Health inequities and access to care for transgender people in Brazil: evidence from public health data and policy analysis
1
Federal University of Uberlândia, Uberlândia, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
ABSTRACT:
Despite constitutional guarantees of universal health coverage through Brazil’s Unified Health System (SUS), transgender people continue to experience significant health inequities. Official data from the Ministry of Health indicate persistent barriers to access, particularly to gender-affirming care and HIV prevention services, revealing gaps between public health policy and effective implementation. This study analyzes secondary data from official Brazilian public health information systems and Ministry of Health reports, combined with a qualitative review of national policies regulating transgender healthcare within SUS. Indicators related to service availability, access to prevention strategies, and regional distribution of care were examined to assess structural inequities affecting transgender populations. Between 2018 and 2023, Ministry of Health data show that 149022 individuals initiated HIV pre-exposure prophylaxis through SUS, of whom 9599 were transgender people, representing 6.4 of all users. Access to gender-affirming healthcare remains highly restricted, with fewer than 15 public health facilities accredited nationwide to provide comprehensive transgender care. This limited availability results in long waiting times, geographic concentration of services in major urban centers, and unequal access across regions. Surveillance data further indicate high levels of healthcare avoidance among transgender users due to experiences of discrimination within health services, contributing to delayed care and increased vulnerability. Official public health data demonstrate that transgender people in Brazil face persistent structural barriers to equitable healthcare access despite existing legal and policy frameworks. Expanding accredited services, reducing regional disparities, and strengthening professional training within SUS are essential to improving access and health outcomes. Addressing these inequities is critical to advancing equity, inclusion, and sustainability in public health and to fulfilling the commitment to health without borders.
Despite constitutional guarantees of universal health coverage through Brazil’s Unified Health System (SUS), transgender people continue to experience significant health inequities. Official data from the Ministry of Health indicate persistent barriers to access, particularly to gender-affirming care and HIV prevention services, revealing gaps between public health policy and effective implementation. This study analyzes secondary data from official Brazilian public health information systems and Ministry of Health reports, combined with a qualitative review of national policies regulating transgender healthcare within SUS. Indicators related to service availability, access to prevention strategies, and regional distribution of care were examined to assess structural inequities affecting transgender populations. Between 2018 and 2023, Ministry of Health data show that 149022 individuals initiated HIV pre-exposure prophylaxis through SUS, of whom 9599 were transgender people, representing 6.4 of all users. Access to gender-affirming healthcare remains highly restricted, with fewer than 15 public health facilities accredited nationwide to provide comprehensive transgender care. This limited availability results in long waiting times, geographic concentration of services in major urban centers, and unequal access across regions. Surveillance data further indicate high levels of healthcare avoidance among transgender users due to experiences of discrimination within health services, contributing to delayed care and increased vulnerability. Official public health data demonstrate that transgender people in Brazil face persistent structural barriers to equitable healthcare access despite existing legal and policy frameworks. Expanding accredited services, reducing regional disparities, and strengthening professional training within SUS are essential to improving access and health outcomes. Addressing these inequities is critical to advancing equity, inclusion, and sustainability in public health and to fulfilling the commitment to health without borders.
| eISSN: | 2654-1459 |
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