Breaking Down Barriers to Transgender Health and HIV Care
Part One of a Two-Part Series Exploring Perspectives on Transgender Health Access and Advocacy
June 6, 2012
Olivia Ford: I wanted to ask you, Tei, specifically, about the lead-up to the opening of the fairly new transgender clinic at APICHA. What were the needs in the community that the folks at APICHA saw, and evolved to fill?
Tei Okamoto: We've always had a number of trans patients. And we wanted to create a center that adequately addressed the specific health needs. There are a few other organizations in New York that provide comprehensive health care; but we are also an organization that targets underserved communities. And so it made sense for us to move forward with the trans health clinic. We've heard a number of stories from trans patients who sought care at other sort of LGBT-friendly facilities, but their experiences have been largely negative. More often than not, like Danielle and Dee said, they've spent more time educating their providers on their trans issues than receiving care.
Furthermore, we hear that a lot of medical providers are reluctant to provide hormones to their patients. So at APICHA we're fortunate to have someone like Dr. Robert Murayama as our acting chief medical officer. He's received his training on trans health from his formal medical training and residency, as well as from his long history of interacting with trans people, in and out of the professional setting.
Empowerment was important. We wanted to offer our trans patients a space they could take ownership over, a place they could claim as their own. We employ trans individuals in all capacities. Through our health clinic, a program that's bearing our communal name, we hope to empower trans, gender-variant, gender-nonconforming and genderqueer patients, and invite them to feel that their specific health needs are met, and that they matter.
Opening the trans clinic has allowed us also to fall in line with our belief that health is a human right. We saw that most health centers were willing to treat trans patients, but lacked the resources to treat trans patients. And we wanted to fill this gap in health care.
We offer comprehensive medical care; immunizations; chronic disease management; disease prevention; initiation and maintenance with hormone therapy. We provide mental health assessment and short-term psychotherapy, substance abuse and use treatment counseling, support groups, wellness-oriented psychoeducational workshops. We do targeted outreach to identify high-risk transgender individuals and their partners. We do sensitivity trainings for agencies and community partners that serve the Asian Pacific Islander community, and communities of color in general.
We have use of the agency's referral system for services that aren't provided here at APICHA, particularly for patients requiring long-term mental health and substance abuse services. So we have an internal referral system. Many of the practitioners and providers that we refer to have been vetted, so we know that they have a longstanding commitment to working in the community, and are not just curious about working with this population.
My experience has been, I'll call a mental health provider and ask if they provide mental health to the trans population and they'll say, "Oh, of course," But it's more like, "This is fun and exciting." And then when I get into a longer conversation I find out that they've not worked with very many trans people. So that wouldn't be a place that I would necessarily send somebody.
Right now we're not offering gender reassignment surgery, or long-term mental health or substance abuse services. But we're really looking forward to being able to provide some of these services in the near future.
Olivia Ford: I want to open the floor up to all three of you to talk about any other programs you know of that are addressing the barriers to care for trans folks that we've been discussing throughout this conversation.
Danielle Castro: I work at the Center of Excellence for Transgender Health, and we're looking at addressing the barriers that exist. One of our projects is the Primary Care Protocols Project. We convened a medical advisory board that were individuals that not only have knowledge of trans community and cultural competency, but have provided services for trans people for many years.
We brought them together and they developed what we call the Primary Care Protocol for Transgender Patient Care. It's a first-of-its-kind document. Primary care providers, any health care provider, can go onto our website, look at this guidance and read about how to properly care for trans people. It covers a variety of issues. That's a really groundbreaking, important resource.
We also have on our website for the Primary Care Protocol a one-pager that individuals can download -- trans people that are looking for health care can just give this piece of paper to a doctor and say, "Educate yourself." Again, 50 percent of the respondents to this NCTE study reported that they had to educate their health care providers. I think this is a really good way to help alleviate that.
Also, I work on a national level on a U.S. Centers for Disease Control-funded, first-of-its-kind trans community mobilization project called Coalitions in Action for Transgender Community Health (CATCH). The main focus of the project is to increase access to health care and HIV prevention services for trans people.
I work with communities that are interested in creating coalitions to meet that goal, and walk them through a process and support their efforts around doing federal needs assessments and coming up with strategies on how to address those needs.
There is some momentum.
Devarah "Dee" Borrego: Here in Boston, the clinic where I actually receive my primary care is a specialized clinic that cares for the needs of the LGBT youth community between ages 12 and 29. It's called the Sidney Borum Jr. Health Center. It's a program of Fenway Health, which is another major health organization -- a national leader on health issues affecting trans people, and people with HIV.
At the Borum, which is the clinic I go to right now, they've always provided me with a very high level of transgender competent care. They make access to hormones a really straightforward process. They're wonderful around keeping records in the ways that we've described here: Only documents where it's legally required to use legal name and pronouns contain them. The support staff is well trained. That's a program here in Boston that I'm a big fan of, personally.
Olivia Ford: Danielle, from your perspective, working as you do on a national level: Are there any efforts afoot to engage providers who don't themselves see the importance of being trained in awareness of the needs of their trans clients?
Danielle Castro: Well, you can take a horse to water, but you can't make it drink! But I find that with a lot of health care providers, their motivation behind not wanting to provide services to trans people is that they think it's so difficult and that they need a lot of different resources, like financial resources, to help work with trans people.
But once providers understand that it doesn't take rocket science to work with trans people -- it's just like working with any person, just really understanding what the presenting issues are, etc. -- though of course, there are some specific issues that primary care providers must be aware of.
As part of the community mobilization model that I'm working on, CATCH, we do go out and work with different health care providers. What's been happening in some cases is that state health departments are the ones that are interested in the community mobilization model -- along with community members, of course. But having the buy-in from the local health departments and state health departments provides leverage. Health care providers coming from throughout the state or throughout the city then becomes more like a necessary thing, if they're actually being funded by the health department. The health department can require them to be trained. That's been working out well; and like I said, it's happening all over the country.
We also deliver a training called Best Practices for Transgender HIV Prevention. We've been trying to create coalitions so health care providers do have an opportunity to understand how to work with trans populations around HIV prevention and care.
We are not only working on a national level; we're actually working on an international level now. The Primary Care Protocols are going to be adapted through our international work for international populations.
Our thinking behind the Primary Care Protocols was not just to develop a living body of work that could be referenced; we actually are interested in working with health care providers that want to integrate trans people into their practice and provide services. We've been trying to identify funding to be able to do that. But in the interim, we're just working with providers that are interested, you know, kind of offline.
But I'm hopeful. We're also interested in adapting the Primary Care Protocols to be an online training, a Webinar type of training, for health care professionals.
Tei Okamoto: To add to what Danielle said: While trainings are useful, and educating, we should also think beyond them and think about getting health care providers interested in trans health, specifically -- looking at something like the Mazzoni Center in Philadelphia. This past May, for example, they offered the first annual Transgender Education Certificate course, which is a three-day intensive continuing medical education activity for medical providers. It's hosted by the Trans Medicine Education Initiative. It's designed for new, as well as experienced, medical providers interested in providing primary care to adult and pediatric transgender patients. In this way, Mazzoni Center has really tried to formalize proper and excellent health care for trans people.
Danielle Castro: There are other organizations that are really working for this cause. And there are various conferences throughout the world, and in this country. The Transgender Law Center has the Transgender Health Care Access Project (HCAP). They've been working with health care agencies throughout the State of California to help them really open their doors to trans people. There is a lot of fantastic work going on around the country around this issue.
There's the World Professional Association for Transgender Health. And they have guidance for working with trans people, as well. They are more like guidelines; it's not really a protocol. There are definitely steps being taken in the right direction.
This transcript has been edited for clarity.
Olivia Ford is the community manager for TheBody.com and TheBodyPRO.com.
This article originally appeared in TheBody.com's Pride 2012 special section.
Copyright © 2012 Remedy Health Media, LLC. All rights reserved.
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