JOANNE KEATLEY: This study is just an example
of the state of transgender access to health.
And in a study of four U.S. cities, we found
that transgender women living with HIV were
less likely to receive highly active antiretroviral
therapy than a non-transgender control group.
Melendez et al., you can see that citation.
Next slide.
As a result of many of the negative health
outcomes that we’ve already spoken about,
the Center for Excellence for Transgender
Health decided we needed to look at what was
the kind of state of the art practice in the
field for provision of transgender health
services.
So we convened a medical advisory board of
transgender medicine experts.
They’re here before you.
And we’re very proud of the fact that we
were able to identify not only experts in
the field, but also some transgender identified
physicians who are part of our Medical Advisory
Board.
We felt that that really strengthened our
ability to develop these best practices.
Next slide.
So our protocol for transgender patient care,
our goals for creating the protocol, were
to create a concise yet comprehensive primary
care protocol; to maintain on our website
information for health care providers so that
they would have access to that protocol; and
provide in-person training; inform and empower
primary health care providers; and increase
access to high quality evidence-based health
care for all trans people.
Next slide, please.
The project was supported by the California
Endowment.
We established the MAB, the Medical Advisory
Board, and we did the bulk of our work through
conference calls and some in-person meetings
as necessary.
The protocols are seen as a living document.
And revisions will be made as necessary.
I think that Mattie, Dr. Deutsch, will be
speaking further on about some of the specifics
of the protocol.
Next slide, please.
In terms of creating the protocol, the work
involved an extensive literature review and
gap analysis.
We drafted the protocol with involvement of
the medical advisory board and with support
from Jamison Green, who is the President-Elect
of the World Professional Association for
Transgender Health and is also on our staff
at the COE, the Center for Excellence.
The protocol was peer reviewed by faculty
of the Family and Community Medicine Department
at UCSF.
And we were honored to be able to launch it
at the first National Transgender Health Summit
held at UCSF in April of 2011.
Next slide.
The protocol seeks to provide accurate peer
reviewed medical guidance with basic information
and deeper levels of awareness.
We imbedded a sense of cultural humility,
and based in part on best practices from the
field.
Next slide.
I wanted to give you some general tips in
terms of how to engage with transgender populations.
One of the things that I always caution providers
about is about asking sensitive questions.
So I encourage you to first ask yourself:
“Is your question necessary or are you asking
it merely for your own curiosity, and thus
is it in fact appropriate?”
For example, is “Are you going to have surgery?”
-- and so certainly if this is relative to
your provision of health care service, you
need to be able to arrive at this information.
But some important guidelines to keep in mind
are: what are the questions that are appropriate
to your work?
what do you know already?
So, for example, if you have used our data
collection recommendations then you should
have a sense of whether this is a trans person
before you, and the types of questions that
you need to ask.
What do you need to know in addition to whether
this person is trans?
And then how do ask it in a sensitive way.
I want to just caution you about asking surgical
status questions unless they are relative
to your work.
For transgender people, asking about surgical
status implies a sense of completion or lack
thereof, and so it may not be appropriate.
For example, you are, you know, dealing with
a patient who has presented with a mental
health issue.
It may not be relevant to the presenting issue.
So just keep those kinds of questions in mind
and let these types of questions be your guide.
Next slide.
In terms of pronouns, I encourage you to not
sweat it.
Politely ask -- remember that trans people
will have a sense.
If you are uncomfortable and you are reluctant
to ask a question directly or you come across
as being nervous about asking a question,
they’re going to sense that.
So I really encourage you to be respectful
yet honest in your interaction with your patients.
Remember that trans people may have a preference
of he or she; they may not have a preference,
and then it’s okay to use he or she.
They may prefer that you use a gender neutral
pronoun, or they may prefer that you not use
a pronoun at all and refer to them by the
name that they are using, or by another gender
neutral pronoun such as ‘‘they’’ or
“them.”
Next slide, please.
And then during physical exam, I really encourage
you to assess for immediate health care needs.
Treat the presenting issue and assess the
health of the organs and body parts that are
present.
Respect the patient’s gender identity always,
always.
And delay sensitive exams until they are necessary.
And, you know, be mindful of the need for
privacy with transgender people.
Having a transgender person disrobe and disclose
surgical status at the first appointment is
really a very, you know, very sensitive thing
to do and I would encourage against it.
Next slide, please.
So here are some good treatment practices:
use proper pronouns with all clients; next,
get clinical supervision if you have issues
or feelings about working with trans individuals,
don’t let them just fester; support trans
clients to continue the use of hormones, always.
Next slide.
Facilitate trans clients using street hormones
to obtain competent medical care.
Many of us turn to underground economies to
purchase street hormones because providers
don’t have the knowledge to provide our
care, and so we therefore turn to the Internet
or the street.
It’s important to get those clients into
medical care and treatment and monitoring.
Next point.
Next, do develop a bathroom policy that is
based on gender self identities and gender
roles.
We all have bladders.
We all have to eliminate the content of our
bladders from time to time, so please make
sure in health care facilities that trans
people have access to the bathrooms.
Don’t create hostile environments for them.
Create and maintain a safe environment for
all of your trans clients.
You can do that in a variety of ways.
You know, hire trans people, post trans images
in the waiting room, etc.
Next slide.
Develop and post non-discrimination policy
that explicitly includes gender identity.
Next.
And provide and encourage training on trans
health care issues for all staff, including
front line staff and all of the supporting
staff at clinical settings.
Next.
This is my contact information.
I encourage you to visit our website at http://www.transhealth.ucsf.edu.
And also, certainly, please like us on Facebook.
Thank you again to the organizers.
