Lugar do estigma: uma avaliação da assistência de pessoas transgênero na rede estadual de saúde do Governo do Ceará

Abstract

This dissertation evaluates the healthcare services provided to the transgender population within the state public health network of Ceará, focusing on the Transdisciplinary Outpatient Service for Transgender People (Sertrans), created in 2017 by the State Government. Adopting a qualitative and evaluative approach, grounded in the counter-hegemonic perspective of in-depth evaluation (Rodrigues, 2008), the study analyzes the symbolic, structural, and territorial effects of Sertrans's implementation, particularly during the period it was located within a psychiatric hospital. The research is based on participant observation, a questionnaire applied to service users, and document analysis. The theoretical framework brings together contributions from public health, spatial justice, critical theory, and gender studies to understand how the institutional location and internal dynamics of the service impact access, reception, and the dignity of trans people. The findings indicate that Sertrans’s presence in a psychiatric facility until March 2025 reinforced stigma by associating trans identities with mental illness, undermining the symbolic legitimacy of the care provided. On the other hand, the study highlights the service’s potential for delivering comprehensive care, grounded in a multidisciplinary approach sensitive to the needs of the trans population. The evaluation also identified structural challenges, such as delays in access, lack of federal recognition of the service, and the concentration of care in Fortaleza. The relocation of Sertrans to the Ceará University Hospital in 2025 is interpreted as a significant symbolic shift in confronting stigma, as it breaks with the prior association with psychiatric care. However, this spatial change does not eliminate the persistence of psychomedical logics within the service structure, evidenced, for example, by the requirement of psychological or psychiatric reports to access certain procedures. The study concludes that, to achieve greater effectiveness, Sertrans requires institutional strengthening, service decentralization, and the consolidation of public policies guided by spatial justice and social participation.