housing as a structural intervention for transgender people living with hiv/aids
DESCRIPTION
Housing as a Structural Intervention for Transgender People living with HIV/AIDS. Megan Stanton, MSW* Sambuddha Choudhuri* Samira Ali, MSW* Lynn Walker, D.Min., M.S.Ed.** Virginia Shubert, JD** Toorjo Ghose, MSW, PhD* Virginia (Ginny) Shubert – [email protected]. - PowerPoint PPT PresentationTRANSCRIPT
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Housing as a Structural Intervention for Transgender People living with
HIV/AIDSMegan Stanton, MSW*
Sambuddha Choudhuri*Samira Ali, MSW*
Lynn Walker, D.Min., M.S.Ed.**Virginia Shubert, JD**
Toorjo Ghose, MSW, PhD*
Virginia (Ginny) Shubert – [email protected]
*University of Pennsylvania School of Social Policy and Practice** Housing Works, Inc.
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HIV Prevalence
• 27.7% among transgender women (MtF) (Herbst et al., 2011)
Syndemic Theory: Complex HIV Risk (Operario & Nemoto, 200?)
• Stigma, marginalization, and discrimination.
• Marginalization Risk Environment
• HIV Risk Behavior
Existing Research: Prevalence and Complex Risk
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Housing Works, Inc.
Research has called for: multi-component interventions that can address the full
constellation of service needs of TG individuals increased intervention efforts focused on structural barriers
facing TG individuals, such as housing trans-compenent and trans-specific services
• Very little research exists examining structural intervention models responsive to the complex and unique needs of TG and GNC PLWHA.
Existing Research: A Call to Action
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Housing Works, Inc.
Transgender Transitional Housing Project (TTHP)
Housing first program tailored specifically for TG PLWHA Scattered-site housing in New York City Low threshold/ use tolerant model Supportive Services
Case Management Groups Access to HW continuum of care
Methods: Setting
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Housing Works, Inc.
Community-based participatory approachMeaningful involvement of residents and staff
Quantitative90 TTHP residents (assessed as program exit) were compared to 90 homeless HIV-positive clients on HIV medication
Matched by age and race. Multiple regression to assess effect of TTHP participation on viral
load suppression.
Qualitative
30 semi-structured, in depth interviews with TTHP residents.
Thematic analysis was utilized.
Methods: Mixed Methods
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TTHP: Quantitative Results
TTHP residence was associated with viral suppression
• A significantly higher proportion of those who completed TTHP had suppressed viral loads compared to non-residents (67% vs 32%, p<.01).
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TTHP: Qualitative Results
Main Theme
Stable housing undermined chaotic and risky physical environments and facilitated service-utilization that ultimately reduced HIV risk and improved adherence.
Specifically...
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TTHP: Risk Management
1. Risk management:
– Mitigate exposure to chaos and violence in unstable housing
– Avoid substance use environments
– Provides environment facilitative of safe sex
• Reduces the need to engage in survival sex work
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TTHP: Health Management
2. Health Management
– Supported housing: connects residents to needed services
– Refers to trans-competent services
Critical to participant success in referred program
– Protection from chaos/risk environment promotes personal health management
Maintaining appointments
Medication Adherence
– Increased pride in living space and quality of life associated with motivation to maintain positive health practices
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TTHP: Privacy-Establishment
3. Privacy-Establishment:
– Control over living space promoted residents' sense of self-efficacy over their live and health
– Negotiate societal stigma due to gender identity• Develop and express gender identity on own terms
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4. Public Space-Taking :
– Community space for TPLHA to connect and support one another
• Inspires engagement in gender-based advocacy activities
• Improves collective efficacy as transgender people
– Residents claim ownership of a physical and visible location in the community
• Facilitates claim on public space
• Articulates rights as social citizens
TTHP: Public Space Taking
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5. Resilience :
– Transgender identity is not only a barrier to housing and social service access, but can also be a source of strength for TTHP
• Chosen gender expression encourages attaining health goals
• Transgender community is source of support and education
• Previous experience with advocacy fosters desire for continuing involvement only a source of difficulty with regards to housing and social service access, but can also be a source of strength can be not only a source of difficulty with regards to housing and social service access, but can also be a source of strength
TTHP: Resilience
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Conclusions
Housing operates as both prevention and treatment for TPLHA
• Undermines the HIV risk environment
– Interrupting the marginalization/risk environment feedback loop associated with HIV
• Facilitates positive health behaviors
–Medication Adherence
Housing promotes personal and collective efficacy of TPLHA
• Privacy to negotiate stigma
• Collectivization and command over public space
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Conclusions
The TTHP model can be used as a structural intervention for marginalized and stigmatized communities living with HIV
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Acknowledgments
Thanks to TTHP residents and staff for their support in this research.
Housing Works and the University of Pennsylvania also thank the M*A*C AIDS Fund for supporting this research.