This document summarizes the findings of focus groups conducted with 100 transgender individuals in San Francisco to understand their HIV risk behaviors and access to prevention and health services. Key findings include:
1) Sex work was commonly discussed and seen as necessary due to discrimination, though it increased HIV risk. Unprotected sex was also common due to low self-esteem and desire for validation.
2) Participants reported barriers like insensitivity of providers and fear of discrimination prevented access to services.
3) Recommendations included hiring transgender staff and training providers to be more sensitive.
Transgender Female Youth And Sex Work HIV Risk And A Comparison Of Life Facto...Santé des trans
( A I D S Behavior, 2009)
L'article examine les déterminants du risque d'acquisition du VIH par les jeunes femmes trans du fait de leurs "facteurs de vie", en particulier en regard leur statut par rapport au travail sexuel.
A youth-focused case management intervention to engage and ret.docxransayo
A youth-focused case management intervention to engage and retain young gay men of color
in HIV care
Amy Rock Wohl
a
*, Wendy H. Garland
a
, Juhua Wu
b
, Chi-Wai Au
b
, Angela Boger
b
, Rhodri Dierst-Davies
a
,
Judy Carter
b
, Felix Carpio
c
and Wilbert Jordan
d
a
Los Angeles County Department of Public Health, HIV Epidemiology Program, Los Angeles, CA, USA;
b
Los Angeles County
Department of Public Health, Office of AIDS Programs and Policy, Los Angeles, CA, USA;
c
AltaMed Health Services
Corporation, Daniel V. Lara Clinic, Los Angeles, CA, USA;
d
Los Angeles County MLK-MACC, OASIS Clinic, Los Angeles,
CA, USA
(Received 5 April 2010; final version received 18 November 2010)
HIV-positive Latino and African-American young men who have sex with men (YMSM) have low rates of
engagement and retention in HIV care. An evaluation of a youth-focused case management intervention (YCM)
designed to improve retention in HIV care is presented. HIV-positive Latino and African-American YMSM, ages
18�24, who were newly diagnosed with HIV or in intermittent HIV care, were enrolled into a psychosocial case
management intervention administered by Bachelor-level peer case managers at two HIV clinics in Los Angeles
County, California. Participants met weekly with a case manager for the first two months and monthly for the
next 22 months. Retention in HIV primary care at three and six months of follow-up was evaluated as were
factors associated with retention in care. From April 2006 to April 2009, 61 HIV-positive participants were
enrolled into the intervention (54% African-American, 46% Latino; mean age 21 years). At the time of
enrollment into the intervention, 78% of the YMSM had a critical or immediate need for stable housing,
nutrition support, substance abuse treatment, or mental health services. Among intervention participants
(n �61), 90% were retained in primary HIV care at three months and 70% at six months. Among those who had
previously been in intermittent care (n �33), the proportion attending all HIV primary care visits in the previous
six months increased from 7% to 73% following participation in the intervention (pB0.0001). Retention in HIV
care at six months was associated with increased number of intervention visits (p �0.05), more hours in the
intervention (p �0.02), and prescription of HAART. These data highlight the critical needs of HIV-positive
African-American and Latino YMSM and demonstrate that a clinic-based YCM can be effective in stabilizing
hard-to-reach clients and retaining them in consistent HIV care.
Keywords: adolescents; MSM; HIV/AIDS; Latinos; African-Americans; interventions
Introduction
National HIV and AIDS rates are elevated for
African-American and Latino youth which is consis-
tent with 2008 behavioral surveillance data in Los
Angeles County in which HIV prevalence rates were
17% for African-American and 13% for Latino
18�24-year-old young men who have sex with men
(YMSM) (Bingham & Sey, 2009;.
Il s'agit d'une fiche technique sur la prévention du VIH parmi les trans.
Non datée, elle est le fruit du travail de Rita Melendez, de la San Francisco State University, Valerie Spencer de la Charles R. Drew University, et David Whittier, du Centers for Disease Control and Prevention.
Transgender Female Youth And Sex Work HIV Risk And A Comparison Of Life Facto...Santé des trans
( A I D S Behavior, 2009)
L'article examine les déterminants du risque d'acquisition du VIH par les jeunes femmes trans du fait de leurs "facteurs de vie", en particulier en regard leur statut par rapport au travail sexuel.
A youth-focused case management intervention to engage and ret.docxransayo
A youth-focused case management intervention to engage and retain young gay men of color
in HIV care
Amy Rock Wohl
a
*, Wendy H. Garland
a
, Juhua Wu
b
, Chi-Wai Au
b
, Angela Boger
b
, Rhodri Dierst-Davies
a
,
Judy Carter
b
, Felix Carpio
c
and Wilbert Jordan
d
a
Los Angeles County Department of Public Health, HIV Epidemiology Program, Los Angeles, CA, USA;
b
Los Angeles County
Department of Public Health, Office of AIDS Programs and Policy, Los Angeles, CA, USA;
c
AltaMed Health Services
Corporation, Daniel V. Lara Clinic, Los Angeles, CA, USA;
d
Los Angeles County MLK-MACC, OASIS Clinic, Los Angeles,
CA, USA
(Received 5 April 2010; final version received 18 November 2010)
HIV-positive Latino and African-American young men who have sex with men (YMSM) have low rates of
engagement and retention in HIV care. An evaluation of a youth-focused case management intervention (YCM)
designed to improve retention in HIV care is presented. HIV-positive Latino and African-American YMSM, ages
18�24, who were newly diagnosed with HIV or in intermittent HIV care, were enrolled into a psychosocial case
management intervention administered by Bachelor-level peer case managers at two HIV clinics in Los Angeles
County, California. Participants met weekly with a case manager for the first two months and monthly for the
next 22 months. Retention in HIV primary care at three and six months of follow-up was evaluated as were
factors associated with retention in care. From April 2006 to April 2009, 61 HIV-positive participants were
enrolled into the intervention (54% African-American, 46% Latino; mean age 21 years). At the time of
enrollment into the intervention, 78% of the YMSM had a critical or immediate need for stable housing,
nutrition support, substance abuse treatment, or mental health services. Among intervention participants
(n �61), 90% were retained in primary HIV care at three months and 70% at six months. Among those who had
previously been in intermittent care (n �33), the proportion attending all HIV primary care visits in the previous
six months increased from 7% to 73% following participation in the intervention (pB0.0001). Retention in HIV
care at six months was associated with increased number of intervention visits (p �0.05), more hours in the
intervention (p �0.02), and prescription of HAART. These data highlight the critical needs of HIV-positive
African-American and Latino YMSM and demonstrate that a clinic-based YCM can be effective in stabilizing
hard-to-reach clients and retaining them in consistent HIV care.
Keywords: adolescents; MSM; HIV/AIDS; Latinos; African-Americans; interventions
Introduction
National HIV and AIDS rates are elevated for
African-American and Latino youth which is consis-
tent with 2008 behavioral surveillance data in Los
Angeles County in which HIV prevalence rates were
17% for African-American and 13% for Latino
18�24-year-old young men who have sex with men
(YMSM) (Bingham & Sey, 2009;.
Il s'agit d'une fiche technique sur la prévention du VIH parmi les trans.
Non datée, elle est le fruit du travail de Rita Melendez, de la San Francisco State University, Valerie Spencer de la Charles R. Drew University, et David Whittier, du Centers for Disease Control and Prevention.
Jill Blumenthal MD of UC San Diego presents "Free to Be You and Me: Providing Culturally-Sensitive Patient Care to Transgender Individuals" at AIDS Clinical Rounds
HEALTH POLICY AND ETHICSFacilitating HIV DisclosureFac.docxpooleavelina
HEALTH POLICY AND ETHICS
Facilitating HIV Disclosure
Facilitating HIV Disclosure Across Diverse Settings: A Review
Carla Makhlouf Obermeyer, DSc, Parijat Baijal, MA, and Elisabetta Pegurri, MSc
HIV status disclosure is cen-
tral to debates about HIV be-
cause of its potential for HIV
prevention and its links to pri-
vacy and confidentiality as hu-
man-rights issues.
Our review of the HIV-dis-
closure literature found that
few people keep their status
completely secret; disclosure
tends to be iterative and to be
higher in high-income coun-
tries; gender shapes disclosure
motivations and reactions; in-
voluntary disclosure and low
levels of partner disclosure
highlight the difficulties faced
by health workers; the mean-
ing and process of disclosure
differ across settings; stigmati-
zation increases fears of disclo-
sure; and the ethical dilemmas
resulting from competing
values concerning confidenti-
ality influence the extent to
which disclosure can be facil-
itated.
Our results suggest that
structural changes, including
making more services avail-
able, could facilitate HIV dis-
closure as much as individual
approaches and counseling
do. (Am J Public Health. 2011;
101:1011–1023. doi:10.2105/
AJPH.2010.300102)
THE TOPIC OF HIV STATUS
disclosure is central to debates
about HIV, because of its links to
confidentiality and privacy as hu-
man-rights issues and its potential
role in prevention.1 Disclosure is
also considered a way to ‘‘open up’’
the HIV epidemic2 and hence is
a crucial step toward ending stigma
and discrimination against people
living with HIV and AIDS
(PLWHA). Recognizing its impor-
tance, a number of researchers
have reviewed the literature on
disclosure by women,3 by men,4 or
by parents to children.5 Others
have reviewed what is known
about the factors associated with
disclosure, including the connec-
tions among stigma, disclosure, and
social support for PLWHA6; the
links among disclosure, personal
identity, and relationships7; and
client and provider experiences
with HIV partner counseling and
referral.8 We sought to comple-
ment existing reviews by including
available information on low- and
middle-income countries, which are
poorly represented in all but 1 of
the extant literature reviews, and by
focusing on the role of health ser-
vices and health care providers in
HIV disclosure.
Recently, increased attention to
transmission within serodiscordant
couples has highlighted the po-
tential role of disclosure as a way
to encourage prevention.9 More-
over, as countries scale up HIV
testing, counseling, and treatment,
better evidence is needed to inform
laws and policies, particularly re-
garding how best to facilitate dis-
closure while protecting medical
confidentiality. Ongoing debates
about mandatory disclosure to
partners, health workers’ role in
disclosing without patients’ consent,
and the criminalization of HIV
transmission raise important ques-
tions about the place of disclosur ...
Transgender Health : Findings From Two Needs Assessment Studies In PhiladelphiaSanté des trans
Transgender Health: Findings from Two Needs Assessment Studies in Philadelphia.
Il s'agit d'un article de Gretchen P. Kenagy, paru dans la revue Health and Social Work (volume: 30. Issue: 1) en 2005.
Il présente les résultats de deux enquêtes de recueil des besoins des trans en matière de santé à Philadelphie.
Invisible Men who have Sex with Men and Survival: From Practice to Research a...Jim Pickett
John Schneider's, University of Chicago, presentation at the Sex in the City II: Men, Sex, Love and HIV conference, held in Chicago on September 25, 2014. Sponsored by AIDS Foundation of Chicago and other partners.
EXPLORING U.S. MINORITY ATTITUDES TOWARDS CLINICAL TRIALSCOUCH Health
Patient diversity is still a huge issue in clinical trials. And like us, you might be wondering why this is still an ongoing challenge, and how can it be improved?
This report summarises research from ethnic minority groups in the US to find the answers to those very questions.
Do you feel the assessment was an appropriate tool If so, why, an.docxelinoraudley582231
Do you feel the assessment was an appropriate tool? If so, why, and how could it be beneficial? If not, what were the drawbacks of the assessments?
The Female Sexual Function Index comes out as an assessment tool which mainly focuses on women, therefore, accomplishing its intended purpose. Each of the 19 items tested by the series of questions in the questionnaire touches on the sexual experiences of women prior to, during, or before sexual intercourse making it an appropriate tool to measure the sexual functioning of women. This tool is beneficial for clinical diagnosis of female sexual dysfunction and can be used to identify signs and symptoms of female orgasmic disorder (FOD) and hypoactive sexual desire disorder (HSDD) in women (Metson, 2003).
How? The series of questions focuses on six domains which are; desire, arousal, lubrication, orgasm, satisfaction, and pain. Each of the questions is classified under either domain mainly focusing on the female experiences over time. For example, when it comes to desire, there are two questions which ask about the frequency of sexual desire in the past one month as well as the degree of sexual desire over the same time period. Thus, we can argue that each of the domains has been intensively investigated to come up with the most viable result to be used for the relevant clinical purposes. Besides this, the assessment tool is reliable and relevant since it can be used to indicate different variables in each of the tested domains. The different responses for every question have been assigned different scores which are consistent with the kind of feedback which is to be expected.
References
Cindy M. Metson, (2003). Validation of the Female Sexual Function Index (FSFI) in Women with Female Orgasmic Disorder and in Women with Hypoactive Sexual Desire Disorder. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872178/
According to the CDC the HIV/AIDS reports, African-Americans are disproportionately affected by HIV/AIDS and disparity continues to widen. African Americans represent approximately 12% of the U.S. population, but they account for approximately 43% of HIV diagnoses. The African-Americans who die of HIV/Aids represents 44% of the deaths in the U.S. The worst hit category are the black women, the youths, gays and bisexual men. Dr. Donna Hubbard McCree (2013) notes that HIV/AIDS epidemics among the blacks results from factors including poverty, lack of awareness of HIV status, stigma that prevent the majority from seeking help, high rate of sexually transmitted infection, sexual networks, lack of access to adequate health care and lack sexual education among the most affected population.
Even though recent reports demonstrate encouraging trends of reducing HIV infections among the black population, new diagnoses still occur among the black gay and bisexual men. Therefore, even with continued intervention, disproportionate trends continue among the black population continue to be re.
Social services utilization and need among a community sample .docxrosemariebrayshaw
Social services utilization and need among a community sample of persons living with HIV
in the rural south
Katharine E. Stewart, Martha M. Phillips, Jada F. Walker*, Sarah A. Harvey and Austin Porter
Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, USA
(Received 7 December 2009; final version received 16 June 2010)
HIV prevalence has increased faster in the southern USA than in other areas, and persons living with HIV
(PLWHIV) in the south are often rural, impoverished, or otherwise under-resourced. Studies of urban PLWHIV
and those receiving medical care suggest that use of social services can enhance quality of life and some medical
outcomes, but little is known about patterns of social service utilization and need among rural southern
PLWHIV. The AIDS Alabama needs assessment survey, conducted in 2007, sampled a diverse community cohort
of 476 adult PLWHIV representative of the HIV-positive population in Alabama (66% male, 76% Black, and
26% less than high school education). We developed service utilization/need (SUN) scores for each of 14 social
services, and used regression models to determine demographic predictors of those most likely to need each
service. We then conducted an exploratory factor analysis to determine whether certain services clustered together
for the sample. Case management, assistance obtaining medical care, and financial assistance were most
commonly used or needed by respondents. Black respondents were more likely to have higher SUN scores for
alcohol treatment and for assistance with employment, housing, food, financial, and pharmacy needs;
respondents without spousal or partner relationships had higher SUN scores for substance use treatment.
Female respondents were more likely to have higher SUN scores for childcare assistance. Black respondents and
unemployed respondents were more likely to have SUN scores in the highest quartile of the overall score
distribution. Factor analysis yielded three main factors: basic needs, substance use treatment, and legal/medical
needs. These data provide important information about rural southern PLWHIV and their needs for ancillary
services. They also suggest clusters of service needs that often occur among PLWHIV, which may help case
managers and other service providers work proactively to identify important gaps in care.
Keywords: HIV; health services utilization; rural; south; need
Introduction
The prevalence of HIV infection has increased
rapidly in the southern USA compared to the other
areas of the country (Foster, 2007; Reif, Geonnotti,
& Whetten, 2006) and southern states are among
those with the highest AIDS-related death rates in the
country (Reif, Geonnotti, et al., 2006; Whetten &
Reif, 2006). For example, in 2006, Alabama had an
age-adjusted HIV mortality rate of 4.2 per 100,000
persons, compared to 4.0 per 100,000 persons in the
USA (Heron et al., 2009). Several issues in the south
have been considere.
TRT-5 - Rapport consultation communautaire PrEP (final)Santé des trans
Engagé dans l'élaboration d'un essai de traitement antirétroviral donné en prophylaxie pré-exposition (PrEP), le groupe interassociatif de lutte contre le sida TRT-5 (www.trt-5.org) a coordonné une consultation communautaire sur l'essai.
Les données issues de ce processus mené au printemps 2010 figurent dans ce rapport.
More Related Content
Similar to HIV Prevention And Health Service Needs Of The Transgender Community In San Francisco
Jill Blumenthal MD of UC San Diego presents "Free to Be You and Me: Providing Culturally-Sensitive Patient Care to Transgender Individuals" at AIDS Clinical Rounds
HEALTH POLICY AND ETHICSFacilitating HIV DisclosureFac.docxpooleavelina
HEALTH POLICY AND ETHICS
Facilitating HIV Disclosure
Facilitating HIV Disclosure Across Diverse Settings: A Review
Carla Makhlouf Obermeyer, DSc, Parijat Baijal, MA, and Elisabetta Pegurri, MSc
HIV status disclosure is cen-
tral to debates about HIV be-
cause of its potential for HIV
prevention and its links to pri-
vacy and confidentiality as hu-
man-rights issues.
Our review of the HIV-dis-
closure literature found that
few people keep their status
completely secret; disclosure
tends to be iterative and to be
higher in high-income coun-
tries; gender shapes disclosure
motivations and reactions; in-
voluntary disclosure and low
levels of partner disclosure
highlight the difficulties faced
by health workers; the mean-
ing and process of disclosure
differ across settings; stigmati-
zation increases fears of disclo-
sure; and the ethical dilemmas
resulting from competing
values concerning confidenti-
ality influence the extent to
which disclosure can be facil-
itated.
Our results suggest that
structural changes, including
making more services avail-
able, could facilitate HIV dis-
closure as much as individual
approaches and counseling
do. (Am J Public Health. 2011;
101:1011–1023. doi:10.2105/
AJPH.2010.300102)
THE TOPIC OF HIV STATUS
disclosure is central to debates
about HIV, because of its links to
confidentiality and privacy as hu-
man-rights issues and its potential
role in prevention.1 Disclosure is
also considered a way to ‘‘open up’’
the HIV epidemic2 and hence is
a crucial step toward ending stigma
and discrimination against people
living with HIV and AIDS
(PLWHA). Recognizing its impor-
tance, a number of researchers
have reviewed the literature on
disclosure by women,3 by men,4 or
by parents to children.5 Others
have reviewed what is known
about the factors associated with
disclosure, including the connec-
tions among stigma, disclosure, and
social support for PLWHA6; the
links among disclosure, personal
identity, and relationships7; and
client and provider experiences
with HIV partner counseling and
referral.8 We sought to comple-
ment existing reviews by including
available information on low- and
middle-income countries, which are
poorly represented in all but 1 of
the extant literature reviews, and by
focusing on the role of health ser-
vices and health care providers in
HIV disclosure.
Recently, increased attention to
transmission within serodiscordant
couples has highlighted the po-
tential role of disclosure as a way
to encourage prevention.9 More-
over, as countries scale up HIV
testing, counseling, and treatment,
better evidence is needed to inform
laws and policies, particularly re-
garding how best to facilitate dis-
closure while protecting medical
confidentiality. Ongoing debates
about mandatory disclosure to
partners, health workers’ role in
disclosing without patients’ consent,
and the criminalization of HIV
transmission raise important ques-
tions about the place of disclosur ...
Transgender Health : Findings From Two Needs Assessment Studies In PhiladelphiaSanté des trans
Transgender Health: Findings from Two Needs Assessment Studies in Philadelphia.
Il s'agit d'un article de Gretchen P. Kenagy, paru dans la revue Health and Social Work (volume: 30. Issue: 1) en 2005.
Il présente les résultats de deux enquêtes de recueil des besoins des trans en matière de santé à Philadelphie.
Invisible Men who have Sex with Men and Survival: From Practice to Research a...Jim Pickett
John Schneider's, University of Chicago, presentation at the Sex in the City II: Men, Sex, Love and HIV conference, held in Chicago on September 25, 2014. Sponsored by AIDS Foundation of Chicago and other partners.
EXPLORING U.S. MINORITY ATTITUDES TOWARDS CLINICAL TRIALSCOUCH Health
Patient diversity is still a huge issue in clinical trials. And like us, you might be wondering why this is still an ongoing challenge, and how can it be improved?
This report summarises research from ethnic minority groups in the US to find the answers to those very questions.
Do you feel the assessment was an appropriate tool If so, why, an.docxelinoraudley582231
Do you feel the assessment was an appropriate tool? If so, why, and how could it be beneficial? If not, what were the drawbacks of the assessments?
The Female Sexual Function Index comes out as an assessment tool which mainly focuses on women, therefore, accomplishing its intended purpose. Each of the 19 items tested by the series of questions in the questionnaire touches on the sexual experiences of women prior to, during, or before sexual intercourse making it an appropriate tool to measure the sexual functioning of women. This tool is beneficial for clinical diagnosis of female sexual dysfunction and can be used to identify signs and symptoms of female orgasmic disorder (FOD) and hypoactive sexual desire disorder (HSDD) in women (Metson, 2003).
How? The series of questions focuses on six domains which are; desire, arousal, lubrication, orgasm, satisfaction, and pain. Each of the questions is classified under either domain mainly focusing on the female experiences over time. For example, when it comes to desire, there are two questions which ask about the frequency of sexual desire in the past one month as well as the degree of sexual desire over the same time period. Thus, we can argue that each of the domains has been intensively investigated to come up with the most viable result to be used for the relevant clinical purposes. Besides this, the assessment tool is reliable and relevant since it can be used to indicate different variables in each of the tested domains. The different responses for every question have been assigned different scores which are consistent with the kind of feedback which is to be expected.
References
Cindy M. Metson, (2003). Validation of the Female Sexual Function Index (FSFI) in Women with Female Orgasmic Disorder and in Women with Hypoactive Sexual Desire Disorder. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872178/
According to the CDC the HIV/AIDS reports, African-Americans are disproportionately affected by HIV/AIDS and disparity continues to widen. African Americans represent approximately 12% of the U.S. population, but they account for approximately 43% of HIV diagnoses. The African-Americans who die of HIV/Aids represents 44% of the deaths in the U.S. The worst hit category are the black women, the youths, gays and bisexual men. Dr. Donna Hubbard McCree (2013) notes that HIV/AIDS epidemics among the blacks results from factors including poverty, lack of awareness of HIV status, stigma that prevent the majority from seeking help, high rate of sexually transmitted infection, sexual networks, lack of access to adequate health care and lack sexual education among the most affected population.
Even though recent reports demonstrate encouraging trends of reducing HIV infections among the black population, new diagnoses still occur among the black gay and bisexual men. Therefore, even with continued intervention, disproportionate trends continue among the black population continue to be re.
Social services utilization and need among a community sample .docxrosemariebrayshaw
Social services utilization and need among a community sample of persons living with HIV
in the rural south
Katharine E. Stewart, Martha M. Phillips, Jada F. Walker*, Sarah A. Harvey and Austin Porter
Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, USA
(Received 7 December 2009; final version received 16 June 2010)
HIV prevalence has increased faster in the southern USA than in other areas, and persons living with HIV
(PLWHIV) in the south are often rural, impoverished, or otherwise under-resourced. Studies of urban PLWHIV
and those receiving medical care suggest that use of social services can enhance quality of life and some medical
outcomes, but little is known about patterns of social service utilization and need among rural southern
PLWHIV. The AIDS Alabama needs assessment survey, conducted in 2007, sampled a diverse community cohort
of 476 adult PLWHIV representative of the HIV-positive population in Alabama (66% male, 76% Black, and
26% less than high school education). We developed service utilization/need (SUN) scores for each of 14 social
services, and used regression models to determine demographic predictors of those most likely to need each
service. We then conducted an exploratory factor analysis to determine whether certain services clustered together
for the sample. Case management, assistance obtaining medical care, and financial assistance were most
commonly used or needed by respondents. Black respondents were more likely to have higher SUN scores for
alcohol treatment and for assistance with employment, housing, food, financial, and pharmacy needs;
respondents without spousal or partner relationships had higher SUN scores for substance use treatment.
Female respondents were more likely to have higher SUN scores for childcare assistance. Black respondents and
unemployed respondents were more likely to have SUN scores in the highest quartile of the overall score
distribution. Factor analysis yielded three main factors: basic needs, substance use treatment, and legal/medical
needs. These data provide important information about rural southern PLWHIV and their needs for ancillary
services. They also suggest clusters of service needs that often occur among PLWHIV, which may help case
managers and other service providers work proactively to identify important gaps in care.
Keywords: HIV; health services utilization; rural; south; need
Introduction
The prevalence of HIV infection has increased
rapidly in the southern USA compared to the other
areas of the country (Foster, 2007; Reif, Geonnotti,
& Whetten, 2006) and southern states are among
those with the highest AIDS-related death rates in the
country (Reif, Geonnotti, et al., 2006; Whetten &
Reif, 2006). For example, in 2006, Alabama had an
age-adjusted HIV mortality rate of 4.2 per 100,000
persons, compared to 4.0 per 100,000 persons in the
USA (Heron et al., 2009). Several issues in the south
have been considere.
TRT-5 - Rapport consultation communautaire PrEP (final)Santé des trans
Engagé dans l'élaboration d'un essai de traitement antirétroviral donné en prophylaxie pré-exposition (PrEP), le groupe interassociatif de lutte contre le sida TRT-5 (www.trt-5.org) a coordonné une consultation communautaire sur l'essai.
Les données issues de ce processus mené au printemps 2010 figurent dans ce rapport.
Transgender Identity And HIV : Resilience In The Face Of StigmaSanté des trans
Il s'agit d'un article de Walter Bockting, publié en 2008 dans Focus, une publication du AIDS Health Project, affilié à l'University of California, San Francisco.
Il s'agit d'une présentation powerpoint de la Directrice du Center Of Excellence For Transgender HIV Prevention,UCSF (2009)
Il y est question d'épidémiologie, bien évidemment, dans un contexte où n'existe aux Etats-Unis (comme en France) aucune donnée nationale sur le nombre de personnes trans, et donc encore moins sur le nombre de trans vivant avec le VIH. La présentation donne des pistes de recommandation concernant la production de données épidémiologiques spécifiques.
La présentation est également l'occasion de passer en revue les enjeux et déterminants de santé liés à l'épidémie de VIH chez les trans, et plus largement à leur état de santé.
Objectifs de l'épidémiologie du VIH chez les personnes trans :
- comprendre les tendances épidémiologiques en cours dans les populations transgenres ;
- comprendre les facteurs favorisant le risque de dissémination du VIH parmi les femmes transgenres
(déterminants négatifs) ;
- comprend les facteurs protecteurs contre les "facteurs négatifs du point de vue de la santé" (negative health outcomes) parmi les transgenres (déterminants positifs).
Transgender Clients : We Need Effective Care Too!Santé des trans
Il s'agit d'une présentation powerpoint de la Directrice du Center of excellence for transgender HIV prevention de l'UCSF, qui passe en revue l'ensemble des enjeux liés à l'épidémie de sida parmi les trans, ainsi que les déterminants de santé globaux. Date inconnue.
Plan de l'intervention
Getting on the Same Page:
Establishing a Common Language
What Are the Facts?
What is the HIV Prevalence among Trans People in the US?
Effects of Stigma & Discrimination on Trans Communities
What are the Barriers and Challenges?
What Are We Going To Do?
Addressing Transphobia
Action Steps & Recommendations
Where do we go for help?
Access To Health Care For Transgendered Persons In Greater BostonSanté des trans
Il s'agit du rapport de l'enquête réalisée en 2000 par l'organisme JSI Research & Training Institute dans le cadre du projet "GLTB Health Access".
Menée auprès de personnes trans recrutées à Boston et dans les environs, l'enquête a investigué les facteurs pouvant contribuer à un meilleur accès aux soins des trans et à la fourniture de services de santé adaptés.
Ce document de la National Coalition for LGBT Health américaine est le fruit du travail de son "Eliminating Disparities Working Group", publié en 2004.
Il présente les chantiers identifiés de sorte à faire reconnaître et mieux prendre en compte les enjeux de santé des trans. Il balaie un large spectre de déterminants de santé : violences, VIH/sida et des autres IST, usage abusif de produits psychoactifs, santé et bien-être mental, couverture maladie, traitements hormonaux, modifications corporelles auto-réalisées, formation des professionnels de santé, tabac etc.
Providing Culturally Sensitive Care For Transgender PatientsSanté des trans
Providing Culturally Sensitive Care for Transgender Patients.
Cet article est paru en 2005 dans la revue Cognitive And Behavioral Practice. Il présente les résultats d'une enquête qualitative menée auprès de MtF sur leur parcours de vie et de transition.
Il plaide pour la fourniture de soins de santé "trans friendly", fondés sur une meilleure connaissance par les professionnels de santé des problématiques de vie des personnes trans.
Transgender Primary Medical Care Suggested Guidelines For Clinicians in Bri...Santé des trans
Transgender Primary Medical Care Suggested Guidelines For Clinicians in British Columbia
Il s'agit de recommandations de bonnes pratiques destinées aux soignants de Colombie britannique publiées en janvier 2006. Elles sont le fruit de la collaboration entre trois organisations : Vancouver Coastal Health, Transcend Transgender Support & Education Society, and the Canadian Rainbow Health Coalition.
Cette publication a pour objectif de fournir aux soignants de cette province canadienne des clefs de compréhension et des outils nécessaires à la prise en compte des enjeux de santé des personnes trans dans leur globalité, y compris leurs spécificités.
Trans : les oublié-e-s de la Conférence de TorontoSanté des trans
Il s'agit d'un article publié dans le numéro spécialement consacré à la Conférence mondiale de lutte contre le sida de Toronto (2006) de la revue Transcriptases (n° 129, octobre 2006).
A travers une revue des résumés soumis à la Conférence en vue d'y obtenir la possibilité d'y présenter des recherches ou des programmes, l'auteur souligne la quasi-invisibilité des enjeux des personnes trans au sein de la Conférence. Il envisage les questions soulevées par les acteurs de la lutte contre le sida : prévalence du VIH, connaissance des comportements et des déterminants de santé, actions spécifiques de prévention et de soutien, santé sexuelle, droits humains bien entendu.
Rencontre du CRIPS / Act Up-Paris "Personnes trans : quels enjeux de santé ?"...Santé des trans
Le 26 juin 2007 se tenait la 67ème Rencontre du CRIPS Île-de-France, en partenariat avec Act Up-Paris, consacrée au thème : "Personnes trans : quels enjeux de santé ?".
Il s'agit du dossier documentaire constitué à cette occasion. Il comporte nombre d'articles et documents qui sont autant d'outils et de ressources utiles à la réflexion, et à l'action militante.
Estimating HIV prevalence and risk behaviors of transgender persons in the Un...Santé des trans
Cet article, paru en 2008 dans la revue AIDS and Behavior, présente une synthèse des données disponibles dans la littérature scientifique concernant la prévalence du VIH parmi les trans aux Etats-Unis et leurs facteurs de risque comportementaux par rapport à la transmission du virus.
Il s'agit d'un article d'Emilia Lombardi, paru en 2001 dans l'American Journal of Public Health, qui identifie des enjeux de santé spécifiques aux personnes trans et plaide pour leur reconnaissance et leur prise en compte par les acteurs des systèmes et des politiques de santé.
Il s'agit d'un "fact sheet" (fiche d'information, fiche technique) publiée (19 juin 2007) par le Center for Diseases Control, organisme public en charge de la veille épidémiologique et de la prévention aux Etats-Unis.
Il fait le point sur les connaissances disponibles sur le VIH/sida chez les personnes transgenres aux Etats-Unis. Il présente les éléments qui font penser que l'épidémie sévit sévèrement parmi elles.
Transsexuel(le)s : conditions et style de vie, santé perçue et comportements ...Santé des trans
Transsexuel(le)s : conditions et style de vie, sante perçue et comportements sexuels. Résultats d'une enquête exploratoire par Internet, 2007
Il s'agit de la publication, dans le Bulletin Epidémiologique Hebdomadaire en date du 1er juillet 2007, des résultats de l'enquête exploratoire menée par le CRIPS Île-de-France et Act Up-Paris avec le soutien de France Lert (Inserm) à l'occasion de la rencontre organisée en juin de la même année sur les enjeux de santé des personnes trans.
Antirétroviraux et traitements hormonaux chez les personnes transSanté des trans
Il s'agit d'un article de Nicolas Hacher, endocrinologue, paru dans la revue Transcriptases, éditée par l'association Pistes.
Ce texte a également été publié dans l'édition 2006 du rapport d'experts sur la prise en charge médicale des personnes vivant avec le VIH (rapport dit Yeni), afin de promouvoir la prise en compte des interactions possibles entre antirétroviraux et traitements hormonaux chez les personnes trans séropositives.
Rencontre du CRIPS / Act Up-Paris : "Personnes trans : quels enjeux de santé ...Santé des trans
Le 28 juin 2007 se tenait la 67ème Rencontre du CRIPS Île-de-France, en partenariat avec Act Up-Paris, consacrée au thème : "Personnes trans : quels enjeux de santé ?".
Ce document est le compte-rendu des présentations et des débats qui s'y sont déroulé-e-s.
Lors de la Rencontre, ont été présentés les résultats de l'enquête menée par Internet au cours des semaines précédentes auprès de personnes trans sur leur "situation au regard de la santé".
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
HIV Prevention And Health Service Needs Of The Transgender Community In San Francisco
1. HIV Prevention and Health Service Needs of the Transgender Community in
San Francisco
by Kristen Clements, MPH*; Willy Wilkinson; Kerrily Kitano, PhD; Rani Marx, PhD
MPH
Citation: Clements K., Wilkinson W., Kitano K., Ph.D., Marx R., Ph.D. (1999) HIV Prevention and
Health Service Needs of the Transgender Community in San Francisco. IJT 3,1+2,
http://www.symposion.com/ijt/hiv_risk/clements.htm
* Correspondence and requests for materials to:
Kristen Clements, MPH
San Francisco Department of Public Health, AIDS Office
25 Van Ness Avenue, Suite #500
San Francisco, California
94102
phone: (415) 554-9496
email: kristen_clements@dph.sf.ca.us
• Abstract
• Background
• Methods
• Results
• HIV Risk Behaviors
• HIV Prevention and Health Service Barriers
• Unmet Need: HIV Prevention Interventions
• Unmet Need: HIV Health Services
• Suggestions for Improving Services
• Discussion of Findings
• Limitations and Conclusions
Abstract
Objective: To qualitatively describe the level of HIV risk behaviors and access to HIV-
prevention and health services among transgendered individuals in San Francisco.
Methods: Eleven focus groups were conducted with 100 Male-To-Female and Female-
To-Male transgendered individuals. Focus groups were transcribed, reviewed, and
comments were coded into categories that emerged naturally from the data. Unduplicated
2. comments were enumerated and summarized.
Findings: HIV risk behaviors such as unprotected sex, commercial sex work, and
injection drug use were common. Low self-esteem, economic necessity, and substance
abuse were cited as common barriers to adopting and maintaining safer behaviors. Many
individuals did not access prevention and health services because of competing priorities
and the insensitivity of service providers. Participants’ recommendations for improving
services include hiring transgendered persons to develop and implement programs and
training existing providers in transgender sensitivity and standards of care.
Background
Previous research suggests that transgendered persons in the United States are at high risk
for acquiring HIV. A small study of transgendered sex workers in Atlanta found that 68%
were seropositive for HIV, 81% had seromarkers for syphilis, and 80% had seromarkers
for hepatitis B.1 The prevalence of HIV infection in this population was much higher than
that of nontransgendered sex workers in the same neighborhoods. 2 A study with a more
representative sample of the transgender community found that 15% of transgendered
individuals seeking hormone therapy at a San Francisco public health clinic were infected
with HIV.3 Qualitative studies conducted in Minnesota, Boston, Los Angeles, and San
Francisco provide further evidence that many transgendered persons engage in behaviors
that may put them at risk for HIV such as injection drug use and commercial sex work.4-8
These qualitative studies also identify psychosocial factors, such as low socioeconomic
status, social isolation, and low self esteem, that are probably associated with risk taking
behaviors.
Although important, there are a number of limitations that characterize prior research. To
date, all studies have focused almost exclusively on Male-To-Female (MTF) populations
despite anecdotal evidence that suggests many Female-To-Male (FTM) transgendered
individuals are also at risk for HIV infection (from injecting hormones and having
unprotected anal sex with gay men). In addition, past studies have sampled a very small
number of individuals (often less than 20), limiting the analysis and generalizeability of
findings.
We conducted eleven focus groups with a large (n=100) and diverse group of MTF and
FTM transgendered persons in San Francisco to assess their HIV risk and access to HIV
prevention and health services. We found high rates of HIV risk behaviors such as
unprotected sex, commercial sex work, and injection drug use. Participants cited low self-
esteem, substance abuse, and economic necessity as common barriers to adopting and
maintaining safer behaviors. Participants also stated that competing priorities, fear of
discrimination, and the insensitivity of service providers were the primary factors that
keep them, and other transgendered people they know, from accessing HIV prevention
and health services. Participants’ recommendations for improving services include hiring
transgendered persons to develop and implement programs and training existing
providers in transgender sensitivity and standards of care.
3. Methods
Sampling
From June 24 to August 8, 1996 ten focus groups were conducted at agencies with
existing services for the transgender population and one group was held in a San
Francisco county jail. There was one African American group, one Latina bilingual
group, one Latina monolingual group, two primarily Asian and Pacific Islander groups,
and one FTM group. The remaining groups were comprised of both MTF and FTM
participants of various racial/ethnic identities. Subjects were recruited primarily by HIV
prevention agency staff who had extensive experience working with the transgender
community in San Francisco. Many subjects had accessed the participating agency’s
services previously or had some contact with the agency staff.
Procedures
Each group was facilitated by a trained Department of Public Health (DPH) staff person
and a member of the transgender community. The facilitators all followed a standardized
outline and set of questions. Participants were asked to respond as a group to questions
that addressed access to and use of HIV prevention and health services in San Francisco
(table 1). Each participant was given a list of specific prevention interventions and health
care services available in San Francisco to ensure that everyone understood service
terminology. Although participants were not directly asked about HIV risk behaviors,
discussion of sex work, drug use, and unprotected sex was frequent in each of the focus
group sessions. Participants were assured complete anonymity, and were told that
disclosure of HIV status was voluntary. However, it is clear from self-disclosure that
individuals living with HIV were represented in most of the focus groups.
After the focus group was completed, participants were given a twenty dollar stipend and
were asked to complete a short, anonymous, questionnaire that assessed their
demographics. All focus groups were professionally taped by a transcriber who took
notes during the discussion and numbered responses of different individuals. The
monolingual Spanish group was transcribed by a Spanish speaking transcriber and was
translated by a Spanish speaking DPH staff person.
Coding and Analysis
The focus group transcripts were read and coded separately by two researchers trained in
qualitative analysis. Participants’ comments were coded into twenty-eight categories that
naturally emerged from the data in the following areas: (1) HIV risk behaviors; (2)
factors associated with HIV risk behaviors; (3) HIV prevention interventions; and
(4) HIV/AIDS-related services. Comments were transcribed verbatim and assigned to
the appropriate category; they were cross-referenced if they addressed more than one
category. Within categories, only comments from unduplicated individuals were
enumerated. For example, if one participant made several comments about a particular
issue or category, they were only counted once. Participants who made (unduplicated)
comments that indicated agreement with a previous comment were counted in the same
category as the original participant’s comment. The topic areas and quotes highlighted in
this manuscript are those with the highest number of unduplicated comments.
4. Comments about HIV prevention activities and HIV/AIDS-related services were counted
if they indicated unmet need (i.e., need for improved services or needing but not getting a
service). Though there were many comments describing participants’ use and awareness
of prevention interventions and HIV/AIDS-related services, we did not include them in
this analysis.
Table 1 -- Focus Group Questions
• What types of HIV prevention activities have you (or your clients) participated in?
Results
Sociodemographics
One hundred individuals participated in the eleven focus groups. Almost two thirds of the
sample was non-white, 29% of the sample was born in countries outside the United
States, and 28% reported that they usually speak a language other than English (table 2).
Participants ranged in age from 18 to 66 years; the average age was 35. Most of the
sample was Male-To-Female (82%) and self-identified as either straight or
bisexual/pansexual.
5. Asian or Pacific Islander* 11
Mixed Race / Multi-Ethnic 9
Native American 3
Nativity / Country of Origin
American Born 70
Foreign Born 29
Missing 1
Gender Identification
Transgender (MTF) 65
Female (born male) 12
Transsexual (MTF) 5
Transgender (FTM) 7
Male (born female) 3
Intersexed 2
Other 4
Missing 2
Sexual Orientation
Straight / Heterosexual 38
Bisexual/Pansexual 22
Gay / Homosexual 19
Other 12
Lesbian 5
Missing 4
* Asian and Pacific Islander category included:
Chinese, Filipino, Hawaiian, Lao, and Vietnamese
HIV Risk Behaviors
Sex Work
Although there were no focus group questions that specifically addressed sex work, this
issue was discussed at length in all of the focus groups except the FTM group. Many
focus group participants had engaged in sex work at some point in their lives and
discussed sex work as a pervasive issue in their communities. Participants said that
economic necessity was the main reason for personal and community involvement in
6. sex work. It was commonly stated that sex work or quot;survival sexquot; was the only option
for many transgendered people because of the severe job, housing, and education
discrimination that they face. Participants also observed a strong association between
drug use (particularly speed use) and sex work. Some participants said they use drugs to
quot;deal withquot; sex work and others stated that they engage in sex work to support their drug
addiction.
quot;The whole scenario of prostitution in our TG community is... I wish we could be
treated like anybody else and have the same job opportunities as anybody else... and I
wouldn’t have to go stand on the damn street. I’m a very intelligent person.quot;
quot;I’m on SSI, and I make almost $800 a month. I have a college education, I’ve owned
nightclubs, restaurants, I’ve been an actor, I’ve been a professional all my life. But my
choices now are to be on SSI disability and prostitute. I guess some girls can find jobs,
but there’s a lot of prejudice out there.quot;
quot;I know I have a little bit of money saved up. But that’s gonna run out sooner or later, so
I have to go back to my original support. And so I’m really taking a chance by doing
that. Which I know is wrong, but I’m not gonna starve either.quot;
quot;Most of the time it comes down to a couple of things. Number 1, it’s economics.
People are on drugs, and that’s the only way they can make money to get drugs. Number
2, there’s a fatalism aspect.quot;
Participants frequently described a cyclic pattern of engaging in sex work, being
incarcerated, and returning to sex work upon release due to lack of employment
opportunities. Many individuals who were currently in jail or had recently been
incarcerated stated that they were HIV positive and desperately wanted to obtain job
training and education to get out of sex work. However, the barriers to getting such
training were so great that they did not feel they would ever break out of the pattern of
prostitution and incarceration.
quot;I cannot go to school because I’m HIV-positive, and I’m going to end up being a
prostitute again, get arrested, lose my apartment. If I sell my body or use drugs I don’t
have my self-esteem..this whole circle.quot;
quot;All the girls that I know about, when they have HIV, they have nothin’ goin’ for
themselves whatsoever. When they get out of jail, only thing they have to do is resort
back to prostitution and come back in here again! When you have HIV, and you did
nothin’ for your entire life but prostitution, what is there else to do?quot;
quot;I was tested in court, and I came out positive. The judge told me that I would either
stop prostituting, or would have to serve the time in prison. But they don’t have
anything to help. They should have some kind of group or program that could point out
my alternatives.quot;
Another rationale given by participants for pervasive prostitution in the transgender
community was validation of one’s gender identity, though this was less frequently
7. mentioned than economic necessity. For many MTF participants, being paid to have sex
as a female (usually by heterosexually-identified clients) reinforced their gender identity
and boosted their self-esteem.
quot;There’s something about the glamour of being on the stroll. It’s fast, easy money.
Shake your tits, shake your tush, and have some guy slip you twenty, fifty, a hundred
dollars. It builds up your self-esteem!quot;
quot;Oh, somebody’s paying them, so they must look real, that validates their femininity.quot;
quot;There are a lot of TGs that have jobs, making 20, 30, 40 thousand dollars, but they still
go to the [bar] and prostitute, because it builds their self-esteem.quot;
Unprotected Sex
In all of the focus groups participants spoke about their own unsafe sexual behavior and
unsafe sex that occurs within their communities. Both MTF and FTM participants stated
that low-self esteem was the main reason for sexual risk taking. Many participants
mentioned that passing or being accepted sexually as male or female often contributes to
self-esteem and willingness to engage in unprotected sex and other high risk behaviors.
Participants also explained that society’s view of the transgender community takes an
enormous toll on their self-esteem, and can contribute to self-destructive behavior.
quot;When you have a low self-esteem and this fine guy comes up to you and it’s like, I
want to have sex with you, and he’s so fine, and you’re like, ’If I don’t use a condom,
he’s not gonna want to do it!’quot;
quot;I went out with a guy who I knew was HIV-positive, and I had unsafe sex with him
because he showed attraction for me. There’s a part of me that’s self destructive. I mean,
you know, we don’t really seem to matter! I mean, we put all this work into looking like
women. We do all this stuff... and it still isn’t good enough.quot;
quot;I’ve been in risky sexual situations just for the attention actually, or just for the
acceptance as being male.quot;
quot;For those of us who aren’t prostitutes, if we get recognition by a man as being a
woman, sometimes you just grab onto that, and maybe ordinarily you would be
cautious. In a case like that you just let it all out, cause someone’s accepting you as
female.quot;
FTM participants felt that engaging in unprotected sex was a part of exploring one’s
new gender identity. Many participants acknowledged a disassociation between their
gender identity and their physical bodies. This disassociation and denial about engaging
in certain types of sexual behaviors (i.e., an FTM who denies he has vaginal sex) are
barriers to engaging in protected sex. Many FTM participants also felt that testosterone
use increased their sex drive and the sexual risks they were willing to take. Several
FTMs also said they started to have sexual relations with men rather than women after
they started hormone therapy.
8. quot;I’ve visited some of the glory hole areas of the city. I have felt like it’s a place I can go
and experience sex with other men where I don’t have to worry about... are they gonna
read me as female?quot;
quot;For gay FTMs, we might be willing to do something with someone that's less than safe,
because it's like 'Oh my God, an opportunity to have this gay experience' I feel that.quot;
quot;My sex drive is totally different now (with testosterone use). It puts me in more of a
head space where I’m more likely to do riskier activities than I would’ve done before.quot;
quot;There’s less of a connection between our identities and our physical bodies. We behave
in ways sexually and take risks that maybe you wouldn’t think would fit our identity.quot;
MTF participants who engaged in sex work typically stated that they were more likely
to use condoms with quot;Johnsquot; than with their husbands, boyfriends, and nonpaying sex
partners. However, many stated that they have unprotected sex with clients if they are
paid more to do so. Some also stated that if they insisted on condom use they could be
physically abused by their clients.
quot;This city is so full of ignorance along these issues that a lot of girls, they feel like,
there’s nothin’ else they can do. They can’t even do the community college when it’s
free, because of the stigma so they wind up doing sex work. And they’re out there, and
yes, they want to use condoms, but goddammit, if they’ve gotta make rent... if they’ve
gotta keep somebody who expects something happy... if they want to eat, if they want
their drugs...quot;
quot;I’m asyptomatic... but it’s hard when dates think I look cute, and that I don’t look like
I’ve got AIDS and they don’t want to use a condom, and if it’s a $300 date, I’m like,
‘screw it’ and then I have unprotected sex with them anyways.quot;
quot;Remember, you are hungry, you haven't had anything for a couple of days, and this jerk
comes up and says, 'I have twenty dollars, and I don't want to use a condom.' What are
you gonna do? You're gonna take his twenty dollars, and you're gonna deal with this
freak. Sometimes they put you in a situation that you say, ’I have to do this’ because this
freak might come back and really attack me.quot;
Alcohol and Drug Use
Although there were no specific questions about substance use, there was discussion of
frequent injection and non-injection drug use in the transgender community. Several
individuals believed they became infected with HIV from sharing syringes. Participants
felt that the prevalence of drug use in their respective communities was a result of lack
of education and job opportunities, low self-esteem, and limited social support. As
stated before, participants felt that drug addiction and prostitution often coincide and are
mutually reinforcing.
quot;I'm shooting up on heroin, I'm shooting up on speed. I been using one needle for almost
a week and they say that’s how I got HIV.quot;
quot;A lot of the transsexuals I know who are prostitutes are having unprotected sex and
9. they’re also shooting up... and sharing needles.quot;
quot;A lot of FTMs in the community are struggling with drug and alcohol issues, and there
is no in-patient, or really adequate out-patient treatment to meet the needs of FTMs.quot;
quot;It’s about the self esteem issue. You feel like, at times, that you’re doomed to live your
life all by yourself, and that plays into HIV status, cause you figure, What the fuck? I
might as well go ahead and go out and have a good time, and die from it. I might as well
get loaded. What does it matter?quot;
quot;I have a girlfriend...at one time she was the most beautiful-est woman in the world.
Now she's living' in a hotel and smokin' crack! And that's the only thing she talks about!
'Please give me hit!' It’s because she has no support.quot;
HIV Prevention and Health Service Barriers
Competing Priorities
HIV was not a primary concern for many participants. There was general agreement
among participants that securing employment, housing, and substance abuse/mental
health treatment were more pressing issues for many transgendered people and such
issues had to be addressed before HIV prevention and/or treatment would be effective.
Participants underscored the need for transgender-specific job training, job placement,
housing placement, and substance abuse/mental health programs, including transgender
sensitivity training for landlords, employers, and service providers.
quot;Not looking at these other issues like employment that are not related directly to AIDS
prevention is an unwise thing to do. I think these things are all very interrelated and
interdependent. And they have to be addressed.quot;
quot;If you get the people off the drugs and the alcohol... you’re gonna cut down on both the
STDs and AIDS. And I’ll tell you right now that there is not a truly transgender friendly
recovery program in this city.quot;
quot;If it’s anything that pushes me...into tough, bad things, like drugs or coming up close
with AIDS, its the unemployment thing.quot;
quot;There are a lot of girls that are sex workers because they have no choice. It’s pure
survival. And we’re in desperate need of training and education, to upgrade our skills
and then find employers who will employ us. And in terms of long-term prevention, if
you cut down the number of sex workers, you’re gonna cut down AIDS, so I see job
training as vital.quot;
quot;Housing and employment are the biggest issues for our community. There’s major
discrimination through building owners. It took me four months to find an apartment
that would accept me besides roach coaches.quot;
Sensitivity of Providers
10. Participants in all of the focus groups highlighted the insensitivity of service providers
as a major barrier to receiving HIV prevention and health services. Participants stated
that they often experienced discrimination when they tried to obtain services,
particularly from quot;gay and lesbianquot; agencies. There was also frequent discussion about
providers who make assumptions about gender identity and do not differentiate MTF
clients from gay men, or FTM clients from butch lesbians. The FTM participants
expressed a great deal of concern that service providers have little knowledge about the
FTM population and do not understand their specific needs. Participants generally felt
that a transgendered person who has a negative experience when trying to receive
services is unlikely to return to the agency or seek other services in the future.
quot;A lot of the service organizations exclude us. They focus mainly on the lesbian and gay
community. I was at an agency, and these gay boys were just coming and going. I
waited two hours, and they just forgot about me! I would rather go to a heterosexual
organization and get help from them, than go to a lesbian and gay organization, because
a lot of times, the lesbian and gay community does leave us out.quot;
quot;Every time I've gotten tested, I've run across people looking at me, deciding that I'm
female, or deciding whatever, and then determining what my actions are, without asking
me. Don't assume what my activities are, based on how you perceive me.quot;
quot;They [the clinic staff] are up on all of the HIV stuff, but they don’t want to see us
transgenders there.quot;
quot;I went to [the clinic] and they refused to treat me as... a person, pretty much. I stated
that I was transgender, and they still called me by my boy’s name, just because it’s on
the record. And that really causes... well, I feel embarrassed. And that makes me
reluctant to go back to these services, because of past experience.quot;
quot;The girls don’t feel comfortable going to a male oriented clinic. I’m not a gay man, I
just can’t click with that. I’m a transsexual. I’m a woman, I’m not a man. I may have
been born male, but I’m not a man.quot;
quot;They [health care providers] know about MTF issues but not FTM at allquot;.
Unmet Need: HIV Prevention Interventions
Street Outreach
Participants emphasized the value of street-based outreach and education, but stated that
more outreach activities had to be conducted by outreach workers who are members of
the transgender community. Participants suggested that outreach activities need to be
expanded in an effort to reach hidden populations such as FTMs and MTF sex workers
who advertise their services in papers and do not hang out in the usual bar and street
settings. Many of the groups also introduced the idea of tailoring outreach efforts to the
male clientele of MTF sex workers, rather than always targeting the sex workers.
Overall, there was agreement that outreach workers need to offer all forms of safer sex
information and materials so that assumptions are not made about the sexual behaviors
11. of different transgendered individuals.
quot;We need to create an outreach program and have more of the transgender community
trained around issues of HIV and AIDS, where there are stipends, and have the
transgenders go out into the community and do the street outreach.quot;
quot;Ways of reaching out to different parts of the community are gonna have to be
adaptable to that community. With the FTM community, you’re probably gonna have to
go where they’re at or it’s gonna be like trying to find a needle in a haystack.quot;
quot;Thanks to all these sex ads and newspapers, you know, a lot of the working girls in the
community do not go out to bars any more, so it makes the outreach harder. Because
those girls want to stay invisible. The girls that are working out of the Spectator, the LA
Express, they don’t want to go in for services.quot;
quot;We need to reach and educate the men, the heterosexual-identified male clientele.quot;
Individual Risk Reduction and Education
Participants felt that HIV prevention education for individuals and their partners is very
important, but most believed such interventions are not effective because they are not
transgender specific. Many participants expressed concern that their gender
identification is not addressed in HIV risk reduction education and counseling sessions.
MTF individuals discussed the need for counseling and education that builds their self-
esteem; FTMs emphasized the need for counseling that directly addresses their new
gender and sexual identities.
quot;Counseling needs to address self-esteem. And there’s a lot of girls, and a lot of guys, in
the community, that are very low self esteem... because of mainly what has happened to
them in the past. And they will latch on to almost anybody that will pay attention to
them, especially when they want to be recognized as male or female.quot;
quot;I would like to see more counseling that addresses gay FTMs in a more direct way.quot;
quot;There needs to be a sufficient level of safety to talk about things like getting penetrated
in your vagina. I’m telling you, we [FTMs] are doing everything with everybody out
there. In every possible combination you can imagine. It’s important that those identities
and those sexual experiences be validated.quot;
HIV Prevention Support Groups
Participants expressed a need for a space where they could talk with their peers about
the complex issues and problems that they face. Frequent suggestions for improving
support groups included: 1) educating individuals about condom use and safe
hormone/drug injection; 2) improving self-esteem, 3) developing safer sex negotiation
skills, and 4) helping clients build job skills to facilitate a transition out of commercial
sex work. Participants also called for specific groups for FTMs, youth, and those who
speak languages other than English.
quot;The more we talk about this, the more I really am feeling that some kind of support
12. group-type environment would be really useful for us to have a space where we can talk
about the really specific things that are different from straight genetic men and gay
genetic men, the real specific issues around increasing sex drive, and trying to re-create
an identity for ourselves as sexual men.quot;
quot;We need more support. I’ve been attending this support group and it’s really good. I’m
at risk you know, I’m badly on drugs, and really didn’t care about anybody or myself.
But now my self esteem is really rising, and I am grateful to be here.quot;
quot;There are a lot of gay men who feel like, ’Well, I’m gonna get it anyway, so why
bother?’ And I, for the first time in my life, have experienced that. Feeling like, ’Oh, I’m
a gay man now, in San Francisco. Of course I’m gonna get it.’ I think it would be really
helpful for us to have groups where we can go and sit and talk about this, or just be able
to say, ’Well, I feel like this.’quot;
quot;They invited me to several support groups, but there's the language barrier. There are a
lot more in English. Why not Spanish? Why don't they ask us? Why isn't there a Latina
group?quot;
Culturally Appropriate Prevention Materials
Participants stated that HIV education, media, and referral materials were developed for
non-transgendered populations and the information is not factually or culturally
appropriate for the transgender community. For example, MTF individuals are often
given HIV education materials that were developed for either women or gay men.
However, such materials are usually ineffective because MTFs can’t identify with
messages and images that do not fit their body or self-image. Both MTF and FTM
participants discussed the importance of seeing transgender images that they can
identify with in HIV prevention media and education campaigns. There was also a lot of
discussion about the need for transgender-specific materials in a languages other than
English.
quot;My friend and I have never been exposed to any AIDS prevention. It's already a day
late and a dollar short for transgenders. Gays don't think of us as gay, we don't think of
ourselves as gay, so we ignore half of the advertising that's out there, it doesn't apply.quot;
quot;You always see AIDS posters, with two women together or two men together, or a man
and a woman, but you never see another transgender person with another man, or
woman, or another transgender person.quot;
Unmet Need: HIV Health Services
Primary Health Care for Transgendered Individuals Living with HIV
By far, the most common area of unmet service need for HIV-infected transgendered
people was primary medical care. Many comments were made about physicians’ lack of
knowledge about the effects and potential dangers of taking hormones and seeking
sexual reassignment surgery for those who are living with HIV. HIV-positive
participants stated that they receive extremely confusing messages from medical
13. providers and felt that they need more information about hormone therapy and sexual
reassignment surgery to make more informed decisions.
Discussion of the need for improved general health services for people living with HIV
centered on the need for affordable, accessible, and transgender-friendly health care and
greater inclusion of transgendered persons in AIDS clinical trials.
quot;A lot of doctors discourage transgenders who are HIV-positive to go through sex
reassignment surgery because it would suppress the immune system. I personally see
getting hormones and getting stuck, and I’m not really going anywhere. I feel like I’m in
limbo, taking hormone therapy and not able to have the operation. It’s affecting my self-
esteem and the way I see myself. I think a stronger self-esteem would be a better way to
cope with the virus.quot;
quot;I asked my doctor if I could keep using hormones after I found out I was HIV-positive
and he told me yes, but then I heard from another source that they can make you ill.quot;
quot;Clinical trials for HIV-infected people, very few if any include transgender persons.quot;
quot;I would like to see a health program open that is specific to the needs of the transgender
population. I would like for that agency to be culturally sensitive.quot;
HIV Peer Support Groups
Focus group participants stated that there are no support groups for HIV-infected
transgendered individuals to talk about the social, medical, and mental health issues they
face. Participants underscored the value of support groups in improving self-esteem,
increasing access to health care, and encouraging healthy lifestyles.
quot;I believe that most of the transgenders that are HIV-positive need an outlet, such as
support groups.quot;
quot;There are hundreds of support groups in the City, but there isn't a FTM HIV support
group. I've heard things here today that I identify with, that I've never heard before. That
says how little is available to us.quot;
Client Advocacy / Case Management
Client advocacy and case management were two important areas of unmet need for
transgendered people living with HIV. Participants who were HIV-infected stated that
they needed client advocacy services such as benefits counseling, legal assistance, and
housing placement. The lack of case management services for HIV-infected incarcerated
individuals who are released from jail was of concern to participants. Participants
related that most transgendered people are able to get adequate medical care when
incarcerated, but they are unable to maintain this level of health care once they return to
the community.
quot;If I’m sick and the clinic is all full, I have to go across town... and if I don’t have bus
tokens I’ll have to crawl there and you have to have below 200 t-cells to get SSI...being
on GA is not hacking it, you’ll live in a flea bag hotel... if you want to change your life
you’ve got to change your medical situation... seems like people would want me to keep
14. my body with high t-cells, my whole system being good and keep going in that
direction, instead of tearing me down.quot;
quot;A lot of my transgender girlfriends here in jail are HIV-positive, the care they receive
here is adequate enough, but a majority of them have no resources when they hit the
streets to maintain this care, and they go straight down the tubes again as far as their
health, their weight, their taking care of themselves.quot;
quot;I’ve spent two years waiting for my housing and now my number is 2,004, so I don’t
believe that the HIV housing list (CHIPS) moves, and I’m never going to get housing,
we need assistance.quot;
quot;I walked into this town with my SSI case, and when I got told on the phone that this
clinic had their own lawyer, or had access to one, when I got there, I just got dumped!quot;
Suggestions for Improving Services
Peer Approach to Service Provision
Implementing a peer-based approach to service delivery was thought to be one of the
most efficient and effective ways to improve prevention and health care services for the
transgendered population. Participants believed that hiring and training MTF and FTM
transgendered individuals as support group facilitators, client advocates, substance
abuse counselors, media campaign coordinators, case managers and outreach workers
could facilitate access to services for the transgender community. Employing
transgendered staff would also provide jobs to a community which has suffered severe
employment discrimination.
quot;When I see all these agencies who are being funded all this money to do transgender
prevention, and provide transgender services, I really find it hard, when I see that some
of these agencies are funded to hire four and five outreach workers. And they hire all
these outreach workers, and not one of them is transgender.quot;
quot;I've had clients come from an agency, and they're talking about the staff calling them
’boy’ and ’he’, and asking them questions, like why they want to do that. If they're
going to be serving transgender persons, they should be obligated to make sure that their
staff is trained on transgender sensitivity issues, and that their staff is transgender.quot;
quot;We're transgendered men. We might fall into other categories, but there's nothing that's
being directed at us. When I hear that an agency is transgender friendly, it sometimes
means that there's no transgenders on staff. The book's gotta be written, with us as the
subject.quot;
Service Provider Training
The need for transgender sensitivity training for health and social service providers was
discussed frequently. Most participants felt that existing providers would not be able to
meet the unique needs of this community without more training. The development of
guidelines for service provision (particularly for HIV-positive individuals who want to
pursue hormone therapy and sexual reassignment surgery) is a critical component of
15. such training efforts. A training unit responsible for developing and implementing in-
service trainings should be formed to ensure that systematic training of all service
providers takes place on an ongoing basis.
quot;We’re an abomination to society, to the medical and health community. Medical and
mental health services are not educated about transgender people. If they’re not
educated,how can the community get educated from them?quot;
quot;Make mandatory sensitivity trainings to all service agencies that come in contact with
transgender clients.quot;
Discussion of Findings
To our knowledge this is the first study to qualitatively examine the HIV risk behaviors
and service needs of a large and diverse sample of Male-To-Female and Female-To-
Male transgendered individuals. The potential for HIV transmission among
transgendered individuals and those in their sexual and drug use networks is great. We
found alarmingly high levels of HIV risk behaviors including sex work, injection drug
use, and unprotected sex. We also found that many transgendered persons had multiple
barriers to accessing needed HIV prevention and health services.
Economic necessity, as a result of severe employment and housing discrimination,
results in a reliance on sex work to secure food, shelter, and money for many MTF
individuals. Our findings support previous research that has identified a cyclic pattern of
sex work and drug use which is difficult to break.5,8 Once involved in sex work, high
rates of drug use and sexual risk taking with multiple partners place this vulnerable
population at risk for HIV infection.1
Transgendered MTF and FTM populations who do not engage in sex work also appear
to be at risk for acquiring HIV. Our findings confirm other qualitative work which found
that injection and non-injection drug use is very common, and that many transgendered
individuals engage in unprotected sex because it makes them feel sexually validated and
increases their self-esteem. 4,5,8 This form of self-validation was particularly important
for FTMs who identified as gay or bisexual and had sex with gay men, a troubling
finding given the high HIV seroprevalence in San Francisco’s gay male population.
Although the need for HIV prevention and health services is great, many transgendered
individuals do not access services because of fear of discrimination and dissatisfaction
with the quality of care. Focus group participants who had a negative experience trying
to access services said they were reluctant to try to obtain services again.
Limitations and Conclusions
Focus groups introduce some limitations that should be acknowledged. The non-
probability sampling methods and qualitative nature of the data compromise our ability
to estimate the prevalence of HIV risk behaviors and generalize our findings to
transgendered persons in San Francisco. Since only two groups were conducted in a
language other than English (the Spanish-speaking groups) and only one FTM-specific
16. group was held, the issues of transgendered persons who speak other languages and
FTM individuals may not be adequately captured in this report. Additionally, the study
population was largely comprised of individuals who have some access to services since
all the focus groups were conducted at agencies providing HIV prevention or care; our
results may fail to represent transgendered persons who are not accessing services.
Despite the aforementioned limitations, our research provides an in-depth description of
the HIV risk behaviors and service needs of a large and diverse sample of MTF and
FTM individuals. The high levels of unemployment, substance abuse, and homelessness
in this population suggest that HIV prevention and health services need to be
complemented with job training, education, drug treatment, and housing placement in
order to be effective. Hiring transgendered persons to be involved in the development
and implementation of such programs is probably the best way to reach and retain
individuals who are most in need of services. To overcome barriers to care seeking and
improve the quality of care delivered, transgender sensitivity training for service
providers is also needed. Strengthening prevention and health services for the
transgender community is critical to preventing further HIV transmission and
facilitating improved health for this high risk and underserved population.
References
1. Elifson KW, Boles J, Posey E et. al. (1993) Male Transvestite Prostitutes and HIV
Risk. American Journal of Public Health. 83(2):260-262.
2. Elifson K, Boles J, Sweat M, Darrow W, Elsea W, Green R. (1989) Seroprevalence of
human immunodeficiency virus among male prostitutes. N Engl J Med. 321:832-833.
3. Peterson J, Zevin B, Brody B. (1996) Characteristics of Transgender Persons
Attending a Public Clinic. In: Abstracts of the Annual Conference of the American
Public Health Association.
4. Bockting, WO, Robinson, E, and Rosser, BRS. (1998). Transgender HIV Prevention:
a Qualitative Needs Assessment. AIDS Care. 10(4):505-526.
5. Mason TH, Connors MM, Kammerer CA. (1995) Transgenders and HIV Risks:
Needs Assessment. Prepared for the Massachusetts Department of Public Health,
HIV/AIDS Bureau. Gender Identity Support Services for Transgenders (GISST).
6. Sandoval Chris. (1995) Focus Group Findings on Transgendered Persons in
California. Polaris Research and Development Inc.
7. Support Center for Nonprofit Management. (1994) Results From a Transgender Focus
Group. Prepared for the San Francisco Prevention Planning Council.
8. Yep GA, Pietri MP. (1996) Communicating to the Gender Transposed about
HIV/AIDS: An Application of the PRECEDE Framework. Presented at the 82nd Annual
17. Meeting of the Speech Communication Association. San Diego, California.
Acknowledgements
The authors would like to acknowledge the work of the Transgender Advisory
Committee members (Connie Amarthitada, Neil Broome, Tamara Ching, Russell
Hilkene, Jade Kwan, Yosenio Lewis, Margaret Morvay, Major, Gina Tucker, Adela
Vasquez, and Kiki Whitlock), the Department of Public Health, AIDS Office staff
(Celinda Cantu, Gene Copello, Veronica Davila, Brian Dobrow, Delia Garcia, Keiko
Kim, Michael Pendo, Tracey Packer, and Billy Pick), and our focus group transcriber
(Marilyn McDonald).
A special thanks to the agencies and their clients who made this project possible: Asian
AIDS Project (now known as the Asian & Pacific Islander Wellness Center), Brothers
Network (now known as New Village), the Center for Special Problems, the Center for
Southeast Asian Refugee Resettlement (now known as Southeast Asian Community
Center), Proyecto ContraSIDA Por Vida, San Francisco County Jail (San Bruno),
Tenderloin AIDS Resource Center, and the Tom Waddell Clinic.