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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.

Denna rapport handlar om hälsa och livsvillkor bland hbtq-personer över 65 år. Resultaten bygger på kvalitativa intervjuer med 16 deltagare i åldrarna 65–83 år.

Önskan om att få åldras som jag lever nu: Det övergripande resultatet kan sammanfattas i en önskan om att få åldras som man lever nu. Det handlar bland annat om att kunna fortsätta leva ett öppet liv som hbtq-person och att bli bemött med respekt. Det rymmer även förhoppningen att ha kvar hälsan, behålla sitt oberoende, kunna vara social och engagera sig i sina intressen.

God hälsa nära kopplad till livsvillkor: Studiens resultat visar att många deltagare uppger en god hälsa. Samtidigt framkommer att hälsan är tätt sammankopplad med livsvillkor och levnadsförhållanden såsom öppenhet och synlighet, tillgång till sociala sammanhang, socialpolitiska förutsättningar samt hbtq-kompetent vård och omsorg. Deltagarnas berättelser visar på erfarenheter och oro som de delar med äldre personer generellt, men det synliggörs också hur hetero- och cisnormativitet samverkar med ålder och skapar specifika erfarenheter och livsvillkor som kan påverka hälsan både negativt och positivt.

Åldrandet ger både trygghet och rädsla: Åldrandet upplevs generellt som oproblematiskt, i vissa fall också som positivt eftersom det kange en större trygghet. Några deltagare beskriver hur åldrandet inneburit nya eller större möjligheter att leva öppet. Det finns samtidigt en rädsla att som äldre komma att förlora fysiska och psykiska förmågor och därmed bli beroende av andras omsorg. Trots en övervägande god hälsa beskriver deltagarna samtidigt en del krämpor, mindre allvarliga medicinska diagnoser och minskad sexlust. En del beskriver också psykisk ohälsa som en konsekvens av internaliserad homo- och transfobi.

Sociala sammanhang och relationer skyddar mot ensamhet: Sociala sammanhang såsom partner och egna barn, självvald familj, vänner och organiserad hbtq-verksamhet är mycket viktiga för deltagarnas hälsa. Utöver att vara en källa till glädje, social stimulans och praktiskt såväl som emotionellt stöd, upplever deltagarna att goda relationer ökar deras trygghet. Motsatt är oro för ensamhet kopplat till rädsla bland deltagarnaoch ofrivillig ensamhet ökar upplevelser av utsatthet.

Öppenhet är centralt för hälsan: Att vara öppen med sin identitet har stor betydelse för hälsan, inte minst påverkar det deltagarnas självbild. Vidare kan möjligheten att vara öppen även ha betydelse för sociala sammanhang och relationer, samt för hur man föreställer sig framtiden. Möjligheterna att leva öppet har för deltagarna varierat utifrån olika tidsperioder och sammanhang. Den socialpolitiska situationen och samhällsattityder har stor betydelse för deltagarnas upplevda möjligheter till öppenhet. För en del beskrivs öppenheten också som villkorad av närstående.

Beredskap och oro för okunskap i vård och omsorg: Deltagarna har överlag goda erfarenheter av vården och beskriver generellt att de får ett gottbemötande. Trots detta beskriver de olika strategier och en beredskap för att hantera eventuellt dåligt bemötande. Vad som beskrivs som ett dåligt bemötande är oftast relaterat till okunskap om hbtq, eller normativa antaganden bland vårdgivare, snarare än avsedd diskriminering. En del upplever eventuella framtida omsorgsbehov som oproblematiska, medan en majoritet geruttryck för oro. Oron handlar bland annat om att deltagarna är osäkra på om personalen kommer att ha adekvat utbildning om hbtq för att kunna ge ett gott och respektfullt bemötande och tillgodose hbtq-specifika behov.

Socialpolitisk situation påverkar hälsa och livsvillkor: Den socialpolitiska situationen är betydelsefull för deltagarnas hälsa och livsvillkor. Åldersgruppen som ingår i studien har en livstid som spänner över en omvälvande tid i svensk hbtq-historia. Under perioder när hbtq har ansetts avvikande och bemötts negativt har de flesta känt sig begränsade, rädda och utsatta. För vissa har tidigare erfarenheter av våld, hot, diskriminering, osynliggörande och patologisering lett till långvariga negativa konsekvenser förhälsan. I resonemang om den nutida socialpolitiska situationen upplever flera deltagare hbtq-rättighetersom hotade. Vissa anger också att kampen för lika rättigheter ständigt måste pågå.

Identifierade utvecklingsområden: Utifrån studiens resultat och befintlig kunskap har Folkhälsomyndigheten identifierat följande utvecklingsområden:

• Befintlig kunskap om äldre hbtqi-personers hälsa och livsvillkor är begränsad och behöverutvecklas
• Det finns behov av att implementera kunskap om hbtqi i vård- och omsorgsutbildningar från gymnasienivå upp till universitetsnivå.
• Genom integrering av hbtqi-perspektiv i organisationer och äldreförbund skulle förutsättningarna för inkludering av hbtqi-personer i olika sammanhang kunna öka
• Fler organiserade mötesplatser, särskilt bortom storstäderna, skulle kunna skapa bättre sociala förhållanden och ökad trygghet för äldre hbtqi-personer

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

Objective: To explore whether cisgender naive listeners, transgender and gender diverse (TGD) listeners, and speech-language pathologists (SLPs) experienced in providing gender-affirming voice training differ in their perception of femininity and masculinity in voices.

Methods: Samples of spontaneous speech were collected from 95 cisgender, and 37 TGD speakers. Three listener groups of cisgender naive (N = 77), TGD (N = 30), and SLP (N = 14) listeners, respectively, rated the voices on visual analog scales in two randomly ordered blocks, in which the perceived degree of femininity was rated separately from the perceived degree of masculinity.

Results: The three listener groups showed similar patterns in their distribution of ratings on the femininity and masculinity scales. The TGD listeners’ mean ratings did not differ from the cisgender naive listeners’, whereas SLPs showed a small, but significant, difference in their ratings compared with both TGD and cisgender naive listeners and rated the voices lower on both the femininity and masculinity scales.

Conclusion: The results differ from previous studies as TGD, and cisgender naive listeners rated the voices very similarly. The lower ratings of femininity and masculinity by the SLPs were likely influenced by their awareness of the complexity in the perception of voices. Therefore, SLPs providing gender-affirming voice training should be attentive to how their professional training may influence their perception of femininity and masculinity in voices and encourage discussions and explorations of the TGD voice client's perceptions of voices.

Today, we see many different forms of separatists and what may be a safe place for some may be provocative for others. In this article, we focus on separatist spaces, by analysing complaints submitted to the Equality Ombudsman, a governmental agency that supervises compliance with the Discrimination Act in Sweden. Through these complaints, we explore expressions of resistance to separatist spaces and how exclusion from such spaces is understood and made sense of. Hence, the aim is to, through analysis of complaints about perceived discrimination, explore which spaces and contexts are perceived as discriminatory and who is argued to be discriminated against. This analysis shows a clear pattern in how the complaints are filed against three different categories of places and contexts for women (gyms/swimming baths, The Statement Festival and contexts/networks for women). It is noteworthy that only one complaint is directed against a men-only space. The discussion focuses on how the definition of what constitutes discrimination spans between spatial exclusion to missed opportunities, how the complaints differ in terms of being expressions of personal experiences or a matter of principle, and finally, how the complainants argue that separatist spaces are constructing gender in specific ways. In conclusion, the complaints frame the gender separatist strategy as inherently exclusionary to men, threatening to their masculinity, unjustly portraying them as dangerous, and with complainants often casting boys and men as victims. Some of these complaints align with anti-feminist agendas, and some intersect with racist discourses about which groups of men that are to be perceived as dangerous.

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.

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.

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.

En Suède, les femmes représentent près de 40% des personnes vivant avec le virus de l’immunodéficience humaine (VIH). Pourtant, on sait peu de choses sur leurs expériences, en particulier celles qui se rapportent à la santé et aux droits sexuels et reproductifs. Cette étude souhaite explorer les perceptions et les expériences de la santé et des droits sexuels et reproductifs chez les femmes vivant avec le VIH. Douze entretiens ont été menés avec des femmes séropositives entre septembre et octobre de 2019, et ont fait l’objet d’une analyse thématique. « La discrimination est plus difficile à vivre que la maladie elle-même » est le thème central qui décrit les expérience des participantes en matière de relations sociales, de rencontres intimes et de vie reproductive. L’analyse est fondée sur trois thèmes qui contiennent des sous-thèmes. Le thème 1 décrit comment les participantes revoient et réorientent leur vie sexuelle et reproductive après le diagnostic. Le thème 2 met en lumière comment les idées (erronées) sur le VIH influent sur la vie sexuelle et reproductive et conduisent à des traitements abusifs et à l’intériorisation. Le thème 3 décrit un déplacement paradoxal des responsabilités où les participantes sont contraintes d’assumer une plus grande responsabilité dans certaines situations et sont privées du droit de décider dans d’autres. Cette étude suggère qu’en dépit des progrès notables accomplis dans le traitement du VIH, la stigmatisation et la discrimination découlant de croyances obsolètes et d’idées erronées, de politiques et de directives ambiguës, et d’un accès inégal à l’information influent davantage sur les expériences des femmes vivant avec le VIH en matière de santé et droits sexuels et reproductifs que le virus lui-même. Les résultats mettent en évidence la nécessité: de mettre à jour les connaissances dans les établissements des soins de santé et parmi le grand public; de clarifier les législations et les directives ambiguës; de garantir l’accès sur un pied d’égalité à l’information afin de permettre à toutes les femmes vivant avec le VIH de prendre des décisions éclairées, de faire des choix pleinement informés et de réaliser leurs droits à la santé sexuelles et reproductive; de tenir compte de la diversité des femmes vivant avec le VIH et de permettre une prise de décision partagée.

Aproximadamente el 40% de las personas que viven con el virus de inmunodeficiencia humana (VIH) en Suecia son mujeres. Sin embargo, no se sabe mucho sobre sus experiencias, en particular aquellas relacionadas con la salud y los derechos sexuales y reproductivos (SDSR). Este estudio pretende explorar las percepciones y experiencias de SDSR entre mujeres que viven con VIH (MVVIH). Se realizaron 12 entrevistas con MVVIH de septiembre a octubre de 2019, las cuales se analizaron con análisis temático. “Es más difícil vivir con discriminación que con la enfermedad” es el tema central que describe las experiencias de las participantes con relaciones sociales, encuentros íntimos y su vida reproductiva. Se basa en tres temas que contienen subtemas. El tema 1 describe cómo las participantes reconsideran y reorientan su vida sexual y reproductiva después del diagnóstico. El tema 2 destaca cómo las percepciones (erróneas) del VIH afectan la vida sexual y reproductiva y propician un trato abusivo e internalización. El tema 3 describe un cambio paradójico de responsabilidades mediante el cual las participantes se sienten obligadas a asumir mayor responsabilidad en algunas situaciones y despojadas de su derecho a decidir en otras. Este estudio indica que, a pesar de notables avances en el tratamiento del VIH, el estigma y la discriminación derivados de creencias y conceptos (erróneos) obsoletos, políticas y directrices ambiguas, y acceso no equitativo a la información afectan las experiencias de SDSR de las MVVIH más que el virus. Los Resultados Ponen de Relieve la Necesidad de: Actualizar los Conocimientos en los Establecimientos de Salud y en el Público; aclarar legislaciones y directrices ambiguas; garantizar acceso equitativo a la información para que todas las MVVIH puedan tomar decisiones informadas, hacer elecciones completamente informadas y realizar su SDSR; y considerar la diversidad de MVVIH y permitir la toma de decisiones compartida.

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.

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.