JOANNE KEATLEY: My talk is exploring health
care needs of transgender people.
Next slide, please.
So I think it is important to understand who
we’re speaking about, so this is a working
definition of transgender.
For us, it is a person whose gender identity
or gender expression differs from the sex
that was assigned to them at birth.
And we also use “trans” as shorthand for
transgender and transsexual and any myriad
of ways in which transgender people identify.
We don’t have enough time today to go through
all of the identities, so we’ll just use
trans as the shorthand.
Next slide, please.
At the Center for Excellence for Transgender
Health our mission is to increase access to
comprehensive, effective and affirming health
care services for trans and gender variant
communities throughout the country and beyond.
Next slide, please.
We include community perspectives in guiding
all of our work by actively engaging a national
advisory board of 12 transgender identified
leaders from throughout the country.
And you can see our wonderful NAB before you
in the picture on the slide.
Next slide, please.
This is -- this diagram is a diagram that
we’ve developed to demonstrate how these
issues interact in leading to the poor health
outcomes that so many transgender people experience
in this country.
What we’re attempting to demonstrate here
is that as a result of transphobia in society
and in health care and governmental systems
and just in general society, transphobia plays
out in terms of housing and job discrimination,
both internalized and societal transphobia,
and then leading to issues of self esteem
within the trans community, leading to often
dependence on drug use in order to cope with
a very oppressive environment that many trans
people find themselves in.
And then that leads to increased mental health
issues and certainly incidents of unprotected
sex as a result of these types of coping mechanisms.
That leads to overrepresentation in jails
and in correctional facilities, prisons, where
transgender people are often in sex-segregated
-- well, almost universally in sex-segregated
facilities according to genitalia.
And so therefore trans women are housed in
men’s facilities, trans men are housed in
women’s facilities, and there is very little
sex education and access to any kind of protective
materials.
And so people do engage in unprotected sex
while incarcerated.
Then the dependence on sex work as a survival
technique, because so many trans people are
denied employment and therefore have to turn
to sex work as one way to be able to sustain
themselves.
And also the dependence on sex work for many
transgender women in terms of gender affirmation,
which also leads to incidents of unprotected
sex.
So this slide demonstrates how all of these
issues impact the trans community and are
kind of cyclical in nature.
Next slide, please.
Which leads us to the over-representation
of trans women, in particular, in terms of
HIV incidence.
This is a little tricky for us because up
until 2011, the data on transgender women
was routinely collapsed into the MSM category.
And so this data is based on meta analysis
that was conducted by the CDC and published
in 2008 where 29 studies were looked at.
And of those 29 studies, where there was lab
confirmation of HIV status, we showed overall
prevalence of 20 percent or roughly 1 in 4
transgender people were HIV positive.
And when you compared that to the incidence
by self report, the prevalence by self report,
there was a shift in the numbers.
So 28 percent versus 12 percent.
So what that said to me is that we weren’t
actually doing a very good job of reaching
trans community and testing them and then
linking them to care, which as we all know
is really the aim of the national HIV AIDS
strategy.
Of course, particularly tragic is the impact
on African American transgender women where
we saw the highest prevalence of any group,
really, in this country: 56 percent compared
to other racial and ethnic groups; just really
a public health tragedy.
Next slide, please.
So that data that I shared with you was from
a report in 2008, a meta analysis.
But this slide is on the HIV surveillance
report that was issued last year by the Centers
for Disease Control, and shows that the highest
nearly identified confirmed HIV positivity
was found among transgender persons in both
2008 and 2009, so 2.4 and 2.6 percent respectively.
And then among African American transgender
women you can see 4.5 and 4.4 percent respectively;
and then Hispanics, 2.7 and 2.5 respectively.
The next slide shows how this compares to
other populations.
You can see here along the left side the data
is broken apart by race.
And then towards your right you can see by
gender: male, female and transgender is the
way the CDC reported this data.
And you can see the transgender African Americans
actually have the highest incidence of new
HIV positivity across all CDC funded sites
in this country compared to their racial and
gender counterparts.
Next slide, please.
So to that end, one of the things that we
would like to put forth as recommendations
-- and I’m happy to say the CDC has implemented
these types of data collection measures -- the
Center for Excellence for Transgender Health
has these recommendations on our website.
You can access them at http://www.transhealth.ucsf.edu.
Basically, this is a shortened version of
our recommendations that we ask that all health
care providers anywhere in the country and
health departments collect data on what is
a person’s current gender identity as well
as what was the sex that was assigned to them
at birth.
Next slide.
So this is an example of the way that you
could ask these questions.
During patient intake, you could ask, “What
is your current gender identity?” and then
have drop down menus with different options
for people to disclose.
This is just an example of one way to allow
people to self-disclose their current gender
identity.
You can create a measure that would have the
same information based on local language for
trans identities.
Next slide.
And then, you know, the important follow up
question is what was the sex that was assigned
to the person at birth.
Another way to ask this same question is,
“What is the sex that is on your birth certificate?”
which arrives at the same information.
So this is an example of the way that we ask
it: male, female, declined to state, so respecting
the individual’s right to chose whether
to disclose or not.
