Welcome to the AcciWelcome to the Accióón Mutua web-seminar:n Mutua web-seminar:Understanding Transgender Latinas Understanding Transgender Latinas

and other Transgender Women of Color and other Transgender Women of Color and their HIV Concernsand their HIV Concerns

Presentation by seminar speaker (approx. 40 min.)Followed by question and answer session (approx. 20 min.)

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•Please press *6 on your telephone keypad to mute your telephone line (to un-mute your line, press *6 again)•If you are experiencing difficulty with your phone connection, dial *0 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 MutuaAcción Mutua is a capacity building assistance (CBA) program of AIDS Project Los AngelesAIDS Project Los Angeles in collaboration with the César E. Chávez InstituteCésar E. Chávez Institute

of San Francisco State University

Funded by the Centers for Disease Control and Prevention

Understanding Understanding Transgender Latinas and Transgender Latinas and

other Transgender other Transgender Women of Color and their Women of Color and their

HIV ConcernsHIV Concerns

Presented byPresented by

JoAnne Keatley, MSWJoAnne Keatley, MSWPacific AIDS Education & Training CenterPacific AIDS Education & Training Center

University of California, San FranciscoUniversity of California, San Francisco

Today’s Web-Seminar ObjectivesToday’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?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?

BIOLOGICAL SEX (chromosomes, anatomy)

female intersex/hermaphrodite male

GENDER IDENTITY (psychological sense of self)

woman gender queer/neutral man

GENDER EXPRESSION (communication of gender)

feminine androgynous masculine

SEXUAL ORIENTATION (sex attracted to)

attracted to men bisexual attracted to women

“traditional” woman “traditional” man

Gender & SexGender & Sex

Gender & SexGender & Sex

Binary Gender System:Binary Gender System: The societal division of human beings into two, distinct categories of male and female.

Chromosomes: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: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 & SexGender & Sex

““Biological Sex.”Biological Sex.” The sex assigned at birth typically based on examination of the genitals.

Gender Identity:Gender Identity: Self-image or belief a person has about their gender as being female, male, or something altogether different.

Sexual Orientation:Sexual Orientation: The internal experience that determines who we are physically and/or emotionally attracted to.

Transgender PeopleTransgender 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.

EpidemiologyEpidemiologyRates of HIV infection estimates

13 – 68% for transgender women 2 – 3% for transgender men

Rates are higher for transgender people who are

Male to FemaleOf ColorEngage in sex workUse injection drugs

HIV* AIDS HIV* AIDS HIV* AIDS

African American

26.8 15.5 32.1 19.7 37.2 17.8

Asian/PI 30.9 16.1 42.1 22.3 52.4 31.9

Hispanic/Latino 40.0 23.0 47.9 29.6 52.0 31.0

Native American

34.5 21.9 35.6 24.1 28.6 N/A

White 21.6 12.2 32.9 20.7 32.7 18.4

*Includes only HIV cases reported via non-name code

Mathew Facer, Epidemiologic Studies Section, California Office of AIDS

Gender-Specific % of HIV/AIDS Cases Gender-Specific % of HIV/AIDS Cases Younger than 30Younger than 30

Race/Ethnicity Male Female Transgender

HIV Risk Behaviors among MTF HIV Risk Behaviors among MTF Transgenders of ColorTransgenders of Color

Tooru Nemoto, PhD., Principal InvestigatorDon Operario, PhD. Research AssociateJoAnne 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:Sexual Behaviors: primary, casual, and commercial•Health Outcomes:Health Outcomes: HIV/STD, depression, need and access to care•Substance Use: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:Psychosocial Factors: transphobia, depression, self-esteem, gender identity, social support

Table 1. Demographics by EthnicityTable 1. Demographics by EthnicityTotal

(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:

Income in past 30 days ($)

0-499

500-999:

1,000-1,999:

2,000 (and above)

92 (28)

170 (51)

64 (20)

110 (34)

70 (21)

84 (26)

18 (16)

56 (50)

15 (13)

51 (46)

31 (28)

15 (13)

24 (22)

79 (72)

36 (33)

35 (32)

15 (14)

22 (20)

50 (45)

35 (32)

13 (12)

24 (22)

24 (22)

47 (44)

Table 2. HIV/STD by EthnicityTable 2. HIV/STD by Ethnicity

Total

(n=332)

N (%)

Afri. Am.

(n=112)

N (%)

Latina

(n=110)

N (%)

API

(n=110)

N (%)

HIV Positive Status

86 (26) 47 (41) 25 (23) 14 (13)

Any STD, past 12 months

46 (14) 20 (18) 21 (19) 5 (4)

Major FindingsMajor Findings1. About three-quarters of the participants had recently

engaged in receptive anal sex.

2. A significantly higher proportion (47%)had recently engaged in URAS with primary partners than with casual (26%) and commercial partners (12%).

3. Current URAS with primary and casual partners, but not commercial partners, was significantly and independently correlated with having had sex under the influence

4. 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, continuedMajor Findings, continued

5. 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 ServiceBarriers 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: ProvidersBarriers to Care: Providers

Lack of knowledge and informationPersonal discomfortLack of clinical research, literatureLack of agency supportNot enough people doing the workReligious/Moral concerns

Barriers to Care: ClientsBarriers 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 HormonesHIV 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 Suggestions for Making Your Agency Trans AffirmingTrans 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 CharlaCostura 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…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 CharlaCostura y Charla

Costura y CharlaCostura y Charla

Costura y CharlaCostura y Charla

Thank You!Thank You!  

Comments & DiscussionComments & Discussion

JoAnne Keatley, MSWJoAnne Keatley, MSWJoanne.keatley@ucsf.edu

415.597.4960415.597.4960

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

AcciAcción Mutuaón Mutua (Western region Latino CBA provider):

213.201.1345 or www.accionmutua.org

TransitionsTransitions (nation-wide transgender CBA provider):

j.sevelius@ucsf.eduwww.caps.ucsf.edu/projects/Transitions/