Transcript Avenues for action for the provision of care and the promotion of well-being Walter Bockting, PhD Past President, World Professional Association for Transgender.

Avenues for action for the provision of care
and the promotion of well-being
Walter Bockting, PhD
Past President, World Professional Association for Transgender Health
Coordinator of Transgender Health Services
Program in Human Sexuality
Professor
Department of Family Medicine and Community Health
University of Minnesota Medical School
Blueprint for the Provision of Comprehensive Care
for Trans Persons and their Communities in Latin
America and the Caribbean
1.
Terminology, definitions, description of the population
2. The health situation of trans persons in the region
3. Determinants of health and socio-cultural, legal, and
structural barriers to comprehensive care
4. Advocacy, public policy, training, and research
5. Comprehensive care, prevention, and support
6. Working with gender variant children and adolescents
Care, prevention, and support
 Infrastructure and settings; coordination of care
 Reception, first encounter, and first clinical evaluation
 The Oral Health Practitioner’s office as a point of entry into the
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health system
HIV and STI testing, counseling, and treatment
Addressing mental health concerns
Alcohol and other substance use and addiction
Coping with stigma, discrimination, and violence and the
promotion of resilience
Addressing the consequences of physical violence
Specific health care related to gender affirmation (including
hormone therapy and surgery)
Trans-positive interventions (child, family, school, early medical
intervention)
Algorithm for management of minority stress
Algorithm for hormone therapy
Peer education
and support
Emotional and
social support
Provide information on results, side effects, reversibility,
social impact.
Verify patient’s decision to undergo hormonal treatment.
UNDECIDED
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Explain procedures and obtain consent
Referral to medical practitioner
Inhibition of endogenous
hormones
Hormone replacement
Follow-up
•Incl. possible surgical procedures
Recommendations for members of
health care teams
 Develop the technical skills and cultural competency
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necessary for providing appropriate health promotion,
prevention, care, and support services to trans persons
Respond to the health care demands of trans persons by
providing the highest attainable standards of care
Ensure that trans clients are addressed with due respect,
using their preferred name and pronouns that correspond
to their gender identity
Organize facilities (including restrooms and inpatient
accommodation) in a way that acknowledges the gender identity
of trans clients
Ensure the provision of biomedical interventions for gender
affirmation (including hormonal treatment and surgery) by
qualified professionals
Be aware of the risk of generalizations and preconceived
assumptions about and/or prejudices against trans persons
Recommendations for policy and
decision makers in the health sector
 Recognize and address the negative impact of transphobia on the
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provision of health care services
Ensure that provision of care to trans persons be comprehensive
and not just limited to HIV/STI care, including all areas related
to personal wellbeing
Recognize that biomedical interventions for gender affirmation
are not merely cosmetic but a matter of medical necessity
Ban the practice of so-called “reconversion” therapies that aim at
changing a person’s gender nonconformity or non-heterosexual sexual
orientation
Adapt existing algorithms for the provision of care of trans persons to
reflect national standards and specific realities of relevant populations
Ensure that recommendations are based on evidence as well as on the
expressed needs of trans persons themselves
Recommendations for managers of
public services across different sectors
 Implement and enforce zero tolerance policies
with regards to transphobia in public services
 Implement measures to ensure respect for the
use of names and gender markers that differ
from a person’s official identity documents
Recommendations for members of
academia and professional associations
 Publicly endorse and promote knowledge of the fact that
gender non-conformity does not in itself represent a
pathological condition of any kind
 Intensify research aimed at expanding knowledge about trans
populations, their needs, demands, common health problems,
and social determinants of health
 Clearly define samples and results of investigations as
pertaining to trans populations, avoiding the conflation of data
with gay, lesbian, bisexual or other populations
 Address gaps in medical research, e.g. in relation to sideeffects and their effective remedy associated with the use
of hormones and soft-tissue filler injections and the
interaction between the use of hormones and established
algorithms for the treatment of HIV and other conditions
Recommendations for governments
 Undertake measures and campaigns with the goal of
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reducing verbal, emotional, and physical violence
against trans persons
Ensure that trans persons have access to identity
documents that adequately reflect their gender identity
Ensure that public health systems provide quality services
that are accessible and acceptable for trans persons
Guarantee the uninterrupted access to care by persons
deprived of liberty
Collect, collate, and disseminate relevant data and strategic
information that may serve as a reference for the
improvement of programs and services directed at trans
persons
Recommendations for bi- and
multi-lateral organizations
 Support global, regional and national efforts to
fight transphobia and other expressions of hatred,
ostracism, or intolerance
 Gear resources towards capacity-building to
address the needs of trans persons in the
health sector and other areas of public policy,
including legislation and law enforcement
Recommendations for leaders and
members of CBOs
 Proclaim and advocate for the respect of the human dignity of trans persons
 Develop community organizations and networks at local, national, regional and
global level
 Remind national authorities of their international commitments to the protection
of human rights
 Participate in local, provincial, and national legislative health commissions to
ensure equitable and appropriate provision of high-quality health care
 Provide peer support to trans persons who deal with stigma, family rejection,
harassment, anxiety, depression, or other hardships
 Develop educational processes and materials for educating peers on issues relevant
to personal wellbeing, such as the risks to health associated with self-administered
hormones or soft-tissue filler injections as well as nutrition, use of cosmetics,
dressing, and safer sex
 Promote the development of leadership and other skills that contribute to the
realization of personal capacities
 Develop competencies that would enable representatives of trans communities to
participate in public discussions, conferences, and social gatherings
 Develop vocational training programs to facilitate entry into safe and reliable lines
of work
Thanks to all the
organizations who sponsored
and supported the
development of the Blueprint
and this session.