HIV Frontlines: Addressing the Needs of the API Community in New York City
A Conversation With Robert Murayama, M.D., Chief Medical Officer of Asian & Pacific Islander Coalition on HIV/AIDS Community Health Center (APICHA CHC)
May 17, 2012
That's such a critical piece that I wish more LGBT organizations would do. There are so many younger gay men who don't have any role models and don't have any one gay in their lives to help them navigate the early stages of being out.
We are very excited about that program. We believe that mentorship is really helpful, because so often the only source of information might be from our families and, if you are gay, then most likely you are not getting the information that you need. And in terms of their peers, they may not be the best source of information.
It's also nice to have somebody not only helping you with making connections, but helping you with sort of organizing your life. So we have men from different backgrounds give presentations on various aspects like how to balance your checkbook, how to prepare a resume, and how to dress for success.
That's awesome. What are some of the programs that you have for women?
We have a testing and prevention program for women and youth where we teach women about STDs and HIV, and we go out and do testing in this population. We have also been able to link HIV testing with STD testing. Over the years, what we found was that people may be on the fence about getting tested for HIV, but they are certainly interested in getting tested for STDs. So if we can test them for gonorrhea, chlamydia and syphilis, we will say, "While we're at it, why don't we test you for HIV?" People are much more receptive if we are offering an array of those services.
Let's talk more about the transgender clinic. How did that come about?
The trans community has been a very invisible community. Yes, there are some members who are highly visible, but I think that, for the most part, trans and gender-variant people tend to fly under the radar. And recently, there has been some data showing the incredible injustices that have been done to this community.
A few years ago, the largest data on transgender Americans [emerged]. I believe that they surveyed more than 6,500 trans folks and they found some really eye-opening information. A majority of the respondents lived in extreme poverty. They also pointed out that so many trans people faced so many hardships in their lives from childhood, being in school, entering the workforce, being out in public, and even the contact that they have with the medical community and the police. And that's why the suicide rates were amazingly high. One report found that over 41 percent of those who had responded to the survey said that they attempted suicide and 78 percent reported harassment in schools, including sexual harassment. People reported loss of their job, harassment at work and housing discrimination as well. And what really got me upset -- not that everything else didn't get me upset -- was that 19 percent of respondents had reported that they were refused medical treatment.
So APICHA had been taking care of the transgender and gender non-conforming folks since we started providing medical care, but there was this decision that, if we really wanted to make sure that we were addressing marginalized communities, then we really needed to create a clinic that was addressing the unique and specific needs for this community.
This is the first time, to my knowledge, that private or public funds were given to a clinic that was not specifically doing HIV prevention work for the trans community and not solely focused on trans women, but allowing us to address the needs of the very diverse trans community.
The clinic opened last October. How many clients are you all serving?
We have about 50 transgender/non-conforming folks that are in care right now and we haven't even begun to do our big launch. [Laughs.] Right now we are in our start-up phase and we are excited that we have been able to get the word out. But we've noticed that since we've been doing this work that we need to do more advocacy, because there are numerous barriers that keep coming up more and more.
One of the biggest barriers is this lack of insurance coverage for trans folks. There was this big hope that when New York state Medicaid was undergoing its redesign, that trans-related services, which include hormone testing, providing hormones, surgical interventions and mental care, might be covered. Well, that didn't fly, especially because the goal of the Medicaid redesign was to save money, not spend more money.
But unfortunately, for those who do have insurance, it doesn't cover anything trans-related. And that's because they lump everything into this one kind of garbage can silo called "Gender Identity Disorder." Once someone is labeled as having that, even something as cheap as an oral estrogen hormone isn't covered by private insurance because you have a gender marker on your insurance card. Now, if your gender marker says "female" and you need that hormone, it's covered; you're fine. But if that marker says "male," your insurance won't even cover the medical visit. We are not even talking about surgery; we are talking about the basics -- meeting with a medical provider to get basic information and mental health. None of that ends up being covered by private insurance.
What has been the community response to APICHA?
The Asian LGBT community knows about us. And I'd love to say that the [general Asian] community has wholeheartedly embraced us, but we are still kind of a dirty little secret. People don't necessarily like to talk about the work that we do, even though we like to talk about the work that we do.
It is hard getting the word out about us in a hundred different languages and ethnic groups, but many do know about us and we get a bunch of referrals, especially when people have been identified as HIV positive in the Asian community.
But what does happen is that there can be a lot of competitive infighting. For example, we are involved in health care, not just prevention, so we see one of our missions as providing for the care needs of our community. And right now, we have a situation where there is a large Asian-Chinese focused community health center next door. They really don't want for us to exist, but they don't want to serve the population that we serve, which is unfortunate, and they are doing everything they can to make sure that we don't receive designation from the federal government as a federally qualified community health center.
That's actually quite ridiculous.
It really is. And to me, it's like saying there aren't enough poor, sick Asians to go around or that they feel that they can do it all, but yet they are really not serving the needs of a very important population.
How worried are you that this tension will affect your funding?
I think everybody is worried about funding in general. We do receive a lot of funding from federal and state and city grants, and when you are receiving grant funding, you are always worried about which way the wind will blow in terms of politics. So yes, we're concerned about it and we've certainly been trying to diversify our private foundation funding, but that's also been difficult, especially in this economic environment.
Sometimes this work can be such a mix of emotions -- it can be amazing, fulfilling, but at times it can be frustrating, and even depressing. How do you personally cope with your job? How do you decompress?
No, I have a good support network of like-minded folks. I have a gay, Asian doctor network and once a month we get together and eat really unhealthy food and get bombed and have a good time. I also have other folks in my network and we are able to text each other and commiserate, but I also work with an amazing group of people here at APICHA. People here are really committed and it really makes me energized that there are these young people that are coming up through the ranks that are just energized and excited and are ready to fight the fight.
This transcript has been lightly edited for clarity.
Kellee Terrell is the former news editor for TheBody.com and TheBodyPRO.com.
Follow Kellee on Twitter: @kelleent.
Copyright © 2012 Remedy Health Media, LLC. All rights reserved.
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