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Providing Care to Transgender People

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Providing Care to Transgender People A JOURNAL ON HIV PREVENTION, TREATMENT AND POLITICS VOLUME 9, NO. 1 acHIeVe INSIDE HACKING TRANS- GENDER HEALTH CARE 4 Going to the doctor is stressful, but as a transgender person it can be downright terrifying. BEYOND THE BINARY 6 People who exist outside of the gender binary of male/female make up a growing part of the population. Personal Perspective: MY TEAM SAVED MY LIFE 8 Providing Care to TRANS YOUTH: AC- CESS AND EQUITY Transgender People IN HEALTH CARE 10 There is limited infor- mation on how to educate younger trans folk on navigating the system. by Finn Brigham A large part of the problem begins with healthcare training. Few medi- Personal Perspective: WE FOUGHT ne of the most common reasons cal professionals are offered any kind FOR THEIR FREEDOM 14 that Transgender and Gender of LGBT training in medical or nursing Non-Binary (TGNB) people do school and for those that are, it is usually MORE THAN A RISK GROUP 16 O not have access to healthcare is a short session focused on the HIV risk of HIV in that they simply cannot find a competent gay men. Even well-intentioned provid- Transgender Sex provider. TGNB people living outside ers who want to provide competent care Workers’ Lives of large U.S. cities are unlikely to have a don’t know how to get the information TGNB-competent healthcare provider they need. TGNC OLDER within a four-hour drive, and those who All of this can lead to poorer health ADULTS WITH do often find that those providers are too outcomes, especially when coupled with HIV 19 booked to accept new patients. other barriers to health. TGNB people are Providers can According to a 2009 Lambda Legal more likely to live in poverty, more likely play a critical study, 89% of TGNB people reported to experience homelessness, and less likely role in reducing there were not enough health profession- to be employed and insured than their the barriers TGNC older adults face. als adequately trained to care for people cisgender (non-transgender) counter- who are TGNB, 73% reported that they parts. They also experience higher rates of EDITORIAL 23 feared medical personnel would treat tobacco use, substance use, depression, and them differently, and 51% said they anxiety. Tragically, suicide rates among feared they would be refused care based TGNB people are substantially higher Achieve is a publication of on their TGNB status. In addition, 26% than among cisgender people (studies of respondents said they had been refused have found that 41% of TGNB people have care based on their TGNB status. continued on next page fit into the gendered structure of care that Providing Care cont. from first page they experience. For example, TGNB men seeking GYN care in a female-focused acHIeVe attempted suicide). These social determi- clinic can face extraordinary problems, nants of health affect everyone, but are and finding providers who can provide made worse by the fact that TGNB people post-surgical GYN care for transwomen EDITOR IN CHIEF who can access healthcare are rarely able can be like finding a needle in a haystack. Kelsey Louie to find a competent provider. Additionally, TGNB women seeking anal or prostate care can cause great distress EDITOR Specific Needs for both the patient and the provider. It’s Mark Milano Most healthcare for TGNB people is important to consider that some TGNB ASSOCIATE EDITOR exactly the same as care for cisgender people may use alternative language to Joseph Lunievicz people – there is no difference when car- name or describe their body parts, so it’s ing for strep throat or a broken bone, for PUBLICATIONS MANAGER good practice to ask them what terminol- example. The difference is the barriers Mark Milano ogy they prefer. For example, using terms that TGNB people face in getting these like “chest exam” rather than “breast PUBLICATIONS ASSOCIATE things treated. But there are some specific exam” can be helpful for transgender men Laura Engle healthcare needs for TGNB people that all who have not had top surgery. Any pro- providers should be aware of. vider working in sexual health needs to be Hormones: Many TGNB people (but aware of the healthcare issues that TGNB not all) choose to take hormones to better people face and how best to serve them. align their physical body with their gen- For information on how to der identity. It is important for medical obtain bulk copies of Achieve, providers to educate their patients about Some TGNB people call 212-367-1077, email the risks and benefits of hormones so they use alternative [email protected], or write to: are clear on the likely effects. Gender-Affirming Surgeries: There Achieve are many different surgeries TGNB peo- language to ACRIA @ GMHC ple can get to better align their physical describe their body 307 W. 38th St. bodies with their gender identities. In New York, NY 10018-9502 addition, many states (including New parts, so it’s good York) now require insurance companies to cover these surgeries, making them practice to ask Copyright © 2018 ACRIA and more accessible than ever. Providers GMHC should be aware of the different types of them what they All rights reserved. Non- surgeries that are available, be knowl- prefer. commercial reproduction is encour- edgeable about diagnosis and the CPT aged provided appropriate credit codes used in billing, and have a referral is given. Subscription lists are kept system in place. HIV confidential. Insurance companies will often HIV is another large issue in the TGNB Individuals pictured are models and require patients to obtain letters from their community. Around a quarter of TGNB are use for illustrative purposes medical and behavioral health providers to women are living with HIV, and 56% of only. Photos used in Achieve imply obtain these surgeries. Providers should be black/African American TGNB women nothing about the health status, well versed on how to write these letters. have HIV. In addition, TGNB people sexual orientation, or life history of Depending on the insurance company, are 49 times more at risk of HIV than the models. various information must be included in the general population. It’s also impor- the letters, such as the length of time the tant to be aware of whom we are talking Every “Personal Perspective” in person has been in care, the length of time about when we talk about TGNB people Achieve contains the views and they have been on hormones, information and their higher HIV risk. Oftentimes, opinions of the attributed author on contraindications, etc. Health care transmen and transmasculine people are and does not necessarily represent providers (including behavioral health not considered in the research and media the views and opinions of ACRIA. care providers) should create templates for around HIV risk, treatment, and preven- these letters that can be altered based on tion. Due to the reasons discussed earlier, many TGNB people are hesitant to engage ISSN 1948-0687 (print) each patient and the requirements of their in medical care out of fear of discrimina- ISSN 2165-4883 (online) insurance plan. Sexual Health: When TGNB people tion. This can affect their HIV testing, seek sexual healthcare, they often do not treatment, and adherence. 2 VOL. 9, NO. 1 acHIeVe It is important to understand the unique way transgender people experi- ence HIV risk and infection in order to treat them competently. For example, although HIV among TGNB women is often spread by unprotected sex, that risk factor cannot be lumped in with gay male sex. Most HIV prevention funding is focused on gay men, and the few inter- ventions for transgender women have rarely involved transwomen in their cre- ation or implementation. We cannot use the lens of gay men when trying to stop HIV in TGNB women. Many TGNB people prioritize their TGNB healthcare over their HIV care. They may be concerned that HIV meds will interfere with their hormones, or that providers will not prescribe hormones if they are HIV positive. There are no con- firmed interactions between hormone therapy and first-line HIV meds. Providing Competent Care There are many easy steps a healthcare agency can take. Most HIV prevention funding is focused 1. Hire TGNB people! Having TGNB- identified people on staff, on your on gay men, and the few interventions board, and on your community advi- sory board are great ways to ensure for transgender women have rarely that trans issues are being addressed on a day- to-day basis. involved transwomen in their creation or 2. Check your antidiscrimination policy to ensure it includes gender identity and implementation. expression. If it doesn’t, update it. Post this nondiscrimination policy around your clinic so patients care see it. whether they are perceived as trans. All this means the medical commu- 3. Update your intake form to ensure it 6. Get educated. There are many TGNB nity is going to have to do better when it includes multiple options for gender health conferences that take place comes to serving the transgender com- (male, female, TGNB, genderqueer, around the country and the globe. munity. We need more providers who other). It should also include space Send staff members to gain new infor- are better trained in this type of care. for chosen name, legal name, and mation. Have an LGBT-focused health We need more insurance companies that preferred pronoun. All of this infor- center (such as Callen-Lorde or Fenway understand our needs and work with us mation should be recorded in your Health) provide on-site training to your around our unique care needs. We need electronic medical record, and staff staff.
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