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Welcome to the Acci ón Mutua web-seminar:

Understanding 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 un-mute your line, press *6 again) •If you are experiencing difficulty with your phone connection, dial *0 (to for the conferencing service operator •Questions submitted prior to the web-seminar will be addressed first during the Q&A •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 Q&A

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

Understanding 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

Today’s 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

Transgender?

 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?

Gender & Sex

“traditional” woman

BIOLOGICAL SEX

(chromosomes, anatomy) female intersex/hermaphrodite “traditional” man male

GENDER IDENTITY

(psychological sense of self) woman gender queer/neutral man

GENDER EXPRESSION

(communication of gender) feminine androgynous masculine attracted to men

SEXUAL ORIENTATION

(sex attracted to) bisexual attracted to women

Gender & 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

Gender & 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.

Transgender 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.

Epidemiology

 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

Gender-Specific % of HIV/AIDS Cases Younger than 30 Race/Ethnicity HIV* Male AIDS 15.5

African American Asian/PI 26.8

30.9

Hispanic/Latino 40.0

Native American White 34.5

21.6

16.1

23.0

21.9

12.2

Female Transgender HIV* AIDS HIV* AIDS 32.1

19.7

37.2 17.8

42.1

47.9

35.6

32.9

22.3

29.6

24.1

20.7

52.4 31.9

52.0 31.0

28.6 N/A 32.7 18.4

*Includes only HIV cases reported via non-name code Mathew Facer, Epidemiologic Studies Section, California Office of AIDS

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)

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

Table 1. Demographics by Ethnicity

Total (n=332) N (%) Afri.Am. (n=112) N (%) Latina (n=110) N (%) API (n=110) N (%) Income source(s) in past 6 months Full time job: Prostitution: 92 (28) 170 (51) 18 (16) 56 (50) 24 (22) 79 (72) 50 (45) 35 (32) Income in past 30 days ($) 0-499 500-999: 1,000-1,999: 2,000 (and above) 64 (20) 110 (34) 70 (21) 84 (26) 15 (13) 51 (46) 31 (28) 15 (13) 36 (33) 35 (32) 15 (14) 22 (20) 13 (12) 24 (22) 24 (22) 47 (44)

Table 2. HIV/STD by Ethnicity

HIV Positive Status Total (n=332) N (%) 86 (26) Afri. Am. (n=112) N (%) 47 (41) Latina (n=110) N (%) 25 (23) API (n=110) N (%) 14 (13) Any STD, past 12 months 46 (14) 20 (18) 21 (19) 5 (4)

Major 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.

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

Barriers 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

Barriers 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

Barriers 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.

HIV 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.

Suggestions for Making Your Agency



Trans Affirming

Don’t 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 transphobia —in staff and community  Have trans-inclusive imagery in waiting room  Use inclusive or gender neutral language  Create safe bathroom policies!

 Hire Transgender people!!!!!!!!!!!

Costura 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

Costura 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

Costura y Charla

Thank You!

Comments & Discussion

JoAnne Keatley, MSW [email protected]

415.597.4960

For more information on how to receive CBA services please contact:

Acci ón Mutua

(Western region Latino CBA provider): 213.201.1345 or www.accionmutua.org

Transitions

(nation-wide transgender CBA provider): [email protected]