Building Systems of Care for Trans Health

People of transgender and gender non-conforming experience often face widespread discrimination and misunderstanding from health care providers. In 2011, the National Gay and Lesbian Task Force and the National Center for Transgender Equality reported that transgender and gender non-conforming people faced injustice “at every turn,” including stigma and maltreatment in childhood homes, bullying and discrimination within the same school systems that promised to shelter and educate, discrimination and unlawful termination in the workplace, at the grocery store, at hotel front desks, in doctors’ offices and emergency rooms, before judges, by landlords, police officers, health care workers, and other service providers. These reports of widespread injustice are further supported by high ongoing rates of attempted suicide (41 percent), public harassment and abuse (53 percent), and extreme poverty (Grant, Mottet, & Tanis, 2011):

 For more on this topic, take a listen to Ms. Rapues’s and Dr. Pardo’s webinar here. You can find the slides here.

• Trans people are nearly four times more likely to have a household incomes of less than $10,000 per year compared to the general population
• As many as 19 percent report homelessness
• 28 percent have postponed needed medical care due to discrimination

Moreover, San Francisco has an estimated HIV prevalence rate of 39.5 percent primarily concentrated among transgender women of color. These numbers make clear that persons of transgender-lived experiences lack safe access to basic needs including housing, safety, primary and preventive healthcare, which may account for a great deal of the poor health outcomes and inequities within the transgender community.

Transgender health and HIV prevention is more than a public health priority: it contributes to broader trans social justice and human rights issues. HIV disproportionately affects trans communities and over the last three decades, the public heath sector has moved towards addressing this disparity. There is a growing evidence base on trans HIV prevention needs, priorities, and best practices. Social media and other popular media outlets have enhanced the visibility of trans people and current trans social movements. For example, online and open access publications including those mentioned herein have increased awareness among health care professionals about the growing social disparities among trans women of color. Trans community advocates and public health champions are now looking beyond the HIV framework to examine trans health within the broader healthcare landscape. Trans Health is now reaching beyond the WPATH Standards of Care[1] to now include integrated systems of care that aim to meet the needs of the whole person and not just their gender identity.

[bctt tweet=”Transgender health and HIV prevention is more than a public health priority.”]

Steps to Integrating Trans Health into Service Delivery

Building capacity for fully integrated Trans Healthcare Services requires a coordinated effort between health departments, hospitals, community based organizations, and the community members themselves. Collaboratively, key stakeholders from these groups develop (or change) policies to improve the way we count and report trans people in our data systems. Building capacity for Trans Health also requires improvements to our Electronic Health Records (EHR) systems to better track improvements (or other changes) in patient care. It requires broadening access to workforce trainings on cultural humility and cultural competence when working with transgender clients/patients. Finally, it requires interdisciplinary partnerships within the health department to maximize the collective impact of our collaborations despite limited funding, personnel, and resource constraints.

[bctt tweet=”Building capacity for integrated Trans Healthcare Services requires a coordinated effort.”]

There’s a lot to be taken into account and we will go into more detail on the different aspects of trans health and HIV prevention in an upcoming webinar. We’ll highlight best practices from San Francisco’s transgender HIV prevention efforts and other Trans Health Initiatives and explore transgender health priorities and issues through a trans health lens.

As Trans Health continues to advance as a movement and as a named initiative, we are learning that health equality is not the end game in and of itself. It is becoming increasingly clear that systems coordination, transgender responsiveness policies, increasing provider and staff competencies, and best practices that reduce stigma and inequality can collectively have a more positive impact on health.

[bctt tweet=”Health equality is not the end game in and of itself.”]

The webinar will take place on June 18, 2015 at 11 am PST.

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Notes:

[1] A set of protocols outlining the usual treatment for individuals who wish to undergo hormonal or surgical transition to the other sex.