaneously; GBV is something that women who had experienced it carry with them as an ‘untouched truth’ waiting to be discovered by social workers while women’s worries about the consequences of telling are not made intelligible. The very speaking as such is seen as emancipatory, and the social worker is understood as a facilitator. With this approach follows standardised questions, aiming for neutrality and equity. However, these are so wide and unspecific, that the risk is that no one thinks the questions are directed to her. By making the assumptions and effects of a seemingly self-evident strategy visible, we demonstrate areas in need of further research and policy development, such as barriers to help-seeking (beyond stigmatisation) and effects of standardisation. This is an important undertaking since without critical scrutiny of the policies there is a risk that stakeholders assume that merely asking will resolve the problem of GBV.

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  • 4.
    Goicolea, Isabel
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Linander, Ida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Richter Sundberg, Linda
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Protecting, managing and bending boundaries: a biomedicalization perspective on Swedish youth clinics’ responses to mental (ill) health2022In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, no 1, article id 863Article in journal (Refereed)
    Abstract [en]

    Background: Sweden has provided around 300 youth clinics (YCs) to address the health needs of young people since the 1970s. During the last few years, and as part of an effort to strengthen mental healthcare for young people, YCs’ role in the provision of mental healthcare has been widely debated. With such debates as background, the aim of this study is to analyse Swedish YCs’ responses to the mental (ill) healthcare needs of young people, from the perspective of national level stakeholders.

    Methods: We used thematic analysis of interviews with eight national level stakeholders in the field of youth mental health in Sweden. Building upon the concept of biomedicalization we examined the discourses on mental (ill) health, healthcare and youth that such responses reproduce.

    Results: YCs engage in the three simultaneous, but at times contradictory, responses of protecting, managing and bending boundaries. Remaining true to their mission as a health-promotion service compels them to protect their boundaries and limit the type of mental health issues they address. However, the perceived malfunctioning of specialized services has led them to bend these boundaries to allow in more young people with severe mental health problems. Caught between protecting and bending boundaries, the response of managing boundaries to decide who should be allowed in and who should be sent elsewhere has emerged as a middle-way response. However, it is not free from conflicts.

    Conclusion: Building upon the concept of biomedicalization, this study poses two questions. The first relates to whether it is possible to support young people and their health without reinforcing discourses that represent young people as collectively at risk, and if so how this can be done. The second relates to the provision of mental healthcare for young people, and the need to identify conditions for integrating diagnosis and treatment within YCs, without hindering their holistic and youth-centred approach.

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  • 5.
    Gotfredsen, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Linander, Ida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Young trans people's experiences of leisure and mental health: belonging, creativity, and navigation2023In: Wellbeing, Space and Society, ISSN 2666-5581, Vol. 4, article id 100139Article in journal (Refereed)
    Abstract [en]

    There is a lack of research on young trans people's everyday leisure. This article analyses how leisure, defined within a broad spatial context beyond sport and physical activity, is perceived and experienced by trans youth in relation to their mental health and wellbeing. We draw upon theoretical concepts of cisnormativity and spatiality to our analysis of sixteen interviews with young trans people (16-25 years old) in Sweden. Three themes emerged. The first refers to how both queer- and non-queer-specific leisure spaces connect people with similar (and different) experiences regarding queer and trans identities and shows how these identities can shift in importance. The second highlights how creative spaces (e.g., theatre, cosplay) can offer opportunities to carve out a leisured space to explore different gender identity/ies and expressions that are often crucial and life changing. The final theme illustrates how leisure is avoided, postponed, waited for, and reclaimed by trans youth. Excluding mechanisms such as transphobia, cisnormativity, and the lack of access to gender-confirming care can hinder young people's leisure participation. Our analysis illustrates the complex connections between leisure and mental health among young people with trans experiences. Leisure can be a source of discomfort and distress but also of belongingness and affirmation of one's identity. Finding and accessing strengthening leisure spaces demands emotional investment, engagement, and navigation.

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  • 6.
    Gustafsson, Per E.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Linander, Ida
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mosquera, Paola A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Embodying pervasive discrimination: a decomposition of sexual orientation inequalities in health in a population-based cross-sectional study in Northern Sweden.2017In: International Journal for Equity in Health, E-ISSN 1475-9276, Vol. 16, article id 22Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Studies from Sweden and abroad have established health inequalities between heterosexual and non-heterosexual people. Few studies have examined the underpinnings of such sexual orientation inequalities in health. To expand this literature, the present study aimed to employ decomposition analysis to explain health inequalities between people with heterosexual and non-heterosexual orientation in Sweden, a country with an international reputation for heeding the human rights of non-heterosexual people.

    METHODS: Participants (N = 23,446) came from a population-based cross-sectional survey in the four northernmost counties in Sweden in 2014. Participants completed self-administered questionnaires, covering sexual orientation, mental and general physical health, social conditions and unmet health care needs, and sociodemographic data was retrieved from total population registers. Sexual orientation inequalities in health were decomposed by Blinder-Oaxaca decomposition analysis.

    RESULTS: Results showed noticeable mental and general health inequalities between heterosexual and non-heterosexual orientation groups. Health inequalities were partly explained (total explained fraction 64-74%) by inequalities in degrading treatment (24-26% of the explained fraction), but to a considerable degree also by material conditions (38-45%) and unmet care needs (25-43%).

    CONCLUSIONS: Psychosocial experiences may be insufficient to explain and understand health inequalities by sexual orientation in a reputedly 'gay-friendly' setting. Less overt forms of structural discrimination may need to be considered to capture the pervasive material discrimination that seems to underpin the embodiment of sexual minority inequalities. This ought to be taken into consideration in research, policy-making and monitoring aiming to work towards equity in health across sexual orientations.

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  • 7.
    Holmberg, Jenny
    et al.
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Linander, Ida
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Södersten, Maria
    Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Medical Unit Speech-Language Pathology, Karolinska University Hospital, Stockholm, Sweden.
    Karlsson, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Exploring motives and perceived barriers for voice modification: the views of transgender and gender-diverse voice clients2023In: Journal of Speech, Language and Hearing Research, ISSN 1092-4388, E-ISSN 1558-9102, Vol. 66, no 7, p. 2246-2259Article in journal (Refereed)
    Abstract [en]

    Purpose: To date, transgender and gender-diverse voice clients' perceptions and individual goals have been missing in discussions and research on gender-affirming voice therapy. Little is, therefore, known about the client's expectations of therapy outcomes and how these are met by treatments developed from views of vocal gender as perceived by cisgender persons. This study aimed to explore clients' individual motives and perceived barriers to undertaking gender-affirming voice therapy.

    Method: Individual, semistructured interviews with 15 transgender and gender-diverse voice clients considering voice therapy were conducted and explored using qualitative content analysis.

    Results: Three themes were identified during the analysis of the participants' narratives. In the first theme, “the incongruent voice setting the rules,” the contribution of the voice on the experienced gender dysphoria is put in focus. The second theme, “to reach a voice of my own choice,” centers around anticipated personal gains using a modified voice. The third theme, “a voice out of reach,” relates to worries and restricting factors for not being able to reach one's set goals for voice modification.

    Conclusions: The interviews clearly indicate a need for a person-centered voice therapy that starts from the individuals' expressed motives for modifying the voice yet also are affirmative of anticipated difficulties related to voice modification. We recommend that these themes should form the basis of the pretherapy joint discussion between the voice client and the speech-language pathologist to ensure therapy goals that are realistic and relevant to the client.

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  • 8.
    Högberg, Ann
    et al.
    Umeå University.
    Linander, Ida
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Neuroplasticitet, epigenetik - och nya perspektiv för genusvetenskapen: [Neuroplasticity, epigenetics - and new perspectives for gender studies]2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 8, p. 424-426Article in journal (Other (popular science, discussion, etc.))
  • 9.
    Jonsson, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Arctic Research Centre at Umeå University.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Hjelte, Jan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Linander, Ida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Representing a Fading Welfare System that Is Failing Young People in 'NEET' Situations: a WPR Analysis of Swedish Youth Policies2022In: Journal of Applied Youth Studies, ISSN 2204-9193Article in journal (Refereed)
    Abstract [en]

    The situation of young people who are neither in employment, education nor training (referred to in political, scientific and public discourses as ‘NEETs’) has received widespread attention during the last decade. However, while policy responses to young people’s work- and school-related marginalisation have been analysed by international scholars in a variety of contexts, to the best of our knowledge, no study to date has scrutinised problem representations of ‘NEET’ young people in youth policies in Sweden. To bridge the current knowledge gap and uncover taken-for-granted assumptions about the otherwise largely unchallenged Nordic welfare model, the aim of this research was to explore how the ‘problem’ of ‘NEET’ young people is represented in Swedish policies and policy proposals. To facilitate this, a discursive approach to policy analysis was adopted, following Bacchi’s ‘What’s the Problem Represented to be?’ (WPR) methodology. By focusing on the solutions that have been proposed to reduce the size of the ‘NEET’ group in two selected policies, four problem representations were developed. These connect the ‘NEET’ problem in Sweden, at the general level, to the ‘vulnerability’ of young people on the margins of education and employment (especially certain sub-groups) and, more specifically, to the failure of a fading welfare system to provide services and support for these ‘vulnerable’ subjects. Beyond representing the ‘problem’ along these lines, the identified problem representations may contribute to silencing young people’s agency and ignoring the consequences of a growing labour-market precarisation in Sweden, while failing to provide a basis for equity and social justice.

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  • 10.
    Kawsar, Mithila
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Linander, Ida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    "It’s a patient safety issue": A qualitative study with care professionals on their experiences of meeting trans people in obstetric and gynaecological care2022In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 34, article id 100786Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this explorative study was to analyse how encounters with trans people in the obstetrics and gynaecological department are experienced by healthcare professionals and what needs to be implemented in practice to improve these encounters.

    Methods: Six participants – physicians, midwives, and a nurse, from four different regions in Sweden – were interviewed, and the interviews were then analysed following inductive thematic analysis according to Braun and Clarke.

    Results: The analysis of the interviews resulted in three themes: “Lack of structure, organization, and medical competence”; “Engaged healthcare professionals push the work forward”; and “Working continuously to improve access to healthcare and the clinical encounter”. The results indicated that the participating healthcare professionals experienced shortcomings regarding different aspects of encountering trans people in care settings. These concerned, for example, structure and organization of care, guidelines, routines, and administrative systems, and a lack of medical competence when it comes to trans people.

    Conclusion: The results can be interpreted as indicating that there is an inequality in access to healthcare compared to cis people (those who identify with their gender assigned at birth). However, the study also shows that actions can be taken at both the individual level and the organizational level. Education about how to encounter trans people and having clear guidelines and routines are among the improvements that are needed to be more respectful towards trans people and to provide healthcare on equal terms as to cis people.

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  • 11.
    Lauri, Johanna
    et al.
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Linander, Ida
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Statementfestivalen: begär efter trygghet2020In: (O)tryggt?: Texter om makt, plats och motstånd / [ed] Malin Rönnblom, Ida Linander & Linda Sandberg, Premiss förlag, 2020, p. 149-171Chapter in book (Other academic)
    Abstract [sv]

    Under de senaste åren har frågor om trygghet tagit allt mer plats i det offentliga samtalet. Det kan handla om att otryggheten breder ut sig, att den måste bekämpas och att vi måste kunna vara trygga på gator och torg. Vissa grupper pekas ut som mer otrygga medan andra blir de som står för otryggheten. Vid en närmare granskning blir det dock tydligt att trygghet är mer komplicerat än så. Att det som är tryggt för vissa kan vara otryggt för andra. Att talet om trygghet kan betyda både hårdare straff och en längtan efter ett eget hem. Denna bok består av två delar som tillsammans tar sig an (o)trygghet från olika perspektiv samhälleliga föreställningar, politiska förändringar och ambitioner att arbeta för förändring. Bokens författare har sin hemvist i olika akademiska discipliner etnologi, folkhälsovetenskap, genusvetenskap, konstvetenskap, kulturgeografi, socialt arbete, statsvetenskap och urbana studier och ger därmed en mångfacetterad bild av vad (o)trygghet betyder i dagens Sverige. 

    I bidraget "Statementfestivalen - begär efter trygghet" undersöks medierapporteringen från den separatistiska festivalen Statement utifrån ett diskursteoretiskt och psykoanalytiskt perspektiv för att förstå ett begär efter trygghet. 

  • 12.
    Lauri, Johanna
    et al.
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Linander, Ida
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    'The patriarchy can’t dance with us': Statement, separatism and safety2023In: Culture Unbound: Journal of Current Cultural Research, E-ISSN 2000-1525, Vol. 15, no 2, p. 1-21Article in journal (Refereed)
    Abstract [en]

    The music festival Statement was initiated as a response to sexual violence towards women at other festivals, and during the work of creating a safe festival, separatism became a central strategy. In this paper we analyse media reporting from Statement, with a focus on the desire for safety. Using psychoanalytical discourse theory, we analyse different media materials, focusing on emotive language and fantasmatic narratives. We argue that in the media representations, a desire for safety is linked to enjoyment, opportunities to be oneself, predictability and lack of conflict. Safety is also strongly represented as linked to a focus on security and the absent man is continuously present in the media articulations. While the media representations tend to reconstruct a heterosexual Woman with a universal experience, the focus on the patriarchy, a common 'we' and the emotive language might nevertheless spur political mobilisation.

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  • 13.
    Lauri, Marcus
    et al.
    Mid Sweden University, Department of Psychology and Social Work, Östersund, Sweden.
    Carbin, Maria
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Linander, Ida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    The rise of carceral feminism in sweden: analysing political debate and policy on men's violence against women2023In: Women's Studies: International Forum, ISSN 0277-5395, E-ISSN 1879-243X, Vol. 99, article id 102780Article in journal (Refereed)
    Abstract [en]

    Drawing on recent parliamentary debates and policy proposals, this article illustrates how penal policies and punitive agendas to combat gendered violence are on the rise in Sweden. While right-wing parties have long deployed a rhetoric of crime and punishment, today the Social Democrats and Left Party (labelling themselves feminist), as well as parts of the women's shelter movement, are deploying a similar discourse. This article shows how men's violence against women suddenly became a highly prioritised political issue within a discursive framework of ‘crime and punishment’, thereby asking whether carceral feminism is emerging in Sweden. Firstly, we analyse the logic of this approach, after which we discuss associated risks, such as how carceral feminism (re)shapes the understanding of gendered violence, that it is neither effective nor demanded by victims and has stratifying and stigmatising effects on racialised communities. Furthermore, it silences material welfare solutions and ultimately legitimates the expansion of penal policies, thereby providing a foundation for a carceral state in which repression becomes the standard response to social problems.

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  • 14.
    Lauri, Marcus
    et al.
    Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden.
    Lauri, Johanna
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Linander, Ida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Women’s shelters and private shelters discursive struggle: separatism, security and social change2023In: Nordic Social Work Research, ISSN 2156-857X, E-ISSN 2156-8588Article in journal (Refereed)
    Abstract [en]

    The increase in private shelters for women escaping men’s violence in Sweden prompts an analysis of discursive struggles on separatism, violence, and safety. The analysis of websites and interviews with representatives from private shelters and women’s shelters show that the woman-to-woman approach is important for women’s shelters whereas private shelters frame their use of male staff as a practical necessity or a way to show women that there also exist ‘good’ men. Women’s shelters articulate the importance of knowledge about men’s violence for counteracting normalization of violence and self-blame, while private shelters emphasize therapeutic knowledge and interventions. To provide safety, women’s shelters articulate the importance of a homey atmosphere and ‘inner safety’, where private shelters emphasize security; shell protection, perpetrator profiles, and risk assessments. The women’s shelters position their work within a discourse of social change, whereas private shelters emphasize their lack of political ambitions, with profit-making as their primary motivation. Should public funding continue to be funnelled to private shelters, rather than to women’s shelters, it will undermine women’s shelter’s dual role of providing refuge and contributing to social change. Should the private shelters discourse prevail it will likely alter the support provided to victims of violence.

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  • 15.
    Linander, Ida
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    “It was like I had to fit into a category”: people with trans experiences navigating access to trans-specific healthcare and health2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Trans issues have received increased attention over the last couple of years and important changes have been made in the legislation relating to gender reassignment and in trans-specific healthcare practices. At the same time, many people with trans experiences report poor mental health, bad experiences when encountering the healthcare and a tendency to postpone seeking care due to being badly treated. Previous research has also shown that gender norms guide the evaluation that precedes access to gender-confirming medical procedures. Critical studies examining practices within trans-specific healthcare in the Swedish context and health among people with trans experiences are limited, especially qualitative interview studies involving people with trans experiences.

    Aim: To analyse how constructions of trans experiences and gender can affect trans-specific healthcare practices, experiences of navigating access to gender- confirming medical procedures, inhabitancy of different spaces and, ultimately, health.

    Conceptual framework: Three areas of theory are used for the conceptual framework: trans studies, queer phenomenology and Foucauldian theories of power and governmentality.

    Methods: The thesis includes three sub-studies (generating four articles): two interview studies that build on interviews with 18 people with trans experiences, and a policy analysis of the guidelines for trans-specific healthcare published by the Swedish National Board of Health and Welfare. For the interview studies, grounded theory and thematic analysis were used as the analytical method. The guidelines were analysed using Bacchi’s method: “What’s the problem represented to be?”.

    Results: The participants experienced trans-specific healthcare as difficult to navigate due to waiting times, lack of knowledge and/or support and relationships of dependency between healthcare users and providers. In the evaluation, gender is reconstructed as linear – stereotypical, binary and stable – and the space for action available to care-seekers is affected by discourses existing both inside and outside trans-specific healthcare. The difficulties in navigating access to care were experienced as creating ill-health. In order to negotiate access to gender-confirming medical procedures, the participants took responsibility for the care process by, for example, ordering hormones from abroad, acquiring medical knowledge and finding alternative support. The linear gendered positioning was variously resisted, negotiated and embraced by the participants.

    The analysis of the guidelines showed that gender identity is constructed as a fixed linear essence but that the guidelines also open up space for a non-linear embodiment. Gender dysphoria is closely constructed in relation to psychiatric knowledge and mental health and the gate-keeping function among mental healthcare professionals is reconstituted in the guidelines. Hence, care-seekers are constructed as not competent enough to make decisions concerning access to gender-confirming medical procedures.

    The participants experienced several different spaces, such as bars, public toilets and changing rooms, gyms and cafés, as unsafe and as contributing to ill-health. In order to overcome the barriers to comfortably inhabiting spaces, the participants performed a kind of labour; for example, preparing in order to visit public baths and to answer transphobic comments and questions. Some spaces, such as trans-separatist, feminist and queer spaces, were experienced as safer and contributed to improved health through experiences of belonging, being able to share bad experiences and being able to relax.

    Conclusions: Trans-specific healthcare practices need to become more affirming and change so that care-seekers have more space for self- determination. Trans-specific healthcare needs more resources in order to decrease waiting times, improve knowledge and support, and hence to improve access to gender-confirming medical procedures. Actions need to be initiated to make spaces safer in order to improve the health of people with trans experiences.

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  • 16.
    Linander, Ida
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Alm, Erika
    Department of Cultural Sciences, Gothenburg University, Gothenburg, Sweden.
    Waiting for and in gender-confirming healthcare in Sweden: An analysis of young trans people’s experiences: [Väntar på och inom könsbekräftande vård i Sverige: En analys av unga transpersoners erfarenheter]2022In: European Journal of Social Work, ISSN 1369-1457, E-ISSN 1468-2664, Vol. 25, no 6, p. 995-1006Article in journal (Refereed)
    Abstract [en]

    The role of waiting and temporality has been explored in relation to gender-confirming healthcare for adults. However, young people's experiences have been lacking, both in previous research and in the public debates on young trans people's access to gender-confirming medical procedures. This paper explores young trans people's experiences of waiting for and in gender-confirming healthcare in the Swedish context. The analysis draws on 16 semi-structured interviews with young trans people (16-25 years old). The analysis was done using thematic analysis and conceptual work on 'waiting' and 'youth'. The participants described waiting as one of the most challenging aspects of their encounters with the gender-confirming healthcare, and the findings also show that this waiting has consequences for youth's mental health and social life. Social workers can have an important role in providing psychosocial support in times of waiting.

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  • 17.
    Linander, Ida
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Alm, Erika
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Harryson, Lisa
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    'It was like I had to fit into a category': care-seekers' experiences of gender regulation in the Swedish trans-specific healthcare2019In: Health, ISSN 1363-4593, E-ISSN 1461-7196, Vol. 23, no 1, p. 21-38Article in journal (Refereed)
    Abstract [en]

    The few previous studies investigating regulation of gender in trans-specific healthcare are mainly based on text material and interviews with care-providers or consist solely of theoretical analyses. There is a lack of studies analysing how the regulation of gender is expressed in the care-seeker's own experiences, especially in a Nordic context. The aim of this study is to analyse narratives of individuals with trans experiences (sometimes called transgender people) to examine how gender performances can be regulated in trans-specific care in Sweden. The conceptual framework is inspired by trans studies, a Foucauldian analysis of power, queer phenomenology and the concept of cisnormativity. Fourteen interviews with people with trans experiences are analysed with constructivist grounded theory. The participants' experiences indicate that gender is constructed as norm-conforming, binary and stable in trans-specific healthcare. This gendered position is resisted, negotiated and embraced by the care-seekers. Norms and discourses both inside and outside trans-specific care contribute to the regulation and limit the room for action for care-users. We conclude that a trans-specific care that has a confirming approach to its care-users, instead of the current focus on gender norm conformity, has the potential to increase the self-determination of gender performance and increase the quality of care.

  • 18.
    Linander, Ida
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Alm, Erika
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Harryson, Lisa
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Negotiating the (bio)medical gaze: Experiences of trans-specific healthcare in Sweden2017In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 174, p. 9-16Article in journal (Refereed)
    Abstract [en]

    In Sweden as well as in other western countries persons with trans experiences have to go through a clinical evaluation in order to get access to gender-confirming medical procedures. The aim of this study is to analyse care-users' experiences of navigating and negotiating access to gender-confirming medical procedures in Sweden. Biomedicalisation is used as a theoretical framework in order to analyse how technoscientific and neoliberal developments are parts of constructing specific experiences within trans-specific care. Constructivist grounded theory was used to analyse 14 interviews with persons having experiences of, or considering seeking, trans-specific healthcare. The participants experienced trans-specific healthcare as difficult to navigate because of waiting times, lack of support, provider ignorance and relationships of dependency between healthcare-users and providers. These barriers pushed the users to take responsibility for the care process themselves, through ordering hormones from abroad, acquiring medical knowledge and finding alternative support. Based on the participants' experiences, it can be argued that the shift of responsibility from care-providers to users is connected to a lack of resources within trans-specific care, to neoliberal developments within the Swedish healthcare system, but also to discourses that frame taking charge of the care process as an indicator that a person is in need of or ready for care. Thus, access to gender-confirming medical procedures is stratified, based on the ability and opportunity to adopt a charge-taking role and on economic and geographic conditions. Based on the results and discussion, we conclude that trans-specific care ought to focus on supporting the care-seekers throughout the medical process, instead of the current focus on verifying the need for care. There is also a need for increased knowledge and financial resources. A separation between legal and medical gender reassignment could contribute to a better relationship between care-providers and care-users and increase the quality of care.

  • 19.
    Linander, Ida
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Alm, Erika
    Hammarström, Anne
    Harryson, Lisa
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    (Un)safe spaces, affective labour and perceived health among people with trans experiences living in Sweden2019In: Culture, Health and Sexuality, ISSN 1369-1058, E-ISSN 1464-5351, Vol. 21, no 8, p. 914-928Article in journal (Refereed)
    Abstract [en]

    Lack of safe space has been connected to ill health among people with trans experiences. This study analyses trans people’s experiences of being in public, semi-public and community spaces using the analytical concept of safety/unsafety in relation to perceived health. The analytic framework draws on the concepts of cisgenderism, orientation, lines and comfort. The material analysed consisted of 18 individual interviews with people with trans experiences, which were analysed using constructivist thematic analysis. The analysis resulted in the identification of three themes: straightening devices creating limited living space, orienting oneself in (cis)gendered spaces and creating safer (?) community spaces for healing. Experiences of unsafety ranged from incidents and fear of different kinds of violence in public and semi-public spaces to the lack of a transpolitically informed agenda in, for example, feminist spaces. Safer spaces helped participants to feel a sense of belonging, to share their experiences and to heal. Experiences of unsafety and discomfort are important as they will help us to understand the health situations of people with trans experiences. It is important to facilitate the creation of safer spaces to improve the health of members of this group.

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  • 20.
    Linander, Ida
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Gotfredsen, Anne
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Strömbäck, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Power and subjectivity: Making sense of sexual consent among adults living in Sweden2021In: NORA: Nordic Journal of Feminist and Gender Research, ISSN 0803-8740, E-ISSN 1502-394X, Vol. 29, no 2, p. 110-123Article in journal (Refereed)
    Abstract [en]

    While sexual consent has been a hot topic during recent years in the Swedish context, there is a lack of empirical studies on the issue. The aims of this study were to analyse how adults in Sweden experience and make sense of sexual (non)consent in sexual encounters, and to contribute to a conceptual discussion of sexual consent, especially in relation to a Foucauldian understanding of power and subjectivity.

    The analysis is based on 31 interviews with adults living in Sweden. Participants describe consenting to sex due to being exposed to interpersonal forms of power, ranging from violence and clear violations of consent to nagging and being subjected to pressure from others. But they also feel pressure and give consent to sex based on self-regulation and disciplinary forms of power, connected to normative ideals about "the good relationship", monogamy and heterosexuality, men and women, and age. Our Foucauldian analytical lens allowed us to explore and challenge understandings of autonomous, rational subjects who communicate consent on the basis of authentic feelings. It also provided an analytical strategy for analysing and understanding the complex power relations that matter in the negotiation of sexual consent.

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  • 21.
    Linander, Ida
    et al.
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Klara
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Which socio-economic measures are associated with psychological distress for men and women?: A cohort analysis2015In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 25, no 2, p. 231-236Article in journal (Refereed)
    Abstract [en]

    Background: There are contradictory results regarding whether there is a social gradient in common mental disorders or not, or if this relation differs for different indicators or by gender. We analysed the relation between various measures of socio-economic position and later psychological distress among men and women in a Swedish context. Methods: The study is based on data from the Northern Swedish Cohort (N= 1001, 93.5% response rate), a 27-year prospective study. Logistic regression was used to explore the relation between various indicators of socio-economic position at age 30 (occupation, education, financial strain, cash margin, unemployment and living primarily on social welfare or unemployment insurance) and psychological distress (age 42), controlling for earlier psychological distress (age 21) and parental occupational class. Register data were used to measure unemployment. All other variables were self-reported, and measured by a questionnaire. Results: Financial strain and living on social welfare or unemployment insurance at age 30 were associated with psychological distress at age 42 for men and women. Poor cash margin and unemployment were only associated with psychological distress in women, after controlling for potential confounders. Low occupational class and low education were not significantly related to later psychological distress. Conclusion: The two most commonly used measures of socio-economic position, occupation and education, were not significantly associated with psychological distress while other, less studied measures were. This study highlights the importance of measuring socio-economic position in several ways when studying common mental disorders, as well as to take gender into account.

  • 22.
    Linander, Ida
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Lauri, Johanna
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Lauri, Marcus
    Mid Sweden University, Sweden.
    Swedish LGBTQ activists’ responses to neo-nazi threats: anti-gender politics, state appellation, and political aspirations2022In: Lambda Nordica, ISSN 1100-2573, E-ISSN 2001-7286, Vol. 27, no 3-4, p. 51-75Article in journal (Refereed)
    Abstract [en]

    LGBTQ communities and movements across Europe are under attack from various conservative and right-wing extremist groups. What are the political implications of such attacks for LGBTQ activists? Through qualitative interviews and psychoanalytical discourse theory, this article analyses LGBTQ activists’ responses to threats from neo-Nazis in Sweden. By focusing on the problems, solutions and desires articulated by LGBTQ activists, the analysis asks: Who is called upon to handle the neo-Nazis, and how? What fantasies are expressed in such articulations? How may the response to neo-Nazis shape the subjectivities and political aspirations of LGBTQ activists? The analysis shows that the activists adhere to a fantasy of positive and conflict-free politics where the state is called upon to care for them through legal measures, which ties the activists to the state and might block other alliances. The activists also express a desire to inscribe themselves into the LGBTQ movement’s history. This fantasy echo might strengthen a political collective and prove pivotal in future struggles. Taken together, our analysis demonstrates some of the effects of the neo-Nazi presence in Sweden and some of the wider political implications for the LGBTQ movement.

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  • 23.
    Linander, Ida
    et al.
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Lauri, Marcus
    Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden.
    Alm, Erika
    Department of Cultural Sciences, Gothenburg University, Gothenburg, Sweden.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Two Steps Forward, One Step Back: A Policy Analysis of the Swedish Guidelines for Trans-Specific Healthcare2021In: Sexuality Research & Social Policy, ISSN 1868-9884, E-ISSN 1553-6610, Vol. 18, no 2, p. 309-320Article in journal (Refereed)
    Abstract [en]

    Introduction: Sweden has one of the world’s longest histories of providing subsidized gender-confirming medical procedures for people with trans experiences. However, until 2015, Swedish trans-specific healthcare lacked formal guidelines.

    Methods: In this study, we analyse the Swedish guidelines for trans-specific healthcare from 2015 using Bacchi’s approach: “What’s the problem represented to be?” Following this approach, we analyse problem representations in the guidelines with special focus on evaluation, diagnosis of gender dysphoria and criteria for access to care.

    Results: Three problem representations were identified in our analysis: “the problem of (non)linear gender”, “the mental health paradox” and “gender dysphoria as a psychiatric, psychological and psychosocial problem”. Together, these problem representations construct gender dysphoria as a psychopathology and allocate the decision-making power to mental health care providers. Hence, the guidelines reconstruct the gatekeeping function among care providers while undermining care seekers’ ability to attain self-determination. While the guidelines do allow for non-linear embodiment, they simultaneously reconstruct a linear relationship between gender identity and social gender role. Mental healthiness and, for migrants, having a residence permit seem to be favoured in the evaluation of gender dysphoria and for access to gender-confirming medical procedures, while aspects of gender euphoria are silenced.

    Conclusions: We conclude that the guidelines resemble, and have similar effects to, the psychomedical understandings of gender dysphoria prevalent in medical research and practice. At the same time, the guidelines attempt to depathologize trans experiences and open up space for new subjectivities to be eligible for access to gender-confirming medical procedures.

    Policy Implication: The knowledge from this study can be useful when constructing, revising or analysing guidelines for trans-specific healthcare in several contexts.

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  • 24.
    Linander, Ida
    et al.
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Lauri, Marcus
    Mittuniversitetet .
    Lauri, Johanna
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Mindre rum, nya gränser och kollektivets underminering: det nazistiska hotet mot HBTQ-rörelsen2021In: Tidskrift för Genusvetenskap, ISSN 1654-5443, E-ISSN 2001-1377, Vol. 42, no 2-3, p. 49-70Article in journal (Refereed)
    Abstract [en]

    Support for right-wing extremist organizations and ideologies has increased in Sweden and other European countries in recent years, expressed for instance in organized Nazi attacks against LGBTQ activists. Against this background, ten LGBTQ activists in Sweden have been interviewed about their experience of such attacks. By using feminist theories on violence and theories on social movements, our analysis shows that such actions are experienced and affect LGBTQ activists differently depending on context. Being part of a collective seems to provide a sense of safety and thus offers protection in instances of direct confrontation. On the other hand, threats against individuals, in particular online, are described as creating prolonged fear and stress. The presence and actions of Nazis affect both the organizations and individuals in the movement; it drains already limited resources, constrains the space for supporting the community and for pursuing policy issues. The threats also produce individual self-regulation, both in public debate participation and in adapting physical appearance to cis- and heteronormative expectations.

  • 25.
    Linander, Ida
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Lundberg, Tove
    Department of Psychology, Lund University, Lund, Sweden.
    Alm, Erika
    Department of Cultural Sciences, Gothenburg University, Gothenburg, Sweden.
    The gender minority stress model and/or cisnormativity?: The need for pluralistic theoretical perspectives in improving trans health and medicine2024In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 351, article id 116957Article in journal (Refereed)
    Abstract [en]

    The minority stress model has become a well-used framework to explain and analyse health among LGBTQ people, and specifically among transgender and gender-diverse people (TGD), when it is sometimes called ‘the gender minority stress model’. Scholars have argued the need for critical discussions about some of the assumptions underlying the gender minority stress model and how it has been used and discussed. Drawing on a pluralistic understanding of theories and employing a Foucauldian understanding of critique, we discuss implicit assumptions and epistemological standpoints of the gender minority stress model and the connected limitations. We also ask what the concept of cisnormativity can give rise to in comparison with the minority stress framework. We make four arguments: 1) the calls for extensions to the model could be seen as a desire to understand and analyse TGD people's health from an all-encompassing perspective, resulting in theoretical vagueness and the silencing of excluded aspects; 2) in the gender minority stress literature, identity is largely taken for granted and there is no consideration of how power is constitutive for all subjects; 3) the model risks individualising the effects of social norms, and internalisation could be further theoretically developed in relation to the repression hypothesis; 4) in the translation process from LGB minorities to TGD, as well as in thinking about cisnormativity, the issue of gender-affirming care has largely been neglected. By initiating a critical discussion around these issues and illustrating how different theories and frameworks can illuminate different possibilities for thinking and knowing, we aim to open up new routes for thinking about TGD health and medicine.

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  • 26.
    Linander, Ida
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Nilsson, Maria
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    ”Det är fokus på rätt saker”: hbtq-personers upplevelser av Region Västerbottens hbtq-diplomering2021Report (Other academic)
    Abstract [sv]

    Hbtq-diplomeringen i Region Västerbotten ämnar bidra till ett strukturerat och långsiktigt arbete med hbtq (homosexuella, bisexuella, trans- och queerpersoner), normer och jämlikhet inom regionens verksamheter. Detta arbete sker både utifrån ett patientperspektiv, ett arbetsmiljöperspektiv och ett verksamhetsperspektiv. Denna rapport fokuserar på patientperspektivet och fokuserar på upplevelser av hbtq-diplomerade sjukvårdskliniker inom Region Västerbotten. 

    Inom ramen för studien har 12 intervjuer genomförts med hbtq-personer som har erfarenheter från någon av regionens diplomerade kliniker. Intervjuerna har analyserats med hjälp av tematisk analys. 

    Intervjuerna representerar olika erfarenheter av regionens hbtq diplomering, men också olika åsikter och perspektiv. Vissa menar att hbtq diplomering är bra och viktigt, något alla kliniker bör genomgå medan andra har en mer avvaktade hållning och delvis problematiserar fenomenet. Men i stort framkommer positiva erfarenheter av kliniker i Västerbotten som hbtq-diplomerats. Hbtq- kompetens beskrivs ofta i relation till bemötandefrågor men det är tydligt utifrån deltagarnas erfarenheter att ett gott möte med vården inbegriper fler aspekter. Förutom vikten av att ett respektfullt bemötande som undviker normativa antaganden kom medicinsk/klinisk kunskap upp och även kunskaper om hbtq-personers livsvillkor. Deltagarna berör flera faktorer som de menar påverkar fler vårdsökande men kan få större konsekvenser för hbtq-personer, exempelvis att bo i ett stads- eller landsbygdsområde eller ha invandrarbakgrund. Brist på kontinuitet bland vårdgivare beskrivs tvinga hbtq-personer att komma ut om och om igen och brist på resurser och stressad personal upplevs göra personalen mer benägen att återgå till ett mer normativt bemötande, det vill säga utgå ifrån cis- och heteronormativa antaganden. 

    Utifrån intervjuerna framkommer förbättringspotentialer. Ibland handlar det om enskilda vårdgivare som behöver fortbildas och ibland behövs det rutiner för att exempelvis dokumentera saker i journalen. En önskan om hbtq-kompetent gynekologisk vård återkommer och det påpekas att det saknas klinisk kunskap om exempelvis STI och risk för cervixcancer i relation till lesbiska sexuella praktiker, även på diplomerade kliniker. Det är viktigt att diplomeringen uppdateras och att alla på kliniken är utbildade, annars skapas en känsla av att diplomeringen inte spelar någon roll. På samma sätt är det viktigt att diplomeringen inte enbart blir symboler och skrivna ord, det är viktigt att klinikerna faktiskt besitter hbtq-kompetens som omsätts i adekvat vård till hbtq-personer. 

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  • 27.
    Linander, Ida
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Repka, Axel
    Könsbekräftande vård: dåtid, nutid och framtid2023In: Trans: fakta, forskning och erfarenheter / [ed] Edward Summanen; Matilda Wurm, Stockholm: Natur och kultur, 2023, p. 36-57Chapter in book (Other academic)
  • 28.
    Linander, Ida
    et al.
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Sandberg, Linda
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    När nazisterna stjäl ens plats: om NMR:s hotfulla närvaro i Almedalen och Ludvika2020In: (O)tryggt?: Texter om makt, plats och motstånd / [ed] Malin Rönnblom, Ida Linander, Linda Sandberg, Stockholm: Premiss förlag, 2020, p. 297-322Chapter in book (Other academic)
  • 29.
    Linander, Ida
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Strömbäck, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Gotfredsen, Anne
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Ljungcrantz, Desireé (Contributor)
    Folkhälsomyndigheten.
    Eriksson, Tommy (Contributor)
    Folkhälsomyndigheten.
    Deogan, Charlotte (Contributor)
    Folkhälsomyndigheten.
    Ett spektrum av sexuella samtycken: En intervjustudie om samtycke hos sexuellt aktiva vuxna2020Report (Other academic)
    Abstract [sv]

    Studien undersöker hur sexuellt samtycke förstås, praktiseras och upplevs: Samtycke anses ofta vara en typ av avtal för sexuell aktivitet, men definitionen av sexuellt samtycke är komplex. Tidigare forskning har till stor del fokuserat på amerikanska collegestudenter, och det har saknats svenska empiriska studier som undersöker sexuellt samtycke i befolkningen.

    Syftet med den här studien är därför att undersöka hur sexuellt samtycke förstås, praktiseras och upplevs i sexuella relationer bland vuxna i Sverige idag.

    Studien är en kvalitativ intervjustudie med 31 sexuellt aktiva personer 23–61 år. Deltagarna rekryterades via annonser i lokaltidningar, breda Facebook-grupper och på stora arbetsplatser. Intervjuerna var semi-strukturerade och berörde sexuell kommunikation, sexuella relationer och erfarenheter av sexuellt samtycke. Intervjumaterialet analyserades med hjälp av tematisk analys.

    Samtycke kan placeras in på ett spektrum: Analysen av intervjuerna resulterade i ett huvudtema: Ett spektrum av samtycken: kontextuellaoch kontinuerliga sexuella praktiker. 

    Huvudtemat beskriver hur samtycke är mångfacetterat och uttrycks olika beroende av situation,relation och föreställningar om kvinnlig och manlig sexualitet och sexuell praktik. Det beskriver också hur samtycke i sig och hur samtycke kommuniceras är föränderligt och pågående, bådeöver tid och i den sexuella situationen. Huvudtemat beskriver vidare hur deltagarnas förståelse, praktik och upplevelser av samtycke och brist på samtycke kan placeras in på ett spektrummellan fullkomligt samförstånd och avsaknad av samtycke, det vill säga i form av övergrepp och sexuellt våld. Däremellan kan kommunikationen vara bättre eller sämre, och förväntningar på kvinnlig och manlig sexualitet kan spela in i vad som upplevs eller förstås som samtycke. Gråzoner för vad som upplevs som självklart och lustfyllt, eller obekvämt eller tveksamt är en del av samtyckets spektrum. 

    Huvudtemat byggs upp av fem underteman:

    1. Kommunikation – så tydligt, så svårt belyser deltagarnas syn på tydlig och lyhördkommunikation som en nyckel till ett fungerande sexuellt samtycke och samspel. Samtidigt upplever deltagarna att det är svårt att kommunicera om sex och samtycke, och att de därför kan behöva träna på det och finna forum för att förbättra dessa färdigheter. Vidare beskriver deltagarna att typen av kommunikation skiljer sig åt mellan olika slags sexuella situationer och praktiker. Det som upplevs som tabubelagt kan också försvåra en god kommunikation.

    2. Sex och samspel i samförstånd belyser hur sexuellt samtycke när det fungerar bra förstås som självklart och ömsesidigt. Det beskriver hur samtycken kan förändras och fungera olika beroende på situation och utifrån individuella och relationella faktorer. Samtycket är någonting pågående som sker här och nu.

    3. Samtyckets gråzoner beskriver upplevelser där deltagarna varit osäkra på sitt eget eller andras samtycke, och erfarenheter av att bristande lust har omvandlats till samtycke efter hand.

    4. Avsaknad av samtycke handlar om att samtycke inte uppnås utan på olika sätt överträds, exempelvis i form av sexuellt våld. Temat handlar också om konsekvenserna av att bära med sig dessa erfarenheter. 

    5. Att navigera och utmana föreställningar och praktiker för sexualitet belyser hur olika föreställningar om och förväntningar på sexuellt beteende utifrån kön påverkar hur deltagarna förstår, kommunicerar och praktiserar sexuellt samtycke. I temat ingår inslag av att utmana förväntningar på romantisk och tvåsam kärlek. 

    Viktiga insikter för arbetet för sexuell hälsa och motsexuellt våld: Kunskapen från studien kan öka förståelsen för hur sexuellt aktiva vuxna kommunicerar, praktiserar och upplever sexuellt samtycke. Detta har både vetenskaplig och samhälleligbetydelse. Insikterna kan bidra till att utveckla det hälsofrämjande arbetet för sexuell hälsa samtutveckla interventionerna i det förebyggande arbetet och de behandlande insatserna vid sexuellatrakasserier och sexuellt våld.

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  • 30.
    Linander, Ida
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    ”Att bara få finnas, utforska eller prata om det”: unga transpersoners egna erfarenheter av stärkande faktorer för den psykiska hälsan2022In: "Jag är inte ensam, det finns andra som jag": unga hbtqi-personers levnadsvillkor, Växjö: Myndigheten för ungdoms- och civilsamhällesfrågor , 2022, p. 89-113Chapter in book (Other academic)
  • 31.
    Linghede, Eva
    Folkhälsomyndigheten.
    Linander, Ida (Contributor)
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Att få åldras som jag lever nu: en intervjustudie om hälsa och livsvillkor bland hbtq-personer över 65 år2024Report (Other academic)
    Abstract [en]

    This report addresses the health and living conditions among LGBTQ people over the age of 65.The results are based upon qualitative interviews with 16 participants aged between 65 and 83.

    The desire to age as I live now: The overall content can be summarised as the participants hoping to age in a context similar tothe one they are currently living in. This involves being able to continue living openly as an LGBTQ person and be treated with respect. It also involves the hope of remaining in good health, maintaining independence and being able to socialise and pursue personal interests.

    Good health closely linked to living conditions: The results show that many participants report being in good health. At the same time, health appears to be closely linked to living conditions and factors such as openness and visibility, access to social connections, sociopolitical conditions and health and social care that is well-versed in LGBTQ issues. The participants’ accounts demonstrate experiences and concerns they share with older people in general, however they also highlight how both heteronormativity andcisnormativity interact with age and create specific experiences and living conditions that canimpact health both positively and negatively.

    Aging provides both security and fear: Aging is generally seen as being unproblematic and in certain cases even positive as it can provide greater security. Some participants describe how aging has led to new or greater opportunities for living openly. At the same time, there is a fear that as an older person, they willlose physical and mental capacity and become dependent on the care of others. Despite generally being in good health, the participants describe a number of ailments, minormedical conditions and lower sex drive. A number also describe mental health problems caused by internalised homophobia and transphobia.

    Social connections and relationships protect against loneliness: Social connections, such as their own children and partners, chosen families, friends and organised LGBTQ activities are vital to the participants’ health. The participants believe thatgood relationships increase their security – in addition to providing a source of happiness, social stimulation and practical and emotional support. In contrast, fears of loneliness form asignificant concern among the participants, with involuntary loneliness increasing feelings of vulnerability.

    Being open is central to health: Participants being open about their identity is of great importance to their health, especially asthis affects the way participants view themselves. In addition, being able to be open is alsosignificant to social connections and relationships, as well as the way we imagine the future. The ability to live openly varies for the majority of participants, depending on the period and the context. Sociopolitical situations and social attitudes have a major impact on how participants perceive their ability to be open.

    Preparedness and concern that health and social care lack knowledge: Generally, the participants’ experiences of the healthcare services are positive, and they describe being treated with respect and understanding. Despite this, they describe various strategies andpreparedness for responding to any negative actions. These negative actions are described aspoor treatment in terms of ignorance towards LGBTQ issues or normative assumptions from healthcare professionals, rather than blatant discrimination. A number are not concerned about any future social care needs, whereas a majority are. Concerns include participants being unsure whether staff will have the necessary knowledge about LGBTQ issues for providing positive and respectful treatment, while meeting the needs specific to LGBTQ people.

    Sociopolitical situation affects health and living conditions: The sociopolitical situation is significant to participants’ health and living conditions. The age group included in this study have lived through a revolutionary period in Swedish LGBTQ history. During periods when being LGBTQ was seen as being deviant behaviour and met with negativity, the majority felt restricted, afraid and vulnerable. For some, previous experiences of violence, threats, discrimination, erasure and pathologisation have led to long-term negative health effects. When discussing the current sociopolitical situation, several participants feel that the rights of LGBTQ people are threatened. Some also state that the fight for equal rights must never stop.

    Areas for development identified: Based on the results of the study and existing knowledge, the Public Health Agency of Swedenhas identified the following areas for development:

    • There is currently limited knowledge about older LGBTQI people’s health and livingconditions, and this needs to be developed.
    • There is a need to implement knowledge of LGBTQI issues in health and social care training, from upper secondary education to university level.
    • The conditions for LGBTQI inclusion in various contexts can be improved by integrating LGBTQI perspectives into organisations and associations for older people.
    • More organised meeting places – especially outside of the major cities – could create better social conditions and increased security for LGBTQI people
  • 32.
    Nkulu Kalengayi, Faustine
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Linander, Ida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    "Discrimination is harder to live with than the disease": an interview study of the perceptions and experiences of sexual and reproductive health and rights among women living with HIV in Sweden2023In: Sexual and Reproductive Health Matters, E-ISSN 2641-0397, Vol. 31, no 1, article id 2245197Article in journal (Refereed)
    Abstract [en]

    Around 40% of people living with human immunodeficiency virus (HIV) in Sweden are women. However, little is known about their experiences, particularly those related to sexual and reproductive health and rights (SRHR). This study aims to explore perceptions and experiences of SRHR among women living with HIV (LWH). Twelve interviews were conducted with women LWH from September to October 2019 and analysed using thematic analysis. The central theme describing participants’ experiences of social relationships, intimate encounters and reproductive life, “Discrimination is harder to live with than the disease itself”, is based on three themes that contain subthemes. Theme 1 describes how participants reconsider and reorient their sexual and reproductive life after diagnosis. Theme 2 highlights how (mis)perceptions of HIV affect sexual and reproductive life and lead to abusive treatment and internalisation. Theme 3 describes a paradoxical shift of responsibilities where participants experience being compelled to take greater responsibility in some situations and stripped of the right to decide in others. This study suggests that despite notable progress in HIV treatment, stigma and discrimination stemming from outdated beliefs and (mis)conceptions, ambiguous policies and guidelines, and unequal access to information affect SRHR experiences of women LWH more than the virus itself. The results emphasise the need to: update knowledge within healthcare settings and among the public; clarify ambiguous legislations and guidelines; ensure equal access to information to enable all women LWH to take informed decisions, make fully informed choices and realise their SRHR; and consider the diversity of women LWH and enable shared decision-making.

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  • 33.
    Pastor Bravo, María del Mar
    et al.
    Department of Nursing, University of Murcia, Murcia, Spain; Biomedical Research Institute of Murcia (IMIB) Pascual Parrilla, Murcia, Spain.
    Linander, Ida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Access to healthcare among transgender and non-binary youth in Sweden and Spain: a qualitative analysis and comparison2024In: PLOS ONE, E-ISSN 1932-6203, Vol. 19, no 5, article id e0303339Article in journal (Refereed)
    Abstract [en]

    Background: Transgender and non-binary (TGNB) people tend to report worse health than cis people, however, despite an increased need for care, they face several barriers when trying to access healthcare. These barriers might be exacerbated when young age intersects with a trans identity, and so there is a need for studies highlighting the experiences of TGNB youth.

    Aims: To explore and compare how TGNB youth (15–26 years old) in Sweden and Spain experienced their access to healthcare, in order to shed light on the strengths and limitations of different kinds of healthcare systems and improve healthcare provision and policy development.

    Methods: This study was based on a qualitative analysis of semi-structured interviews with TGNB youth living in Sweden (n = 16) and Spain (n = 18). Of these, 22 identified as male or transmasculine, six as non-binary, and six as women or transfeminine; 25 had undergone some type of gender-affirming care, and the rest were on the waiting list or undergoing preparatory visits and had not started hormonal treatment. The interviews were analyzed using reflexive thematic analysis. An abductive approach was applied, and the Levesque conceptual framework was used to compare the analyses of each set of materials.

    Results: We present our findings using the structure of the accessibility framework, focusing on approachability, acceptability, availability, affordability, and appropriateness. The conceptualization of accessibility in combination with the concept of cisnormativity illustrates how specific ideals and normative expectations affect access to healthcare for TGNB people across contexts, with most barriers arising from the appropriateness of the services.

    Discussion: Young TGNB people experience barriers to accessing healthcare both in the Spanish and the Swedish contexts. Strategies to reduce these barriers should be framed within the critique of and resistance to cisnormativity and should focus on users with intersecting marginalized identities to promote health equity.

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  • 34. Perez-Urdiales, Iratxe
    et al.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Irazusta, Amaia
    Linander, Ida
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Sub-Saharan African immigrant women's experiences of (lack of) access to appropriate healthcare in the public health system in the Basque Country, Spain2019In: International Journal for Equity in Health, E-ISSN 1475-9276, Vol. 18, article id 59Article in journal (Refereed)
    Abstract [en]

    BackgroundImmigrant populations face diverse barriers to accessing appropriate healthcare services on several levels. In the Basque Country, Sub-Saharan African women were identified as facing the largest barriers to access them. The aim of the study is to analyse Sub-Saharan African immigrant women's perceptions and experiences of access to appropriate healthcare in the public health system in the Basque Country, Spain.MethodsFourteen women from eight Sub-Saharan African countries who have used the Basque public healthcare services were interviewed. A qualitative content analysis was applied: meaning that units were identified, coded and the resulting codes were then organized into three categories.ResultsThe first category, Fearing to enter a health system perceived as not friendly for immigrants, included factors, mainly those related to legal conditions for accessing healthcare services and lack of lawful documentation, that made women avoid or discontinue seeking out healthcare.The second category, Being attended on professionals' own communication terms, comprised how the lack of effective communication compromised not only the access of the immigrant women to healthcare services, but also their health.Lastly, the third category, Is mistreatment based on racism or merely on bad luck? described how being an immigrant and black influenced the way they were (mis)treated in the health system.ConclusionFor Sub-Saharan African immigrant women, accessing appropriate healthcare in the Basque Country was perceived to be subject to institutional barriers. At the legal level, barriers included lack of entitlement, difficulties in fulfilling legal access conditions and lack of documentation. The lack of communication with health centre staff and their attitudes, guided by a stereotyped social image of immigrants and black people, also hindered their possibilities of receiving appropriate healthcare. Facilitators for accessing healthcare included strategies from individual professionals, personal networks and social actors to help them to cope with the barriers. There is a need of reinforcing inclusion values and rights-based approach to attention among staff at the health centres to have more non-discriminatory and culturally appropriate health systems.

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  • 35.
    Rönnblom, Malin
    et al.
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Karlstads universitet.
    Linander, Ida
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Sandberg, Linda
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Inledning: (o)tryggt2020In: (O)tryggt?: texter om makt, plats och motstånd / [ed] Malin Rönnblom, Ida Linander & Linda Sandberg, Premiss förlag, 2020, p. 6-19Chapter in book (Other academic)
  • 36.
    Rönnblom, Malin
    et al.
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Karlstads universitet.
    Linander, IdaUmeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.Sandberg, LindaUmeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    (O)tryggt?: texter om makt, plats och motstånd2020Collection (editor) (Other academic)
  • 37.
    Straube, Wibke
    et al.
    Karlstads universitet, Karlstad, Sverige.
    Linander, Ida
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Henriksson, Andreas
    Karlstads universitet, Karlstad, Sverige.
    Vård för transpersoner i Värmland: rapport 20232023Report (Other academic)
    Abstract [sv]

    Tillgången till könsbekräftande vård i Sverige är begränsad på grund av långa väntetider (2 - 3 år) för kontakt med könsdysforiutredningsteam och det är ofta en lång och komplex utredningsprocess. Många personer som söker vård känner sig maktlösa och ifrågasatta under hälso- och sjukvårdsprocessen. Dessa brister kan ha en negativ påverkan på den vårdsökandes psykiska hälsa. Minoritetsstress och dess negativa inverkan på psykisk och fysisk hälsa utgör ytterligare en faktor och ökar risken för suicid samt misstro gentemot hälso- och sjukvårdssystemet.

    Rapportens syfte är att utforska transpersoners erfarenheter av vård i Värmland med särskilt fokus på funktionen Samordnare transvård. Analysen baseras på erfarenheter från personer som har kommit i kontakt med Samordnare transvård. Erfarenheterna samlades in dels genom en kvantitativ enkät med vårdsökande samt genom kvalitativa, semistrukturerade intervjuer med vårdtagare. Intervjuerna genomfördes i juni 2022, och enkäten var öppen för svar mellan december 2022 och februari 2023. Rapporten syftar till att belysa styrkor och svagheter i vården för transpersoner inom regionen och avslutas med rekommendationer för framtida förbättringar.

    Resultaten presenteras inom fyra teman: Tema 1: Psykisk(o)hälsa och Samordnare transvård, Tema 2: Bemötande, kontakt och stöd av Samordnare transvård, Tema 3: Övriga vårdkontakter inom Region Värmland, Tema 4: Ytterligare behov och områden för förbättring.

    Sammanfattningsvis visar studien att Samordnare transvård är en uppskattad och i många avseenden välfungerande vårdfunktion. Deltagarna upplever att den har god tillgänglighet, ger bra information, är ett viktigt psykosocialt stöd och många uppskattar att den är oberoende av psykiatri. Många söker sig till denna funktion för remiss till könsdysforiutredningsmottagningar vilket respondenterna upplever fungerar bra. Samordnare transvård ska erbjuda stöd och uppföljningsmöten före, under och efterutredningsprocessen, vilket funktionen i viss mån gör men detta är också något som kan förbättras. De som arbetar inom Samordnare transvård upplevs ha god kunskap om könsbekräftande vård, minoritetsstress och utmaningar som transpersoner möter i ett cisnormativt samhälle. Vidare upplever många att Samordnare transvård har givit dem psykosocialt stöd och rådgivning, vilket varit hjälpsamt. Studien visar också att Samordnare transvård kan öka förtroendet för vården och, som många uttrycker det, ger en känsla av att bli sedd och hörd för första gången inom vården.

    Denna studie baseras delvis på tidigare forskning som vi genomförde mellan 2021 och 2022 och som publicerades i en rapport år 2022. I den tidigare studien fokuserade vi på att analysera vårdgivarnas erfarenheter av den nya funktionen att samordna transvård på detta sätt, till exempel hälso- och sjukvårdspersonal, chefer och strateger inom Region Värmland, samt de två samordnarnas erfarenheter av sina arbetsförhållanden och utmaningar genom kvalitativa, semistrukturerade intervjuer (Straube & Linander, 2022).

    Vi avslutar denna rapport med en lista över rekommendationer som vi hoppas kan vara till hjälp för regionen att förbättra denna funktion, liksom för andra regioner som redan har börjat etablera liknande strukturer eller överväger detta.

    En central rekommendation är att andra regioner bör överväga en liknande vårdfunktion för att säkerställa bästa möjliga stöd för transpersoner, särskilt med tanke på den könsbekräftande vårdens bristande tillgänglighet samt transpersoners erfarenheter av minoritetsstress. Denna vårdfunktion i Värmland är framgångsrik eftersom den är lättillgänglig, är placerad utanför den psykiatriska vården och ger psykosocialt stöd tillvårdsökande av transkompetent personal. Andra framgångsfaktorer är personal som har insikt i transcommunityt, ett gott bemötande, professionell yrkeskunskap i form av rådgivare/kuratorer och/eller terapeuter, samt djupgående kunskap om processerna inom den könsbekräftande vården och vårdkedjan i Sverige.

    Studien genomfördes på uppdrag av RegionVärmland. Det tvärvetenskapliga forskarteamet består av Wibke Straube (genusvetenskap, Karlstads universitet), Ida Linander (folkhälsovetenskap, Umeå universitet) och Andreas Henriksson (sociologi, Karlstads universitet). Forskningsprojektet och rapporten har finansierats av det regionala nätverket för suicidprevention i Värmland.

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