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

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."

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.

"The special thing about our clinic is that we're small," says Simmons. "Within this small environment, we are creating an element of safety. When people come, it's not like your typical clinic. You can come in, get snacks. There are plenty of staff on-site to provide love, comfort, and support as clients are waiting to see our physician. It's a nice, comforting place to come to."

That focus on comfort and humanity makes a difference in HIV treatment, too.

"Out of all the clients that are retained in our care, approximately 66 percent have an undetectable or low viral load," Simmons reports. Their comprehensive approach toward HIV includes prevention as well.

"In January, we had Trans Sex Month," says Kowell. "We talked one-on-one about PrEP [pre-exposure prophylaxis], because there's not a lot of information out there about how PrEP works for trans folks." Kowell touches on the fact that PrEP is incredibly effective at preventing HIV but that it, of course, doesn't prevent other sexually transmitted infections or, as is relevant to some, pregnancy. "PrEP is a really great tool, but people need to know how to use it," Kowell explains.

Those candid discussions are integral parts of the comprehensive work being done at TRANS: THRIVE, work that doesn't just treat or prevent HIV, but also improves overall well-being. Of course, part of well-being includes sexual expression.

"Six years ago, I was brought on as a consultant to form a program for trans men who have sex with men," Kowell touches on his start at TRANS: THRIVE. "The program is in collaboration with a local men's sex club, which is known to be really trans friendly. It's in the Castro!" Kowell goes on to say that while the program's focus is HIV prevention, they're "really trying to help educate people about trans men's sexual risks. We do outreach events, we go to the Folsom Street Fair and have a booth. We go to areas that are very gay male centered, and we try to stake out space for ourselves!"

Then there's Transform SF, "a new HIV testing initiative catering to MtF transgender community members, but that's inclusive of all trans people," adds Diaz, a health promotion specialist also at API Wellness Center. "We try to incorporate HIV testing in every single program we do. We coordinate with our testing team to make sure that testing occurs during workshops."

Diaz says that the convenience of accessing HIV testing alongside other programs is vital.

"We work alongside our wellness clinic to make sure that folks who do test HIV positive get the care they need," he says, touting the fact that testing occurs off-site at various community events throughout the year, too. "It becomes a very streamlined process so there's no gaps in services. They're linked to care immediately."

Above all else, Calma says, TRANS: THRIVE strives to simply be present for community members. "We can provide a meal, Lava Mae provides mobile shower units."

In other words, many of the programs help folks take care of themselves today so they can begin to envision a tomorrow.

"I did sex work when I was the hottest little thing on the corner," muses Calma. "It never came into my mind that I would 40, 45. I was forever 21!" Building that future for individuals is integral to the community's overall future. And, it all starts with programming.

"There are a lot of things involved with running a drop-in," Calma goes on to explain. "You've got to have community agreements. You've got people with different, colorful personalities coming in! Every day is a new day at TRANS: THRIVE! It's like a soap opera, and you never know what the script will be!"

More often than not, though, people come to TRANS: THRIVE, Calma says, and find "someone to listen to them, someone to talk to them."

Josh Kruger is an award-winning writer and commentator in Philadelphia. His work often focuses on HIV/AIDS, cultural stigmas and social problems. You can follow him on Twitter @jawshkruger.