Title: Welcome to the Acci
1Welcome to the Acción Mutua web-seminarUnderstan
ding Transgender Latinas and other Transgender
Women of Color and their HIV Concerns
- Presentation by seminar speaker (approx. 40 min.)
- Followed by question and answer session (approx.
20 min.)
- Please press 6 on your telephone keypad to mute
your telephone line (to un-mute your line, press
6 again) - If you are experiencing difficulty with your
phone connection, dial 0 for the conferencing
service operator - Questions submitted prior to the web-seminar will
be addressed first during the QA - For questions that arise during the presentation,
click on the hand button and type your question
or wait to be called on to ask your question over
the phone during the QA
2- Acción Mutua is a capacity building assistance
(CBA) program of AIDS Project Los Angeles in
collaboration with the César E. Chávez Institute
of San Francisco State University - Funded by the Centers for Disease Control and
Prevention
3Understanding Transgender Latinas and other
Transgender Women of Color and their HIV Concerns
Presented by JoAnne Keatley, MSW Pacific AIDS
Education Training Center University of
California, San Francisco
4(No Transcript)
5Todays Web-Seminar Objectives
- Understand the impact of bias on the healthcare
experiences and choices of transgender
populations - Identify ways to design and deliver
gender-appropriate and culturally competent
services for transgender clients - Discuss strategies for effective outreach to and
engagement of the transgender population
6Transgender?
- When you hear the term transgender who/what
comes to mind? - What do you know about transgender people?
- What types of contact have you had with
transgender people? - What more do you want to know about transgender
people?
7Gender Sex
traditional woman
traditional
man
8Gender Sex
- Binary Gender System The societal division of
human beings into two, distinct categories of
male and female. - Chromosomes Genetic material that carry the
genes that determine height, eye color, etc. Two
of them are related to biological sex. XX and XY. - Intersex Can include individuals who are born
with genes other than XX or XY may have
ambiguous genitalia. ISNA 1 in 2000 people
have some form of an Intersex condition
9Gender Sex
- Biological Sex. The sex assigned at birth
typically based on examination of the genitals. - Gender Identity Self-image or belief a person
has about their gender as being female, male, or
something altogether different. - Sexual Orientation The internal experience that
determines who we are physically and/or
emotionally attracted to.
10Transgender People
- May undergo surgical and/or hormonal treatment to
change their physical appearance and/or gender
expression. - Often adopt a new name and lifestyle to reflect
their gender identity. -
- Are sexually diverse, important not to make
assumptions.
11Epidemiology
- Rates of HIV infection estimates
- 13 68 for transgender women
- 2 3 for transgender men
- Rates are higher for transgender people who are
- Male to Female
- Of Color
- Engage in sex work
- Use injection drugs
12Gender-Specific of HIV/AIDS Cases Younger than
30
Race/Ethnicity Male Female
Transgender
HIV AIDS HIV AIDS HIV AIDS
African American 26.8 15.5 32.1 19.7 37.2 17.8
Asian/PI 30.9 16.1 42.1 22.3 52.4 31.9
Hispanic/Latino 40.0 23.0 47.9 29.6 52.0 31.0
Native American 34.5 21.9 35.6 24.1 28.6 N/A
White 21.6 12.2 32.9 20.7 32.7 18.4
Includes only HIV cases reported via non-name
code Mathew Facer, Epidemiologic Studies Section,
California Office of AIDS
13 HIV Risk Behaviors among MTF Transgenders of
Color Tooru Nemoto, PhD., Principal
Investigator Don Operario, PhD. Research
Associate JoAnne Keatley, MSW, Project
Director Center for AIDS Prevention Studies,
UCSF Supported by National Institute on Drug
Abuse (NIDA) (Grant No ROI DA11589-05)
14- We examined HIV-related risk behaviors among
samples of African American, Latina, and Asian
Pacific Islander transgenders in San Francisco. - In our study we focused on specific HIV-risk
behaviors such as - Sexual Behaviors primary, casual, and
commercial - Health Outcomes HIV/STD, depression, need and
access to care - Substance Use (lifetime, past 30 days),
injection drug use, engaged in sex with primary,
casual, or commercial partners while under the
influence of any illicit drugs - Psychosocial Factors transphobia, depression,
self-esteem, gender identity, social support
15Table 1. Demographics by Ethnicity
Total (n332) N () Afri.Am. (n112) N () Latina (n110) N () API (n110) N ()
Income source(s) in past 6 months Full time job Prostitution Income in past 30 days () 0-499 500-999 1,000-1,999 2,000 (and above) 92 (28) 170 (51) 64 (20) 110 (34) 70 (21) 84 (26) 18 (16) 56 (50) 15 (13) 51 (46) 31 (28) 15 (13) 24 (22) 79 (72) 36 (33) 35 (32) 15 (14) 22 (20) 50 (45) 35 (32) 13 (12) 24 (22) 24 (22) 47 (44)
16Table 2. HIV/STD by Ethnicity
Total (n332) N () Afri. Am. (n112) N () Latina (n110) N () API (n110) N ()
HIV Positive Status 86 (26) 47 (41) 25 (23) 14 (13)
Any STD, past 12 months 46 (14) 20 (18) 21 (19) 5 (4)
17Major Findings
- About three-quarters of the participants had
recently engaged in receptive anal sex. - A significantly higher proportion (47)had
recently engaged in URAS with primary partners
than with casual (26) and commercial partners
(12). - Current URAS with primary and casual partners,
but not commercial partners, was significantly
and independently correlated with having had sex
under the influence - HIV positive participants were 3.8 times more
likely to engage in receptive anal sex as well as
URAS with casual partners than HIV negative
participants, controlling for other variables. -
18- Major Findings, continued
- Although only 12 had reported URAS with
commercial partners in the past 30 days, this
risk behavior was significantly and independently
correlated with African American race (4.5 times
more compared with non-African Americans) and
lowest income level (less than 500 of monthly
income). - Nemoto T, Operario D, Keatley J, Han L, Soma T.
(2004). HIV Risk Behaviors Among Male-to-Female
Transgender Persons of Color in San Francisco.
American Journal of Public Health, Vol.94, No.7,
1193-1199
19Barriers to Service
- Lack of information on risk for trans people
- Misinformation within trans community
- Low perception of risks
- Data collection has ignored various trans
identities. - Prevalence drives funding and programs
- FTM incidence not well understood or explored
- TG women continue to be counted in MSM category
for funding and prevention programs
20Barriers to Care Providers
- Lack of knowledge and information
- Personal discomfort
- Lack of clinical research, literature
- Lack of agency support
- Not enough people doing the work
- Religious/Moral concerns
21Barriers to Care Clients
- Fear of disclosure/exposure
- Social and geographic isolation
- History of bad experiences with care providers
- Intake forms, office environment, alienating
process - Lack of insurance coverage
- Trans-related care is often explicitly denied in
insurance policies.
22HIV and Hormones
- There are no significant drug interactions with
drugs used to treat HIV. - Several HIV medications change the levels of
estrogens. - Cross gender hormone therapy is not
contraindicated in HIV disease at any stage. - Transgender patients need ongoing care, not just
access to hormones.
23Suggestions for Making Your Agency Trans Affirming
- Dont just add a T, implement non
discriminatory policies and procedures. - Provide training for all staff front office,
managers, security guards, counselors, outreach
staff - Make intake forms trans inclusive
- include preferred name not just legal name
- include more gender choices
- Challenge transphobiain staff and community
- Have trans-inclusive imagery in waiting room
- Use inclusive or gender neutral language
- Create safe bathroom policies!
- Hire Transgender people!!!!!!!!!!!
24Costura y Charla (Spanish-language
Sewing/Support Group)
- Support group and skills-building class for
Spanish Speaking transgender women - Facilitated by Transgender Health Educators and a
Consultant -
25Costura y Charla continued
- During support sessions, participants received
training in pattern making, design, cutting
fabric, sewing clothes and alterations. - HIV/AIDS prevention, relationships with family,
friends and lovers as well as other issues that
effect the Latino transgender community. - Skill building as well as emotional support in a
culturally appropriate environment -
26Costura y Charla
27Costura y Charla
28Costura y Charla
29 Thank You! Comments Discussion
30- JoAnne Keatley, MSW
- Joanne.keatley_at_ucsf.edu
- 415.597.4960
- For more information on how to receive CBA
services please contact - Acción Mutua (Western region Latino CBA
provider) - 213.201.1345 or www.accionmutua.org
- Transitions (nation-wide transgender CBA
provider) - j.sevelius_at_ucsf.edu
- www.caps.ucsf.edu/projects/Transitions/