Access to Healthcare for Trans, Travestis, and Gender-Diverse People in Latin America: A Scoping Review

Livia Maria de Souza Gonçalves^1*Norberto Rech Bonetti¹Helena Moraes Cortes¹Beverley D Glass²Luciano Soares¹

• ¹Universidade Federal de Santa Catarina, Florianópolis, Brazil
• ²James Cook University, Townsville City, Australia

Background: Trans, Travestis, and Gender-Diverse (TTGD) populations in Latin America face substantial barriers to equitable healthcare - Travesti refers to a regionally specific gender identity with distinct cultural and political meanings. Objective: This scoping review aimed to map and characterize the literature and factors influencing access to health services and goods (such as medicines, diagnostic tests, and other resources for these populations. Methods: Following JBI methodology and PRISMA-ScR guidelines, a comprehensive search was conducted in SciELO, PubMed, LILACS, Web of Science, and Scopus. Paired screening and data charting were guided by a multidimensional access framework encompassing enabling and disabling factors, health needs, and individual behaviors. Inclusion criteria comprised primary studies on healthcare access for TTGD people in Latin America. Results: A total of 115 studies were included, all published between 2007 and 2024, although no publication date restrictions were applied. Disabling factors included undertrained professionals; pathologizing protocols (e.g., requiring diagnoses to access gender-affirming services); institutional transphobia (e.g., disrespect of social names and pronouns); limited funding for gender-affirming care; fragmented services; weak integration with primary care; inconsistent recognition of social names; and geographic or regional access gaps. Health needs were often unmet. Normative needs included gender-affirming procedures, hormone management, and comprehensive care. Felt needs encompassed humanized care, access to medicines and prostheses, chronic disease management, and psychological support. Express needs included emergency care and 1 vaccination. Individual health behaviors reflected resilience and adaptation. Economic vulnerability and systemic exclusion (e.g., denial of care in public health facilities and cisnormative protocols) led many to avoid formal care and seek informal, peer-based, or self-managed alternatives. Access-enabling strategies included services involving TTGD professionals and inclusive policies, mostly implemented at municipal or institutional levels, promoting safe spaces, non-trans-pathologizing care, autonomy, and user collaboration. Conclusion: The findings highlight the importance of inclusive policies addressing cis-heteronormative norms and fostering community participation at all levels of healthcare, particularly in primary care. Key pathways to achieving equitable healthcare include structural reform, investment in provider training, and the adoption of depathologized, rights-based models centered on TTGD leadership.