developing programs to sensitize providers to the unique hiv and health needs of transgender people...
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Developing Programs to Sensitize Providers to the Unique HIV and Health Needs of Transgender
People
JoAnne G. Keatley, MSWCenter of Excellence for Transgender Health:
University of California, San Francisco, United States
Our mission is to increase access to comprehensive, effective, and affirming healthcare services for trans and gender-variant
communities.
National Advisory BoardWe include community perspectives by actively engaging a national advisory body (NAB) of 12 trans identified leaders from throughout the country.
Primary Projects
1. CATCH
2. Transitions Project
3. Primary Care Protocols
4. International Project
5. Sheroes Intervention
Who We Are Globally
Travestís, Transvestites, Transsexuals,Transgender, Hijra, Ali, Arvani, Kothis, Metis,
Mak Nyahs, Mukhannis, Kathoey, Mahuwahine, Fa’afafine, Sistergirls, Waria, Muxhe,
Mujeres Differentes
Transsexual Population Estimates
Weitze C., & Osburg, S., 1996
Sweden Walinder, 1967 1 : 54,000 1 : 37,000 1 : 103,000 2.8 : 1
U.S. Pauly, 1968 1 : 100,000 1 : 400,000 4 : 1
U.K. Hoenig & McKenna, 1974 1 : 53,000 1 : 34,000 1 : 108,000 3.2 : 1
Australia Ross et al, 1981 1 : 42,000 1 : 24,000 1 : 150,000 6.1 : 1
Singapore Tsoi, 1988 1 : 2,900 1 : 9,000 1 : 27,000
Netherlands Gooren et al, 1992 1 : 11,900 1 : 30,400 2.3 : 1
Germany Osburg & Weitze, 1993 1 : 42,000 to1 : 48,000
1 : 36,000 to1 : 42,000
1 : 94,000 to1 : 104,000
2.3 : 1 to2.2 : 1
Country Study & YearOverall
PrevalenceMtF
PrevalenceFtM
PrevalenceMtF/FtM
Ratio
HIV Prevalence Estimates among Trans People in the US
• Transwomen (lab-confirmed)• 12% by self-report28%• African American
transwomen56%• Transmen0-3%
Herbst et al., 2008
Global Trans HIV Prevalence Estimates
• 21.5% to 78%South America
• 8% to 74%Europe
• 11%Middle East
• 2% to 56%South Asia
• 22%South East Asia
• Sex-segregated facilities
• Unprotected Sex
• Gender Affirmation
• Unprotected Sex
• Coping• Mental Health• Unprotected
Sex
• Housing & Job Discrimination
• Internalized• Self Esteem
Trans- phobia
Drug Use
Prison & Jail 37- 65%
Sex Work
Best Practices Course
• Created in order to address the urgent HIV prevention needs of trans people by building capacity of:
– Health care professionals– Social services professionals
How did the CoE come up with the eight best practices?
1. California Resource Inventory
2. California Service Gap Analysis
3. Data Analysis
Background (Cont’d)• Literature & Internet Search
• Identified 24 Trans HIV Prevention Programs in California
• Contacted all programs
• Distributed questionnaire
Best Practices Course
• Theoretical Framework:– Adult Learning Theory– Social Cognitive Theory– Empowerment Model– Social Action Model
Best Practices Course: Learning Objectives
Define the term ‘transgender’. Identify at least 4 different trans identities/communities.
Describe 3 different structural, community, interpersonal or
individual factors that impact HIV prevalence and health care
disparities among trans people.
Explore their personal feelings, beliefs, and attitudes about why HIV
prevention and improving health among trans people is important to
them.
Discuss at least 3 best practices to improve HIV prevention and
services for trans people.
State one action step that the participant will personally implement that directly improves the health and
wellness of trans people.
1. Ground your work in the Community 2. One size does not fit all
3. Use Multidisciplinary Approaches 4. Get the Facts
5. Look in All the Right Places
6. Increase Access to Health Care
7. Staff Development 8. Advocate
Best Practices for Transgender HIV Prevention
1. Ground Your Work in the Community
• Develop partnerships with trans people and organizations
2. Race & Ethnicity: One Size Does Not Fit All
• Like other groups, HIV risk in trans people is compounded by racial discrimination
3. Use Multidisciplinary Approaches
COMMUNITIES
ORGANIZATIONS
SCHOOLS
SOCIAL NETWORKS
FAMILIESINDIVIDUALS
4. Get the Facts! Assess, Evaluate & Enhance
Evaluate
Incorporate Findings
Plan Program Changes
Implement
Disseminate Findings
5. Look in All the Right Places• Trans-specific recruitment
and retention strategies
6. Increase Access to Health Care• Collaborate with local health care
providers who:– Have easily accessible or
multiple locations– Provide services in multiple
languages– Understand trans HIV and
health care issues– Provide hormone therapy as
part of primary care
7. Invest In Developing and Supporting Your Staff
• Prioritize staff development
– Build staff capacity
– Create opportunities for advancement
8. Advocate for Structural & Systemic Changes
• Advocate for policy changes alongside trans people. Examples Include:
Immigration
Health Insurance
HIV Prevention
Housing
Primary Care Protocol Project: Medical Advisory Board
Marvin E. Belzer, MD, FACP, FSAM
Jennifer Burnett, MD
Maddie Deutsch, MD
James Franicevich, NP
R. Nick Gorton, MD
Jennifer Hastings, MD
Dan Karasic, MD
Lori Kohler, MD
Jennifer Vanderleest MD, MSPH
Patient Intake
• What is your current gender or gender identity?– Male– Female– Transgender Male/Transman– Transgender Female/Transwoman– Genderqueer– Other: please specify___________– Decline to state
Patient Intake
• What sex were you assigned at birth?– Male– Female– Decline to state
Patient Intake• What pronouns do you prefer?– Fill-in-the-blank– He, she; hir, ze, they, etc.
Challenges Encountered• What challenges will/might/have you
encounter(ed)?– Interpersonal– Individual– Community– Structural
• How would/did you resolve those challenges?
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Gattari P and Spizzichino L. (1992) Behavioural Patterns and HIV Infection Among Drug Using Transvestites Practicising Prostitution In Rome. AIDS Care, 4(1), 83-87.Netherlands
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ReferencesPalwade P, Jerajani H, Ashok R, Shinde S, & Vivek A. (2004) Prevalence of HIV
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ReferencesVan Veen M, Hofhuis A, van der Helm T, Götz H, Prins M, & van de Laar M. (2006)
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Wimonsate W., Naorat S., Varangrat, A., Phanuphak, P., Kanggarnrua, K., McNicholl, J., Tappero, J., van Griensvn, F., Siraprapasiri, T., and the Thailand MSM Study Group (2005). Risk behavior, hormone use, surgical history and HIV infection among transgendered persons (TG) in Thailand, 2005. AIDS 2006 - XVI International AIDS Conference: Abstract no. MOPE0349
