Hi everyone!
My name is Mannat. I worked on
the Be the Conversation study team as a
research coordinator.  I am going to talk to you about
some of our key findings in relation to the Transgender
Response Team priority work areas.
Be the Conversation was a community-academic
partnership between the TRT and the Johns Hopkins
School of Public Health.
We started with a formative qualitative phase in 2015,
the goal of which was to inform the development of
our eventual needs assessment survey.
We conducted 20 in-depth interviews with trans
community leaders and activists, and local health and
social services providers.
The interviews focused on community priorities and
needs, and how to engage ethically and
respectfully with trans Baltimoreans for research.
In March 2016 we launched the online BTC survey.
Individuals whose current gender differed from
their sex-assigned-at-birth, who lived in Baltimore, and
were 18+ years, were eligible to participate.
We used numerous recruitment methods and some
examples are shown here.
The survey covered many aspects of peoples’ day to day lives,
from HIV and STIs to mental health, access to gender
affirming services and so on.
Now, getting into findings.
One goal of the BTC study was to conduct population
size estimation, using the wisdom of the crowd method.
This involves asking participants to estimate
population size based on their perceptions,
and then we determined the median estimate.
For context, the Williams Institute estimated that
over 22,000 trans people live in Maryland.
BTC participants estimated that 2,000 trans people
live in Baltimore.
Hopefully this is useful context for programming.
This slide provides a brief over view of participant
sociodemographics. I am going to
highlight a few key points.
141 trans and non-binary Baltimoreans participated
in the study and the mean age was 35.
Sixty-five percent of the sample was transfeminine
and 35-percent was transmasculine.
But participants reported a diversity of gender identities,
in fact 21-percent selected more
than one gender identity.
In terms of race/ethnicity, around 50-percent of
the sample was Black or African American.
Notably, we see prevalent socioeconomic needs,
including housing, lack of income, unemployment,
and food insecurity.
And around 14-percent of participants faced challenges
when trying to access gender affirming care
in the past 12 months.
Now this slide really speaks to the heart
of the BTC study, to explore community priorities.
Participants were provided a list of priorities, based on
what we heard during the formative phase,
and asked to select their top 5.
As you can see, the most commonly selected top
priorities align with the TRT work areas.
We also wanted to highlight that access to
transgender-sensitive healthcare was a top
3 priority, endorsed by almost 40-percent
of participants.
We hope that this graph can ground the rest of our
presentation because, as suggested in this quote,
the conversation about needs belongs to the trans
community, who have long faced non-community
members defining their needs
and programming for them.
As you have heard, the TRT priority work areas focus on
violence, sex education, and access to employment.
I will talk through some of the BTC data related
to these topics next.
We’ll start with violence experiences.
Among BTC participants, 3 in 5 had experienced
some form of violence in the past year and
the majority attributed some or most of these
experiences to transphobic discrimination.
Preventing violence and harassment perpetrated
by the police in particular was selected as
a top 5 community priority by 38-percent
of BTC participants.
Relatedly, we have more to learn about common
perpetrators of violence and contexts of violence
exposure, which may vary by transgender sub-population
or community.
The graph below depicts data on recent violence
experiences by [Sex Assigned at Birth] SAB.
Evidently, psychological violence in the form of verbal
insults and abuse was pervasive across groups.
Transfeminine participants were especially vulnerable
to property destruction and physical violence,
and around 10-percent of participants had
actually moved to escape violence in their homes.
Experiencing violence in the past year was also
highly correlated with adverse mental
health outcomes, like suicidality and PTSD.
Importantly, there is a need for more research that
focuses on violence impacts for trans men and
non-binary individuals – this was one of the
first local studies to collect that information.
While targeted efforts are needed to address groups
that are at disparate risk for violence
within the transgender community (e.g., Black
transgender women), it is also crucial that
we work on targeting city-level transphobia
as a determinant of violence,
and take a population approach.
Now, getting into sexual health experiences.
While this wasn’t the focus of the BTC survey, we asked
participants about HIV testing and
to self-report their status.
As shown, around a quarter of transfeminine
participants reported that they were living with HIV.
And almost 3-percent of transmasculine participants, which
aligns closely with national estimates for trans men.
In recent years, local trans men leaders have again
highlighted the need for research that centers their
sexual health needs, and embraces sexual diversity.
I have also boxed off this data on HIV status
by gender identity to highlight that we see
differences when we disaggregate by identity
instead of [Sex Assigned at Birth] SAB.
And it is important to consider how peoples’
lived identities are impacting these experiences.
Here we have broken down lifetime STI history by
[Sex Assigned at Birth] SAB and gender identity,
again leading to a slightly different picture.
We see varied STI experiences by gender, which
highlights the importance of offering tailored
programming that doesn’t assume that all
trans people are having the same experiences,
but instead creates room for assessing unique needs
not only by gender, but also based on other intersecting
identities that impact how people experience the world.
During our qualitative formative phase, program
leaders and health and social services providers
shared helpful advice for building programs for trans
communities, including sexual health programs –
as summarized by these quotes.
One important factor is the reality that survival
day-to-day can outweigh health.
It is not only important for programs to consider this,
but to think about how they can demonstrate
responsiveness to participants’ holistic needs.
Key informants also highlighted that unless programs
are explicitly inclusive of trans individuals, underserved
communities like the trans community may assume
that the space will not be safe for them.
This has important implications for program
communications and advertising.
Key informants also felt that because current programs
are centered around specific health issues, this can lead
to exclusion when certain groups don’t feel
that that issue applies to them.
Lastly, as we see here, there is widespread distrust
of formal organizations, especially for trans people
of color, in part because their needs have not
been prioritized and they don’t see themselves reflected
in organizational leadership or staff.
And finally, employment-related experiences.
Among BTC participants, 2 in 5 were unemployed
and 3 in 5 were living below the federal poverty line.
Around 13-percent actually reported that they
were fired from a job or denied a job or promotion
they were qualified for in the past 12 months.
So, it is clear that lack of access to employment,
and stable employment in particular, is a
crucial community need.
Key informants also noted that hiring trans staff
at organizations that are serving trans people
can improve the community’s access to these
services and how affirmed they feel using them –
representing both an opportunity for employment
access and program success.
Finally, we have summarized some key short
and long term recommendations related to
development and implementation of gender affirming
programs and services.
Short term, programs need to reach out to
trans communities in diverse ways, especially
to build trust.
Explicit inclusion of trans communities and
enacting cultural competency practices are
crucial to ensuring that trans people feel safe.
Long term, we need to be hiring trans leaders to build
and lead sustainable, community-grown programs.
Cultural competency should become an organizational
value, in order to prevent discrimination
and maintain trust.
And finally, programs should center capacity and
skills building curricula, to ensure that we are working
towards community empowerment long term.
Thank you all for listening!
