however, progress on establishing the quilombo has been hampered by ongoing legal complexities, particularly surrounding the expropriation process. the need to provide compensation to current occupants of the land, coupled with conflicting rulings from state and federal courts, has significantly slowed down the process.
consequently, the community remains vulnerable to encroachment by land grabbers and faces a precarious existence.
two separate reports have confirmed the descendants of enslaved people comprise the communities within mata cavalo. these communities have developed unique cultural practices, agricultural methods, and kinship systems.
during the colonial era, the mata cavalo lands were part of several sesmarias, large estates granted by the portuguese crown for agricultural production, similar to plantations in the united states.
specifically, mata cavalo was situated within the sesmaria de boa vida and the sesmaria de rondon.
both prospered by utilizing enslaved labor on plantations and extracting resources from the adjacent biomes. toward the end of the nineteenth century, just before brazil abolished slavery, a segment of the sesmaria de boa vida was gifted to the 34 individuals enslaved there, under the condition they would care for the property owner until her death.
the remaining portion of the sesmaria de boa vida was then sold to vincente ferreira de jesus, who subsequently founded ribeirão da mutuca.
similarly, a part of the sesmaria rondon was sold to marcelino paes de barros, a freed black man and gold miner, who established mata cavalo da cima. the other part was sold to graciano da silva tavares, an enslaved person who later founded mata cavalo de baixo.
following the abolition of slavery, the territory transformed into black lands, with seven distinct communities arising from the foundations laid by their ancestors.
these communities were composed of enslaved and freed black individuals who either acquired land through formal sales or transfers, or settled within the territory based on established customary relationships of sponsorship and kinship.
these acquisitions and donations are largely well-documented, and for a time, community members maintained careful possession of these documents, as barcelos notes.
despite the community's rich history and cultural significance, the absence of a formal legal title to their territory remains a pressing concern. although mata cavalo's territory and way of life were recognized as black, a diverse ethno-racial coexistence has characterized the quilombola territory since its inception.
this characteristic is common among quilombos in brazil.
beatriz nascimento, a quilombola scholar, described them as spaces of interaction and integration, where various marginalized groups in brazilian society intermingled. these included quilombolas, indigenous people, and poor whites who lacked land ownership, setting them apart from the hierarchical structure of brazilian colonial society, as ratts observes.
the cadastro ambiental rural (car), or rural environmental registry, was established by law no.
within the car system, land can be registered as rural property (car-iru), settlements (car-ast), or traditional people and communities (car-pct). quilombola territories are required to be registered collectively under the car-pct system.
however, some quilombola communities have been incorrectly advised to register their land as rural properties or settlements, and some brazilian states lack a functioning car-pct system, according to oviedo et al.
furthermore, despite the fact that car registration does not confer land ownership, it is often exploited as a means of land grabbing, as de almeida and do nascimento have pointed out.
the steps required for the formal titling of quilombola communities in brazil are illustrated in fig. in short, the process starts with self-attestation, which is intended to streamline the titling procedure.
frequently, the titling process comes to a halt during the expropriation phase, primarily due to insufficient resources to compensate farmers and other individuals currently occupying the now-quilombola territories, as shore notes.
the palmares cultural foundation, a state entity established by the federal government to protect afro-brazilian culture, and incra, the national agency responsible for implementing agrarian reform, play key roles in the land titling process for quilombola communities in brazil.
throughout the project, we maintained close collaboration with community leaders from all seven associations, who requested that research participant compensation be provided in the form of training workshops.
to fulfill this request, two workshops were conducted.
in june, we held a half-day workshop focused on quilombola identity, history, and resistance, which was led by an expert in brazilian social thought and critical race theory from the university of são paulo. in july, we hosted a two-day workshop with a brazilian attorney who specialized in federal and international rights of traditional peoples and communities.
the workshop covered legislation related to quilombola communities and land rights, available legal assistance for communities seeking to access affirmative quilombola public policies, and opportunities to foster a network of solidarity.
data collection activities were conducted in conjunction with community researchers selected by community leaders from ribeirão da mutuca and mata cavalo de cima.
in ribeirão da mutuca, gs, the daughter of a community leader and a history student at the federal university of mato grosso, was selected as the author. in mata cavalo de cima, zml, an ancestral community leader who had migrated to the city for 35 years before returning, was selected.
she has maintained a strong connection to the territory and its agricultural and cultural practices. the selection of these two community researchers facilitated a rich epistemological approach, revealing similarities, differences, and conflicts between younger and older generations, and between those who had remained in the community and those who had been dispossessed and later returned.
these community researchers administered questionnaires, facilitated ethnographic research, and conducted semi-structured interviews.
considering the complexity of working with seven communities, each with unique cultural, social, and environmental characteristics, and the large size of the territory—14, hectares, mata cavalo quilombola land, quilombola lands observatory n.d.—our research approach required a nuanced and collaborative methodology.
participatory research involving ethnographic immersion was conducted during a 25-day in-person visit to ribeirão da mutuca between may and june, and a second 25-day in-person visit to mata cavalo de cima between october and november.
this research relied on participant observation, during which tb, the ethnographer author, followed agricultural and cultural practices in these two communities and conducted in-depth interviews with community leaders and elders.
observations were documented in a notebook, along with interviews, videos, and photographs.
two transect walks were conducted to assess the availability of natural resources, land management systems, and productive activities. participants selected routes to encompass areas with varying characteristics and uses. data was collected through notes and photographs.
questions included: how is this land and vegetation utilized?
what crops are grown here? how long is this land used for cultivation? is there time for the land to rest? what is the soil quality like? what types of animals are raised here? which wild animals are present in the area? do animals live in the production area?
who works with and benefits from the various resources?
what challenges exist in this area? what changes have occurred compared to the past? participatory mapping, facilitated by ean, was used to identify occupied locations and highlight important features within the territory.
we used satellite images from google earth to aid in the construction of these maps.
this allowed participants to visualize the entire territory and identify areas of interest, which were then presented, discussed, and marked as geographic points with corresponding attributes.
a descriptive quantitative analysis was conducted in the communities of ribeirão da mutuca, mata cavalo de cima, and capim verde using a structured questionnaire with several open-ended questions (appendix a).
the goal was to characterize household composition, animal ownership, agricultural practices, the presence of land conflicts, and the impacts of these conflicts on human, animal, and environmental health. the questionnaire was pre-tested with two members of a quilombola community from the state of minas gerais and administered by ean, zml, and gs.
the household was the sampling unit.
according to a previous study, there are approximately residences in ribeirão da mutuca, 41 in mata cavalo de cima, and 7 in capim verde. with a target of completed questionnaires, we distributed 67 to ribeirão da mutuca, 25 to mata cavalo de cima, and 5 to capim verde conaq—mato grosso.
data was analyzed using descriptive statistics, with results presented as means and frequencies.
as the communities of mata cavalo were established, each connected to its ancestral roots, resource appropriation practices within the territory evolved to prioritize the needs of the individual community and subsequently, the exchange networks established between communities.
these networks are often based on kinship relationships formed through marriage.
internal conflicts within and between communities mark the history of mata cavalo, making the complex both communal and heterogeneous, contrasting with traditional views of traditional communities as uniform and entirely harmonious.
for example, territorial disputes between white landowners and the quilombolas of mata cavalo were reported in local and national media in the 1990s, raising public awareness and attracting the attention of institutions such as intermat (mato grosso land institute).
this increased visibility brought new financial support and partnership opportunities, but it also sparked internal conflicts over the allocation of these new resources.
the formation of boundaries is another facet of the communal lifestyle within mata cavalo.
while fences are rare in the quilombola complex, agreements, often tacit but collectively respected and legitimate, govern the boundaries of plantations and communities.
in this regard, while the cultivation of the roça de toco (described below) has historically been a communal practice coordinated through muxirums (collective work efforts), each family group has established the boundaries of its own plantation, and individual family members often have their own plantation boundaries.
in essence, our findings demonstrate substantial social heterogeneity within mata cavalo, marked by a profound and fundamental coexistence of communal practices and individual differentiation.
this coexistence shapes all agricultural production and environmental management in the territory.
since the era of slavery, two distinct forms of agricultural production have existed in conflict within the territory: (i) monoculture agriculture, cattle ranching, and mining for commercial production, which initially relied on enslaved labor and, after abolition, on poorly paid freed black workers; and (ii) roça de toco, cultivated by enslaved people for sustenance and passed down to their descendants.
the roça de toco and related natural resource harvesting practices are characterized by solidarity among species and the presence of spiritual entities: saints (with são benedito and nossa senhora aparecida holding prominent positions), orishas (yoruba spirits), hauntings, and especially the presence of deceased ancestors.
non-human elements—domestic animals, plants, rain, and the sun—possess active roles as agents within a system of human relationships defined by hierarchies, power dynamics, and individualization.
within this system, humans and non-humans have varying places and functions, but both contribute actively to the preservation of the quilombola way of life.
for example, a domestic animal can intercept a spell intended for its human caregiver, sacrificing itself as an active act of protection, thus fulfilling its role in the division of activities integral to the quilombo's system of relationships.
in this context, the territory is dominated by what donna haraway terms "nature-culture," characterized by an interconnectedness of physical and symbolic attributes, shaping the territory's composition and the relationships between the various species that coexist within it.
in the roça de toco, a relatively small space can contain crops of rice, corn, tubers, watermelon, bananas, cotton, and castor beans, interspersed with trees naturally growing in the cerrado, such as the babaçu palm.
these swiddens are enclosed by the cerrado and pantanal vegetation, which provide moisture and protect crops from pests and wild animals (fig.).
the health of these biomes is, therefore, essential to the continuation of agricultural techniques and rituals developed by enslaved ancestors and maintained by the quilombolas.
certain areas within the cerrado and pantanal are considered haunted and are, therefore, left uncultivated.
for the quilombolas, these biomes are a living entity with whom they maintain a delicate relationship based on solidarity, exchange, and obligation.
the roça de toco features plantations of sugarcane, beans, and bananas, interspersed with babaçu coconut trees native to the cerrado.
(a) the bag contains castor bean seeds, used for oil extraction. (b) inside the stump garden, where humidity is high and temperature is mild.
(c) watermelon rotting on the plantation due to high temperatures and lack of rain. (d) production of papaya jam, made from the stem of the papaya tree.
the roça de toco is traditionally burned just before the start of the rainy season, from the end of spring through the summer.
around the end of november or the beginning of december, depending on the signs of the first rains, the muxirums gather to prepare the soil.
the vegetation in the biomes is removed manually, using axes and sickles for many years, but now primarily chainsaws.
meanwhile, a portion of the work team creates a firebreak, a physical barrier separating the plantation area from the surrounding biome vegetation to control the fire.
the controlled fire is then started in that small area. after the burning, the land is cleared again.
among the remaining stumps of larger trees, stump gardens of corn, bananas, rice, sugarcane, or even manioc are planted. these crops hold a central position in the plantation hierarchy because they guarantee an economic return and have been traded by quilombolas since abolition.
subsistence-oriented crops are also planted: pumpkins, yams, sweet potatoes, and beans.
watermelon, papaya, castor bean, and cotton crops are consistently present, as are medicinal trees and plants. this year's crop also coexists with crops from previous years, as well as babaçu palms and other trees typical of the biome.
the corn produced in the territory is creole seed—seeds that have been cultivated, saved, but also improved over many generations—which has grown in the territory for over 100 years without contamination from hybrid seeds.
no chemical inputs or pesticides are used. the first harvest takes place about three months after the arrival of the rains.
fire is notably important. in addition to the controlled fire used to clear the area for cultivation, materials used for everyday consumption are also burned.
considered waste in urban centers, here it is seen as an input: after being burned in the backyards of quilombola houses, it is set aside to be used in the plantations, either the roça de toco or in small vegetable gardens.
in this way of life, there is no inherent concept of waste, but a constant transformation of what is no longer useful into something else.
leftover food is given to the animals that live around the house: dogs, cats, pigs, chickens, ducks, cattle, and bees. these animals, in turn, have specific functions and participate in the intricate social hierarchy noted above.
in the case of mata cavalo, this knowledge has evolved in relation to other ways of life, particularly the western or "white" world.
two current examples from mata cavalo are provided below: the confrontations and incorporations of agribusiness production methods. on the one hand (confrontation), the roça de toco continues to resist monoculture and the use of chemical fertilizers and pesticides.
on the other hand (incorporation), forced exodus and the reduction in family size are addressed by adopting western techniques and technologies, such as using tractors for plowing and replacing multi-species cultivation areas with small monocultures in rotation.
this impact is particularly evident among men and younger generations.
the incorporation of agroecological techniques and technologies. the dialogue with agroecology, a western science, is used by quilombolas to enhance and update their knowledge and legitimize their way of life in the face of agribusiness monoculture, given its similarities to the roça de toco.
for example, there is an international movement among traditional populations to maintain and exchange creole seeds, known as creole seed banks.
women from different generations are the protagonists of this cultural exchange with agroecology and the stewards of these seed banks.
as detailed above, the way of life within mata cavalo is not a closed or isolated system: it has always had connections with the white world.
however, economic vulnerability, exacerbated by racism and sexism, puts the population of mata cavalo in a highly unequal relationship with the white world.
our research suggests that securing neighboring biomes through titling tenure regularization of the mata cavalo complex requires the implementation of public policies that ensure more equitable economic exchange between quilombolas and the white world.
two striking examples illustrate the impact of this economic vulnerability on the continuity of the roça de toco: quilombolas being hired by white farmers as agricultural workers under exploitative conditions.
these farmers expanded their properties into quilombola territory by supplying workers with work tools, clothes, food, tobacco, and guaraná at inflated prices and deducting the costs from their extremely low wages.
this debt is then resolved by transferring quilombola lands to white farmers.
it was through this mechanism that white farmers first expropriated tracts of land in mata cavalo. illegal sale of parts of the territory by quilombolas themselves, particularly those who were dispossessed and later returned, but are unable to guarantee their subsistence on the land due to extreme economic vulnerability, the absence of public policies providing support for their resettlement, and the loss of traditional knowledge resulting from their forced dispossession (detailed below).
these individuals and families are doubly victimized by structural racism: first, when they were expelled from their land, and second, when they returned without the necessary conditions for their return.
they are left with no option but to sell the land they live on, increasing the presence of non-quilombolas in the territory.
in both cases, the expansion of large properties on the outskirts of the complex, as well as the influx of non-quilombolas into smaller, dispersed spaces within the complex, has led to environmental destruction, weakening the biomes and hindering the continuation of traditional cultivation methods.
for example, mining operations carried out within the territory are identified by quilombolas as being responsible for both reducing and contaminating rivers and streams (fig.).
this has made the soil sandier and less fertile, making it difficult for plantings to thrive without the use of chemical fertilizers.
water security in the territory is impacted by both climate change and nearby agribusiness activities. (a) a stream in the quilombo impacted by drought and contamination.
(b) quilombola leaders visit a water reservoir that has dried up. territorial conflicts between quilombolas and whites have existed since abolition.
some white farmers were initially welcomed into the territory by the quilombolas themselves, with conflicts only arising later when they exploited the hybrid nature of the land tenure system (between customary and formal) to expropriate black lands and expand their holdings.
after his liberation from sesmaria de boa vida, vincente ferreira de jesus—the founder of ribeirão da mutuca—used gold nuggets he had collected to buy the land his descendants now claim.
viewed by his descendants as a gentle man, vincente married francisca romana, a skilled weaver and a "maluda" woman (a strong woman who is not afraid of hard work or physical conflict, in contrast to the traditional ideal of feminine fragility).
francisca was born and enslaved on the boa vida sesmaria and was among the 34 officially registered enslaved people to whom this sesmaria was donated.
in other words, they complied with the land legislation in force after 1850 and also with mato grosso's first land code, as barcelos notes. barcelos' research also documents the purchase of the land by the freed black marcelino paes de barros, the founder of mata cavalo de cima.
confirming what has been reported by our research participants, barcelos' documentary research demonstrates the legal legitimacy of the quilombola ownership of mata cavalo.
however, this legal ownership was soon undermined by the predatory advancement of land grabbers.
in the late 1980s, a white man named manuel monteiro, who was a close associate of a quilombola resident, was welcomed into the community. after his arrival, manuel monteiro bought a small piece of land in the territory and began selling goods—clothes, guarana powder, tobacco, dried meat, sugar—that he had brought from the city, and hiring quilombola workers using methods rooted in social kinship relations.
to pay off these debts, they worked for free or gave manuel monteiro portions of their land.
in this process, he expanded his property beyond the land he was initially granted by the community. instead of fulfilling his promise, he claimed some 8,000 hectares within the complex as his own, which he quickly divided into small plots and sold.
in ribeirão da mutuca, macário, the son of vicente ferreira de jesus and francisca romana, managed to retain 160 hectares of land in his legal possession.
according to his granddaughters, these lands served as a place of resistance but also confinement, as the family found themselves surrounded by white farmers.
macário would go on to marry rosa, an orphan from the community of capim verde, which is now almost entirely owned by white farmers.
while some other quilombola families managed to retain legal possession of their territory—including many in the aguaçú community—the majority of quilombolas in mata cavalo remained on their land solely due to the resilience of communal customs, continuing to work on stump gardens cultivated on communal land over which they had no legal guarantee, and on farms and in mines on land taken over by white farmers.
this was the case with the family of co-author zml, a descendant of marcelino paes de barros.
her father had been sponsored by manuel monteiro as a child and lived under his guardianship, working the land with the other children until he reached the age of 18 years. as an adult, he raised pigs and free-range chickens and farmed roça de toco, supplementing this income by working for another white landowner also in the quilombola territory.
one day, manuel monteiro's son came to the house where marcelino paes de barros lived with his wife and children and demanded that they leave, threatening to burn it down.
for those who no longer had any legal guarantee over their land, it became increasingly difficult to remain in mata cavalo.
in the 1980s, the territory was divided up by white landowners, and monoculture, cattle ranching, and mining proliferated.
threats of violence by armed thugs, eviction by police forces, and arson of traditional dwellings—mud covered with sapê or babaçu leaves—drove an increasing number of quilombolas to the city or to other farms in the region.
one of the research participants told us that the city of várzea grande, which today has almost 300,000 inhabitants, was born out of the quilombola exodus.
territorial disputes intensified in the territory at the end of the 1980s, becoming increasingly violent. meanwhile, new machinery and chemicals used in large-scale mines and agribusiness expanded the footprint and environmental impacts of these economic activities, with devastating effects on the surrounding biomes.
nationally, brazil saw the end of the military regime and the start of re-democratization, allowing social movements to gain footholds in the constituent assembly that gave rise to the constitution.
in this new context of action for the right to land in brazil, families who had been expelled from mata cavalo in the previous decades returned to the territory and reclaimed their land.
white landowners retreated partially as disputes intensified, leading to a progressive expansion of quilombola-controlled lands from the end of the 1980s through the early 2000s.
at the same time, significant progress was made in public policies aimed at racial and gender equality.
however, some elements are important in this retaking of the territory: although the landowners backed down partially, they continue to challenge the legitimacy of quilombola property in court and have never ceased the economic activities that define the territory: monoculture agriculture, cattle ranching, and mining.
landless white families initially joined quilombolas in their struggle for the territory.
they have now become land grabbers, expanding their holdings and selling land illegally within the territory. the return of families who were expelled from the territory has created conflicts between the quilombola way of life, centered on the roça de toco, and the western way of life as described above.
many who returned lack traditional knowledge and face enormous difficulties in staying in the territory.
some have since left the territory, while others implement western forms of production (e.g., cattle ranching). previously non-existent, there is now a steady flow of state resources and funds for quilombolas, as well as spaces for representation within state and civil society organizations.
these new and limited resources create disputes within and between communities.
on the one hand, the quilombolas of mata cavalo have gained legitimacy for their centuries-old struggles. on the other hand, there has been a change in the dynamics of power and hierarchy within the quilombo, intensifying conflicts.
in this context, the leadership of quilombola women takes on a particular form.
the processes of racialization and genderization intersect in several unique ways within mata cavalo, as detailed in appendix b. the first is the construction of belonging.
the second relates to the mode of agricultural production, as detailed above, whereby women remain the guardians of creole seeds and traditional agricultural knowledge, now seen as essential for survival.
in summary, current territorial conflicts are characterized by escalating internal and external disputes, including the presence of non-quilombolas, the sale of land by quilombolas who have returned, a substantial increase in mining activities (with at least five separate mines present in the territory), and an exponential increase in land grabbers, with deforestation and predatory burning visible on these small plots of land.
these themes—conflict, extractive industries, and environmental destruction—existing within the territory are mirrored outside of it.
nationally, the election of jair bolsonaro, who openly opposed quilombolas and their way of life, both signaled and accelerated the advance of the extreme right.
this has made it difficult for communities within mata cavalo to access public services and resources, and intensified conflicts with agribusinesses.
regionally, the mata cavalo complex is surrounded by the most lucrative economic industries in the state of mato grosso, and large-scale fires, soy plantations, and highly technological mining are causing widespread destruction in the cerrado and pantanal biomes (fig.).
compounding these challenges is the presence of criminal organizations operating within the state and territory.
two transect walks were conducted in ribeirão da mutuca, each approximately one hour long. the findings of our transect walks largely corroborated those of our ethnographic immersions.
namely, the traditional agricultural practice of roça de toco is carried out as a muxirum to clear, burn, dig, and plant seedlings.
the roças de toco vary in size from 0.5 to 2 hectares. they are located away from houses—up to 7 km away—in fertile and forested areas of dense vegetation, where babaçu coconut trees are naturally found.
this model was introduced through the donation of machinery and resources by a non-governmental organization.
community members maintain a close, caring relationship with the land, from which they derive their livelihood and their physical and spiritual well-being. the community grows sugarcane, beans, corn, yam, potatoes, rice, cassava, papaya, banana, and a variety of other edible and medicinal plants, as well as pigs and cattle.
the banana is considered the flagship of production in the territory, contributing to income generation for many families.
other commonly sold products include flour, brown sugar, sweets, livestock, and meat. beekeeping is increasing recently, due to support from non-governmental organizations to establish an agroindustry in the territory.
as a result, some community members are shifting from gathering wild honey towards intensified production.
there is already a small apiary in the community, regulated by the local inspection service. extensive areas of riparian vegetation and savannah were found to be well preserved, serving as a refuge for animals displaced by wildfires and other causes of habitat loss.
it causes a lot of damage and loss.
two participatory mapping sessions were conducted: one with the members of the ribeirão da mutuca community, and a second with members of mata cavalo de cima. in ribeirão da mutuca, participants showed great interest in pinpointing the location of the cemetery in this community, in which all ancestors of the main family line are buried, including the matriarch dona domingas rosa (fig.).
an important finding was that a significant part of the territory is already registered in the car.
these are private—rather than communal—cars drawn in places occupied by non-quilombolas and are thus non-compliant with legislation for the quilombola car (car-pct).
map containing points identified by the community during participatory mapping. (a) identification of houses in the community of ribeirão da mutuca (yellow), mata cavalo de cima (red), and non-quilombolas (blue).
(b) areas illegally registered in the car (green shading). consistent with the findings of our ethnographic immersion, we found the presence of landless families to be a major obstacle to titling.
in the 1990s—a period marked by intense conflicts (detailed above)—a meeting was held between quilombola leaders and representatives of the mato grosso land institute (intermat).
the institute offered the landless families in the area the opportunity to reside within the quilombola territory, thereby avoiding potential land invasions. the proposal was accepted by the quilombo, and the landless were welcomed by the community.
however, over time, new problems arose as the land use and occupation systems employed by the landless families led to increasing demands for land.
the resulting loss of quilombola territory to these families through illegitimate purchase, sale, and occupation has been a persistent issue.
regarding this last figure, we discovered that, due to territorial disputes, the community had split into two factions with 10 households in each.
to ensure sufficient representation, we distributed additional questionnaires to the community of capim verde. considering the enduring history of violations of fundamental rights, especially the right to health, it is essential to identify gaps in knowledge and to understand the various contexts of vulnerability that affect these populations.
such recognition, incorporated into the practices of managers, researchers, and health professionals, would lead to the development of more inclusive strategies and actions.
in light of the above, a survey was carried out of reviews dealing with aspects of health that include trans population in brazil [13, 25, 26].
it was also noted that some studies [27, 28], in other contexts, used the theoretical basis of multidimensional vulnerability presented here.
however, no specific scoping review on the trans people (trans women and trans men) was found in the databases searched, in light of the theoretical conceptualization adopted in this review.
this is the most used in brazilian research [29]. this is a scoping review developed according to the recommendations of the jbi manual for evidence synthesis [30], as well as the checklist of the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (prisma-scr) [31].
based on these guidelines, the following stages were considered: definition of objective, research question, and inclusion criteria; planning of the search strategy; search and selection of research evidence; data extraction; analysis and presentation of results; and synthesis of evidence according to the objective of the review, including the conclusions.
the protocol for this review was registered in the open science framework.
the composition of programmatic vulnerability comprised any level of health care (primary or specialized, outpatient or inpatient). considering the national lgbt comprehensive health policy creation in 2013 as a reference, studies published from 2013 to april 2021 were included, i.e.
those covering between 8 and 12 years since the establishment of this public policy, assuming that this is a reasonable interval to capture programmatic implementation challenges, without disregarding the social and political context of the period.
as for the exclusion criteria, articles that did not provide information in line with the pcc strategy were disregarded, as well as literature reviews, book chapters, editorials, opinion articles, essays, dossiers, and experience reports.
studies whose data was not disaggregated by type of gender identity, which prevented the extraction of information on trans people, were also excluded.
table 1 shows two search strategies that were adjusted according to the peculiarities of each database [see additional file 1].
depending on the database searched, descriptors from the health sciences descriptors (decs), medical subject headings (mesh), or embase subject headings (emtree) were used.
the search strategies were planned in a sequence of three phases. in the second phase, a free search was carried out to check the gray literature published between 2013 and april 2021 on google scholar, in its first ten pages, which we consider the most relevant to the search result.
finally, in the third phase, a search of the references contained in the studies selected in the first phase was carried out, in order to identify additional sources.
after identifying the studies, duplicate and ineligible articles were removed, based on their titles and abstracts imported into the rayyan selection platform, produced by the qatar computing research institute (qcri) [32].
in subsequent stages, three reviewers independently selected the articles, based on reading the titles, abstracts, and full texts, to avoid losses as much as possible and to establish more carefully which studies would be included in the review.
in cases of disagreement in the selection process, a fourth reviewer took part in the process to build consensus among all the researchers.
thus, the extracted and mapped data corresponds to: author(s); publication year; article title; journal of publication; study location; objectives and type of study; population and sample size; profile of diseases and conditions studied; and components of social and programmatic vulnerability, which represent the core of this analysis.
the results from the extracted data were presented in descriptive form and summarized in tables.
the theoretical conceptualization of vulnerability [7-12] described in the introduction supported the analysis of the dimensions according to the adaptation of the following variables:
programmatic dimension: performance of health policies, programs, and actions; governance and governability; structure, organization, and access to the service network; health information and communication; multidisciplinary, interdisciplinary, and intersectoral performance; and professional bond with the people in care.
as this is a scoping review, the project does not require submission to the research ethics committee.
however, the methodological rigor recommended in international protocols for this type of research was observed. figure 1 shows the process of study selection. based on the search strategies in the six databases used, 1,806 articles were identified.
of these, 161 were duplicates and 1,357 were ineligible for the review, totaling 1,518 studies excluded at this stage.
for the selection by title and abstract, 288 articles remained, 45 of which were excluded. of the 61 articles read in full, 15 were excluded, of which nine did not answer the research question, three included trans people outside the established age range, and another three were divergent types of publication (two dossiers and one essay).
no studies from the gray literature or additional sources were included, either because they did not meet the eligibility criteria or were duplicates.
flowchart on the process of study selection for scoping review, adapted from prisma by page et al. table 2 shows the 46 studies selected, distributed numerically according to main themes, gender identity, journals of publication, location, and types of study.
among the topics addressed, the following stand out: hiv and aids [34-40], mental health [41-46], and hormone therapy [47