Legal gender affirmation - legal name and gender marker change - is an important health-promoting health determinant for transgender people. In Peru, the state's failure to universally recognize transgender people's legal identity limits standardized legal affirmation procedures, including the paucity of government officials trained in gender affirmation strategies. This project, in partnership with Registro Nacional de Identificación y Estado Civil (RENIEC) and transgender communities, designed and piloted a group-based intervention to sensitize government officers to the importance of gender-concordant identity documents. Between August 2017 and February 2018, three in-person group intervention sessions were held (each 3-4 hours) with 51 government officers. Guided by Gender Affirmation and Structural Violence Frameworks, the intervention utilized Adult Learning Theory and applied storytelling and testimonials as pedagogy. Pre-/post-test surveys were administered (19 true/false items, summed to create an index score measuring knowledge and attitudes toward transgender people). Within-person changes in pre-/post-intervention scores were evaluated using paired t-tests. Pre-/post-test data were available for 41 participants. After the intervention, there were improvements in knowledge and more favorable attitudes toward transgender people (pre-test mean = 14.09, SD = 2.33 vs. post-test mean = 15.62, SD = 1.82; difference = 1.53, 95% CL = 0.60, 2.67; t-test = 3.30 [df = 46]; p = 0.002). The intervention was feasible to conduct and garnered high acceptability. The results suggest the promise of this brief intervention for future research and testing before potential later implementation and scale-up to increase the capacity of government officers to address legal gender affirmation for transgender people in Peru.

Keywords: Transgender; global health; health disparities; legal epidemiology; program development.

法律性别确认——包括法定姓名和性别标识的更改——对跨性别者而言是一个重要的健康促进因素。在秘鲁，国家未能普遍认可跨性别者的法定身份限制了标准化的法律确认程序，其中包括接受过性别确认策略培训的政府官员数量有限。本项目与@Registro Nacional de Identificación y Estado Civil (RENIEC) 和跨性别社区合作设计并试点了一个小组干预措施，以提高政府工作人员对一致性别身份文件重要性的认识。从2017年8月到2018年2月，为51名政府官员举办了三次面对面的小组干预会议（每次3-4小时）。该干预措施基于性别确认和结构性暴力框架，并利用成人学习理论以及故事讲述和证词作为教学方法。进行了前/后测试调查（19个是非题，总分用来衡量对跨性别者的知识和态度）。使用配对t检验评估了干预前后分数的个体变化。41名参与者的数据可用于前/后测试分析。干预之后，参与者在了解跨性别者方面的知识有所提高，并且对他们持有更积极的态度（前测平均值= 14.09，标准差SD = 2.33对后测平均值= 15.62，SD = 1.82；差异= 1.53，置信区间CL = 0.60, 2.67；t检验= 3.30 [自由度df = 46]；p = 0.002）。该干预措施具有可行性且接受程度高。结果表明，在潜在的未来研究、测试和实施扩大化之前，这一简短的干预措施对于提高秘鲁政府官员处理跨性别者法律性别确认的能力有潜力。

关键词： 跨性别；全球健康；健康差异；法律流行病学；项目开发

简单语言摘要

主要发现：由多学科跨部门团队与跨性别社区合作设计并试点的小组理论指导干预措施是可行的，并且获得了高度接受性，显著提高了负责秘鲁身份文件政府官员对跨性别者的知识和积极态度。增加的知识：法律性别确认对于跨性别者而言是重要的心理健康和福祉决定因素；这项基于证据的干预增加了政府工作人员满足危害健康的法律性别确认需求的能力，特别是合法姓名和性别标识更改的需求。这一措施解决了秘鲁跨性别者法律性别确认中的结构性障碍。对政策与行动的全球健康影响：发现强调了在秘鲁潜在未来研究、测试和实施扩大化之前该干预措施的潜力，并且为其他国家和地区适应政府官员训练以有效处理和实现法律性别确认提供了借鉴，这可以解决跨性别者法律性别确认中的结构性障碍。