1. 2011 NATIONAL PREVENTION CONFERENCE - ATLANTA
TRANS-EXPERIENCE
and SEXUAL HEALTH
in Underserved Communities
Luis Freddy Molano, MD,VP HIV Programs and Services
Renato Barucco, MS, Program Manager
Medical Affairs
HIV Programs and Services
Transgender Family Program
Peter Tesler, MD CMO
Catherine Abate, President/CEO
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2. OVERVIEW
• CONTEXT: CHN and the Transgender Family Program
• CONTEXT: Bronx and Queens
• THE ISSUE
• THE PROJECT
• THE PROJECT: Program Design
• THE PROJECT: Health Literacy and Educational Initiatives
• THE PROJECT: T-Teach Back
• RESULTS
• KEY POINTS and THE FUTURE
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3. CONTEXT
is a not-for-profit organization that provides access to affordable, culturally-
competent and comprehensive community-based primary care, mental
health and social services for diverse populations in underserved
communities throughout New York City.
CHN health centers around the city are Federal Qualified Health Centers.
CHN is one of NYC’s premier community provider for medical and social
services for people living with HIV and people at high risk for HIV and STI’s.
TRANSGENDER The Transgender Program has been implemented at Community
Healthcare Network - Bronx Health Center in 2004 to offer to the
FAMILY increasing number of patients of trans-experience comprehensive and
PROGRAM understanding access to healthcare. Direct services on the transgender
community in a family planning clinic without being part of a larger LGBT
Center. It is founded by NYS AIDS Institute to provide HIV primary care
and support services for HIV positive patients, by NYS AIDS Institute -
Community Of Color to to provide preventive services for the transgender
community, by Rapoport Fundation to expand the program in the
Queens Health Center, and by Henry Van Ameringen, and the New York
AIDS Fund to provide mental health services.
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4. CONTEXT
BRONX AND QUEENS
The highest number of newly HIV/AIDS diagnosed transgender patients in New York City
between 2005 and 2009 lived in Fordham-Bronx Park and west Queens.
- 88% were transgender women and 12% transgender males
- Newly diagnosed transgender patients were primarily in their teens and 20s.
- About 90% of transgender women and men newly diagnosed were Black or Hispanic.
- About 20% of transgender women and men newly diagnosed were foreign-born.
- Sex with a male was the predominant type of HIV risk among newly diagnosed transgender
women and men. *
The Transgender Family Programs at Community Healthcare Network are implemented at the
Bronx Health Center (zip code 10459) and Queens Health Center (zip code 11435).
* www.nyc.gov “HIV Among Transgender Persons in New York City 2005-2009” HIV Epidemiology and Field Services Program
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5. THE ISSUE
Comprehensive searches of the US-based HIV prevention literature clearly shows how in the
US, HIV/AIDS continues to have a devastating impact on people of trans-experience.
These populations, both in urban and rural areas, seem to engage more often in HIV risk
behaviors including having unprotected sex, having sex with multiple partners,, and having
sex with injection drug users. Systematic individual, interpersonal and societal factors seem
to have a role in the development of dysfunctional behaviors.
The recent National Transgender Discrimination Survey Report on Health and Healthcare
conducted from a sample of 6,450 respondents from all 50 states, the District of Columbia,
Puerto Rico, Guam, and US Virgin Island, underlines how transgender or gender-non
conforming people frequently experience discrimination when accessing healthcare.
Participants reported very high levels of postponing medical healthcare due to
discrimination or inability to afford it. Issues mentioned included medical providers directly
refusing care, harassment and violence, and lack of sensitivity. Respondents to the surveys
reported an average prevalence of HIV infection over four times as high as the national
average.
These studies suggest the need of nationwide implementations of programs and services
directed towards the special needs of the transgender communities. Effective programs
should provide access to comprehensive and culturally-competent primary care, mental
health and social services in order to enhance the quality of life of transgender patients
and stop the spread of HIV/AIDS and sexually transmitted infections in the transgender
communities and, indirectly, in the related communities (injection drug users, sex workers
and their clients, men who have sex with men). *
* “National Transgender Discrimination Survey” National Center for Transgender Equality and the National Gay and Lesbian Task Force.
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6. THE PROJECT
Taking in consideration context and issue, the team at Community Healthcare
Network intended to develop the Transgender Family Program in order to offer
the widest spectrum of services to address the several issues of transgender
patients, their families, and allies.
The team’s goal was to improve the quality of life of our patients and stop the
spread of the HIV /AIDS infection by:
• Improve their overall health by providing medical and mental health services
and monitor clinical outcomes while relate to the community in sensitive and
culturally competent manner.
• Improve clients’ health literacy through interventions and supportive services
and raise awareness on transgender health issues amongst providers.
• Give appropriate and accurate referrals for off-site services
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7. THE PROJECT
PROGRAM DESIGN
The Transgender Family Program based its implementation on the principles of the
Medical Home Model and integration of care. The team adopted initiatives in order
to deliver services that are enhanced and comprehensive, client-centered and
family-centered, address the whole range of needs of our transgender patients and
put the needs of the patients first.
The program provides:
MEDICAL CARE COMMUNITY
INTAKE
MANAGEMENT INVOLVEMENT
COMPREHENSIVE COMPREHENSIVE
MEDICAL ASSESSMENT
PRIMARY CARE REFERRAL LIST
PSYCHOSOCIAL MENTAL HEALTH LINKAGES WITH OTHER
ASSESSMENT SERVICES CBO’s
NEED ASSESSMENT TREATMENT ADHERENCE PEER EDUCATION
LEGAL ASSESSMENT ACCESS TO HEALTHCARE STREET OUTREACH
NUTRITIONAL MEDICAL CARE HOME
ONLINE OUTREACH
ASSESSMENT MANAGEMENT
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8. THE PROJECT
HEALTH LITERACY AND EDUCATIONAL INITIATIVES
SUPPORT GROUPS
AND WORKSHOPS
ENGLISH
LANGUAGE
SPANISH
TRANSGENDER
PATIENTS
POPULATION
ALLIES
GROUP LEVEL INDIVIDUAL LEVEL
INTERVENTIONS INTERVENTIONS
MEDICAL CASE
SISTA/TWISTA HIV POSITIVE PATIENTS MANAGEMENT
CDC’s DEBI’s COUNSELING
HEALTHY
RELATIONSHIPS
RISK REDUCTION
HOME GROWN HIGH RISK NEGATIVE
INTERVENTION T-TEACH BACK
COUNSELING
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9. T-TEACH BACK
INTERVENTION
TYPE Group Level
NUMBER OF SESSIONS One-session intervention offered on a monthly basis
Transgender patients, both trans-males and trans-females, and their allies
TARGET POPULATION
including partners, friends, roommates, family members, etc.
SETTING Community Health Center
Behavioral Science:
THEORY
Social Cognitive Theory, Trans-theoretical Model
Facilitator identifies the ideal methods of delivery according to personal
METHOD OF DELIVERY preference (Ppt presentation, activities, movies, group discussion, lecture,
etc.)
NUMBER OF PARTICIPANTS 8 to 12 *
The intervention is led directly by a previously selected transgender
FACILITATOR
program client with minimal supervision from the program staff
The program offers workshops/support groups in English and Spanish on a
weekly basis. The staff selects topics of interest from client suggestions and
program deliverables. The staff prepare up-to-date, simple and culturally
sensitive presentations that changes every week over the course of the
year. The staff records attendance. The staff selects a group of people
DESCRIPTION
from the group participants with consistent attendance. The staff ask the
selected individuals to present the T-Teach Back session. Those who agree
will have to select a topic, prepare a presentation utilizing the favorite
method of delivery and teach back what they have learned to their peers
during two monthly group sessions, one in English and one in Spanish.
* The intervention was delivered to groups up to 20 participants during implementation.
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10. RESULTS
• The Transgender Family Program counts more than 200 patients
from all 5 NYC Boroughs and from out of states. Patients include
transgender persons and their allies.
• The health centers deliver over 90 medical encounters per
month to program participants.
• Since 2007 the rate of HIV infections and sexually transmitted
infection drastically dropped, with one single, non-sexual sero-
conversion since November 2007. Prior to the implementation of
the educational initiatives the prevalence of STI’s was
significantly higher.
• The Transgender Family Program implemented a comprehensive
Quality Improvement Plan that allows staff to track STI’s
Screening and CTR services to program participants. Patients are
referred to CTR every four months and to complete STI’s
screening every six months.
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11. EVALUATION RESULTS
During our support groups/workshops condom use is consistently encourage in addition to other safe-
sex practices. Program’s evaluation clearly shows improvement in condom use amongst the 30
respondents.
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12. EVALUATION RESULTS
Survival sex work is an issue that severely impact the transgender community in underserved
communities. Evaluation respondents reported being significantly less involved in sew work.
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13. RESULTS ACCESS TO SUPPORTIVE SERVICES
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14. RESULTS ACCESS TO MEDICAL SERVICES
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15. KEY POINTS AND THE FUTURE
• Programs addressing the needs of the transgender community should take
into consideration the specificity of the medical, social, and cultural necessities
of individual of trans-experience.
• Programs targeting the transgender community should include
comprehensive assessments, widest offer of on-site services, extensive list of
referrals for off-site services, qualified and cultural competent staff.
• Programs should be client-centered. When possible activities should be peer-
led. Consumer involvement should be encouraged and routinely taken into
consideration.
THE FUTURE
• Staff plans to further study the impact of the T-Teach Back intervention on
program’s participants and possibly create a T-Teach Back-based EBI.
• Staff is in the process of writing a comprehensive curriculum for the program
in its entirety in order to facilitate replication and adaptation.
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16. Thank You
Luis Freddy Molano, MD,VP HIV Programs and Services
fmolano@chnnyc.org (212) 545-2460
Renato Barucco, MS, Program Manager
rbarucco@chnnyc.org (718) 320-6765
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