A regular discussion of efficacy in HIV programming is the distinction between “quality” vs “quantity” metrics of “success.” Personally, I find this distinction to be short sighted and even harmful. Then again, I’m a transgender man that witnesses the word-of-mouth requests for referrals within this highly marginalized community. These requests most often occur after a trans or gender non-conforming person has run into an issue with their current provider or a person in the provider’s office, be it staff or other clients. “Quality” of service directly impacts patient retention and health outcomes; otherwise often considered “quantity” metrics of success.
Those issues can include being called the wrong name, verbal or physical harassment, and having to inform your own medical provider about your specific health care needs.[1] We go to our doctors because they’re supposed to be safe, they’re supposed to know things we don’t know. And these “issues” aren’t isolated to medical providers, transgender people often face unconscious bias or harassment when seeking assistance and social services, again from our peers and from staff.[2]
Some of these issues were recently outlined in an infographic published by the ADAP Advocacy Association. Download the infographic.
When we can’t trust our providers, our case managers as our advocates, or the environment in which we’re supposed to engage them to be safe, we will opt for our own immediate safety over our long(er) term health needs. This is a large part of why those community based, word-of-mouth referrals mean so much to transgender communities: we need to feel and be safe in a world that is often threatening and dangerous.
The World Professional Association for Transgender Health (WPATH) has worked consistently and continuously to create a guideline for providers in transgender care to combat the barriers clients face, updating standards regularly to be more culturally competent. However, that doesn’t provide information to clients on where to go that is safe. That lack of centralized, reliable information is part of why RAD Remedy began building a community based referral database.
With transgender people experiencing lack of legal protections in employment, housing, and medical care and transgender women facing an HIV prevalence rate almost 50 TIMES higher than the general population,[3] the combined situation of lack of resources and heightened risk creates an environment of critical necessity of trans competency among HIV service providers.
Despite the focus on received medical care in these statistics, our social workers are our greatest allies and advocates in seeking the help we need, when we need it. Case managers have the opportunity to reach transgender people living with HIV at the moment dropping out of care becomes something a client has to consider. Peer advocates have the chance to help us change our stories when running into barriers that feel insurmountable.
In so many ways, big and small, our social workers are our life lines when they’re on our side, when we feel seen, and when we know we can trust them to have our backs.
In an effort to raise awareness about transgender health for people living with HIV/AIDS and/or viral hepatitis, we will host an educational training webinar on July 26, 2017. The webinar, "Transgender Healthcare: Removing Barriers to Healthy Cultural Expectations," will provide an introduction to systemic social and policy barriers that separate trans and gender diverse individuals from effective, culturally competent medical and mental health services that they need. Topics include multifaceted meanings of gender terms, defamatory stereotypes that impact trans health and access to care, and current and emerging issues in diagnostic, medical, and public policy.
Registration is open to all stakeholders. Registration is complimentary for PASWHA members, and it is also complimentary for patients living with HIV/AIDS. Use this scholarship link if you are a patient living with HIV/AIDS applying for a webinar scholarship.
Additional information about the webinar is available online at https://www.123signup.com/event?id=nhjqn.
Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.
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[1] Grant, J. M., Mottet, L, A., Tanis, J. (with Herman, J. L., Harrison, J., & Keisling, M.) (October 2010); National transgender discrimination survey report on health and health care; Findings of a Study by the National Center for Transgender Equality and the National Gay and Lesbian Task Force. Retrieved from http://www.thetaskforce.org/static_html/downloads/resources_and_tools/ntds_report_on_health.pdf
[2] National Center for Transgender Equality (2016); The report of the 2015 U.S. transgender survey; National LGBTQ Task Force and the National Center for Transgender Equality. Retrieved from http://www.ustranssurvey.org/report
[3] Centers for Disease Control and Prevention (2016); HIV among transgender people. Retrieved from https://www.cdc.gov/hiv/group/gender/transgender/
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