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Transgender Health, HIV Prevention and Treatment Intersect at San Francisco's TRANS: THRIVE

June 16, 2015

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When the Philadelphia Trans-Health Conference (PTHC) convened in early June, it kicked off several days of workshops and symposiums focused on one thing: the health care needs -- and experiences -- of transgender individuals. Organized by the Philadelphia-based LGBTQ health care organization Mazzoni Center, the PTHC meets annually to "educate and empower trans* individuals on issues of health and well-being" as well as to "educate and inform allies and health service providers." Started 14 years ago, the conference is now one of the preeminent gatherings of professionals, activists and transgender individuals in the nation, all networking, communicating and sharing insight on issues unique to the transgender experience.

One of those issues is, of course, HIV treatment and prevention. After all, the U.S. Centers for Disease Control and Prevention reports that, in some countries, HIV prevalence in "transgender women [is] nearly 50 times as high as for other adults of reproductive age." In the U.S., various socioeconomic factors come into play, with amfAR reporting that "HIV prevalence is more than three times higher among black MtF trans people than among white or Latina MtF trans people."

There's a clear symbiotic relationship between marginalized communities and trauma or risk behaviors as well.

One study conducted in New York City between 2007 and 2011 found that "among newly diagnosed people, 51% of transgender women had documentation in their medical records of substance use, commercial sex work, homelessness, incarceration, and/or sexual abuse as compared with 31% of other people who were not transgender."

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In other words, America's transgender population, particularly its transgender people of color population, is at acute risk of acquiring HIV. With that in mind, organizations like San Francisco's TRANS: THRIVE are working diligently to reach the populations that many traditional organizations aren't.

TRANS: THRIVE stands for Transgender Resource and Neighborhood Space: Transgender Health & Resource Initiative for Vital Empowerment, and based upon the presentation at the Trans Health Conference by Nikki Calma, Sabina Simmons, Niko Kowell and Denmark Diaz, it seems that's exactly what TRANS: THRIVE is about.

Calma, affectionately called Tita Aida, is TRANS: THRIVE's program supervisor.

"We started out as a research project focused on substance abuse and HIV prevention," Calma explains. Over the course of several years, eventually the program found itself under the umbrella of the Asian & Pacific Islander (API) Wellness Center. Early on, "a lot of the [program's] funding came from HIV prevention dollars," Calma says. "It was the only way to get some solid funding to start really good programs. Nowadays we have different funding sources that we can access from foundations to the city."

Today, TRANS: THRIVE has four staff members and functions as a program and drop-in center with volunteers and peer leaders, fostering synergy between transgender individuals, activists and professionals.

"We see a lot of trans people of color, trans people living with or at risk for HIV, trans people with substance abuse issues, homeless and marginally housed trans people," says Kowell, the center's health promotion coordinator. Some of TRANS: THRIVE's programs include support groups and needle exchange programs, both for hormone treatments and intravenous drugs. "We generally have a very holistic model," Kowell goes on to say. "We look at all the things going on for people, not just their HIV risk. If somebody doesn't have stable housing, that puts them at greater risk."

Holistic is the right word, too. Kowell, for instance, isn't merely a programming professional: He also moonlights as a chef for program attendees.

"We have 'Folks Who Feast' where Chef Niko will cook a fabulous meal for everyone," Calma explains, touching on one of the many niche programs TRANS: THRIVE offers as part of its overall model. Folks Who Feast "is the most attended group," Calma laughs as she continues to explain about a few of the other programs offered by the center.

"Tranzotica is our people of color group, they have a circle group that everyone just checks-in, everyone listens, nobody judges. Candy Shop serves trans youth of color ages 14-28. This is what our week looks like. It's pretty busy."

Part of TRANS: THRIVE's busy week includes fast-tracking individuals toward HIV prevention and treatment services.

"TransAccess is an open access medical clinic serving trans women of color living with HIV," states Simmons. Simmons is a senior case manager with the API Wellness Center. "We provide wrap-around support services with an emphasis on peer navigation." A key emphasis of the programming there involves individuals who aren't being reached by other organizations.

"One of the amazing things that happened with TransAccess is that we were able to identify some of the folks who fell out of the medical system because they experienced something really horrible," adds Calma, "with their doctor or even the environment, like mis-gendering. We all know that that's one way a client will leave, and we've identified most of them and they're back in care! That's the beauty of the program."

"Approximately two out of three clients are homeless at time of presentation," Simmons states. "Mental illness, survival sex work, and substance use as a coping mechanism affect the vast majority of our primary care clientele. At this time, we have approximately 50 clients enrolled in our project who are receiving comprehensive case management services."

Of those clients, Simmons says that nearly "78 percent of them receive their primary and HIV care on-site." There's a difference between what they do and what other organizations do, though.

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