Transgender Issues for Health Care Providers

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Transgender Issues for Health Care Providers
Mona Bernstein, MPH Deputy Director, Pacific AETC

• Ryan White Care Act Grantee Conference
• August 29, 2006

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Overview

• Transgender Training of Trainers Project Pacific
  AIDS Education and Training Center
• PAETC TG Curriculum
• Exercise

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Key Issues

• Transgender and gender non-conforming people are
  significantly impacted by HIV/AIDS
• Seroprevalance rates among transwomen in urban
  areas range from 22 63
• Poverty, homelessness, substance use, high STD
  rates also severely impact trans community
• Clinicians lack accurate, relevant information

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Barriers to Care and Treatment

• Not enough people doing the work
• Extensive negative experiences with health care
  (judgmental, patronizing and humiliating
  treatment that medicalizes and pathologizes)
• In-take forms, office environment, alienating
  process
• Insurance issues and long waiting lists

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Provider Issues

• Experience with a range of transgender
  expressions, but lacked information on
  populations, terminology, differences
• Desire to treat TG patients respectfully, but
  admitted discomfort and lack of resources
• Lack of research
• Time constraints create barriers to building trust

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PAETC Transgender Project Goals

• To meet the growing need for sensitive,
  accessible care for trans-infected people
• To meet the growing need to train
  clinicians/agencies to provide that care

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Project Description

• Train-the-trainer program with teams of AETC
  faculty and transgender trainers
• TOT included content and training skills
• Teams from local sites in California, Arizona and
  Hawaii
• Year 1 TOT 2.5 days (content, platform skills,
  adult learning theory)
• Year 2 TOT 2 days (more content, program
  planning skills)

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Year 1

• Picture here

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Year 1 Comments

• I as a transgender needed this training. Because
  everything I heard will help me to empower my
  sisters and brothers. Everything was great.
• I am most impressed by the success of this
  model. I was somewhat skeptical of the potential
  to ask experienced trainers/academics to
  collaborate with people previously unknown to
  them who have less experienceespecially given
  that in most groups the transgender person was
  the less experienced trainer. I was encouraged to
  see that the transgender trainer took the lead in
  some of the groups.

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Cross-cultural Communication

• We need more information on the culture of the
  medical professional field to help trans trainers
  get the message across more effectively for
  better reception.

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Transgender Trainers

• Concerns of tokenism
• Difficulty of topic and revealing personal
  information
• Co-trainers need trusting relationship

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Year 2 TOT

• Picture here

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Recognize Range of Expressions and Desires

• Many words to identify gender-variance,
  including
• MTF, FTM, transman, transwoman, bi-gendered,
  gender-blender, phallic woman, passing man,
  she-male, femme queen, non-op, boi, two-spirit,
  new man, new woman, etc.
• Terms
• Transgender, Transexual
• FTM, Transman
• MTF, Transwoman
• Pre-op, post-op, non-op
• Intersex

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Sensitive Care

• Dont just add T
• Train all staff- receptionists, security guards,
  director
• Make in-take forms trans friendly, i.e. include
  chosen name include transgender and M/F
• Dont make assumptions about sexuality or goals
• Respect confidentiality and choices
• Honor presenting gender and self-diagnosis
• Challenge transphobia
• Unisex bathrooms when possible

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Dr. Lori Kohlers summary

• All trans people are medically underserved
• Hormone treatment is not optional it is primary
  care
• HIV providers have the opportunity to improve
  medical care for trans people
• While there are many unanswered questions about
  long-term effects, benefits of hormones outweigh
  the risks for most patients.

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Lessons Learned

• Inclusion of transgender co-trainer was one of
  the strongest elements, creating an authentic and
  powerful experience
• Word of mouth was an effective marketing tool
• Hard to respond to turnover among transgender
  co-trainers
• Commitment to training model is challenging

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Accomplishments

• 35 trainings presented by local sites in 3 states
• Listserve to maintain communication among
  trainers
• Local sites integrated information on transgender
  issues into clinical training and other cultural
  competency training
• Standardized curriculum

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Recommendations

• Need more programs to increase awareness of
  transgender issues and competency among HIV
  clinicians to provide sensitive care
• This model builds the capacity of organizations
  to address the growing need
• Inclusion of transgender trainers is critical to
  success of training