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

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