Providing safe, affirming and evidence based care for transgender persons: Th...HopkinsCFAR
Tonia Poteat, PhD, PA-C, MPH
Assistant Professor
Johns Hopkins Bloomberg School of Public Health
Jean-Michel Brevelle
Sexual Minorities Program Manager
Maryland Department of Health and Mental Hygiene
Johns Hopkins School of Medicine
August 5, 2016
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).
Providing safe, affirming and evidence based care for transgender persons: Th...HopkinsCFAR
Tonia Poteat, PhD, PA-C, MPH
Assistant Professor
Johns Hopkins Bloomberg School of Public Health
Jean-Michel Brevelle
Sexual Minorities Program Manager
Maryland Department of Health and Mental Hygiene
Johns Hopkins School of Medicine
August 5, 2016
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?
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.
Improving Breast Cancer outcomes in Communities of Color Steps Towards Equitybkling
Hayley Thompson, Ph.D., Faculty Director of the Office of Cancer Health Equity and Community Engagement at Karmanos Cancer Institute and leader of Population Studies and Disparities, gives an overview of recent efforts to improve health equity for women of color with breast cancer and make suggestions about how to make breast cancer outcomes more equitable.
On August 10, I had the wonderful opportunity to work with a group of amazing individuals to assess the biases present in our current healthcare system. This project was a part of a summer intensive program through MedSTEMPowered.
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?
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.
Improving Breast Cancer outcomes in Communities of Color Steps Towards Equitybkling
Hayley Thompson, Ph.D., Faculty Director of the Office of Cancer Health Equity and Community Engagement at Karmanos Cancer Institute and leader of Population Studies and Disparities, gives an overview of recent efforts to improve health equity for women of color with breast cancer and make suggestions about how to make breast cancer outcomes more equitable.
On August 10, I had the wonderful opportunity to work with a group of amazing individuals to assess the biases present in our current healthcare system. This project was a part of a summer intensive program through MedSTEMPowered.
Think of your local community. What health-related issue current.docxirened6
Think of your local community. What health-related issue currently affects a large number of people within your community? How could research help address this issue? How would you go about obtaining more data on the health-related issue you identified?
This is an opportunity for you to explore the practical application of how to create a plan to obtain data on a health-related topic, specifically in your community. Please respond in first person, share personal experiences to further develop your understanding of how evidence-based practice can affect health-related issues at the community level.
Use as references:
National Center for Health Statistics (NCHS)
- National and state data sets as well as statistic reports. Information about ordering data sets that cannot be downloaded.
CDC Data and Statistics page
- much more than NCHS
CDC WONDER
- WONDER provides a single point of access to a wide variety of reports and numeric public health data.
Agency for Healthcare Research and Quality
- Data and Surveys
Statewide Planning and Research Cooperative System (SPARCS)
- Data dictionaries, documentation and request forms. No searchable data online.
U.S. Census Bureau
,
Current census data including information broken down by state, city, and region.
WHOSIS
-- WHO Statistical Information System
In two different paragraph give your personal opinion to Valencia Matilus and Malika Nelson, them do not need a different referents use the same as them.
Valencia Matilus
In the community in Florida many people are infected by the chronic illness hypertension is a common disease cholesterol, fatigues, and stress. Patients are major risks cardiovascular, stokes, and leading causes of death, respectively in the community. In 2016, 80,722 deaths were caused by high blood pressures. In 2014, high blood pressures were five times more deaths than it was in 2016. Hypertension has referred to high blood pressures. Hypertension is a big major cause of premature death worldwide (Benjamin, 2016).
Hypertension very often had no signs or symptoms. Once the primary care doctor has diagnosed the patient had high blood pressures as a medication. Patients can lower their blood pressures by changing their diet, and exercises. In 2015-2016, in the communities 1/3 patients have controlled high blood pressures. 2017, recent revised guidelines more than one patient have unknown or undiagnosed if they have high blood pressures. In 2016, the total costs directed for high blood pressures were $54.8 billion. It’s projected for the year 2035, the total costs will be reach $221.8 billion. I’ll suggest implementing public health to have more programs to help to reduce the hypertension problems. Healthcare providers have provided more information, have classes for the patient, and show them how to eat, have nutrition in the clinic or private doctor offices to reduce mortality. (Benjanmin, 2016).Florida, adults ages 18-39; 45 to 79, nearly half of patients can .
Running Head: COMMUNITY ANALYSIS 1
Community Analysis
The most prevalent risk factors among racial and ethnic minorities are unprotected vaginal or anal sex, inadequate sex education, improving access to prevention and care services and drug use. Jackson, MS has a population of 173,212, with median household income of $32,250. Poverty is one of the major contributing factors to the risky behaviors and the rise of HIV infections within racial/ethnic minority youths. The residents with incomes below the poverty level in Jackson, MS by 2015 was 39.9%, and those with income below 50% of the poverty level was 19.2%, the breakdown is between ages 13 to 19 years of poor residents in Jackson, MS and the percentage is below half of poverty level of 20%. The most common race or ethnicity living below the poverty line in Jackson, MS is Black or African American, followed by White and Hispanic or Latino. The state of homelessness is on the rise and many of these shelters in Jackson, MS now have waiting lists with majority of its occupants are racial/ethnic minority. Even with the waiting lists, those that need to be sheltered will have to call ahead to confirm (City Data, 2015).
Mississippi is one of the most rustic states in the United States and its population is perhaps the poorest. According to the 2010 Census, Mississippi has a population of 2,967,297 people, with a racial distribution of 59% white, 37% black, 3% Hispanic, and 2% other. Mississippi ranks second in the nation (after the District of Columbia) for the highest proportion of African Americans. Through U.S. Census Bureau 2011 American Community Surveys, Mississippi levels the first in the country for the number of people living in poverty (22.6% of the total population) and the lowest middle household revenue ($36,919) (United State Census Bureau, 2011). According to the 2011 National HIV Surveillance Report, Mississippi had the 4th highest rate of HIV infection in the United States. The state’s capital city, Jackson, had the third highest rate of HIV diagnoses within aged 13 to 19 years and the eighth highest AIDS diagnosis by metropolitan statistical area (MSA) in 2011. For the past twenty years, numbers of peoples living with HIV in Mississippi has risen yearly. By the end of December 31, 2013, there was approximately 10,473 Mississippians living with HIV (National HIV Surveillance Report, 2013).
Secondary data
Jackson, MS the state’s capital city and with the most new HIV disease cases are identified in the West Central Public Health District V, which includes the metropolitan Jackson Hinds area, where 47% of all persons with HIV disease in Mississippi reside presently (Mississippi State Department of Health, 2015). According to data for states and metropolitan areas, it’s shown that racial and ethnic minority youths aged between 13 to 19 years rank 4th in the diagnose of HIV at 44.7%. The education b ...
NIH AIDS Executive Committee (NAEC) FY 2019 Ending the HIV Epidemic (EHE) in ...HopkinsCFAR
The NIH Office of AIDS Research (OAR) is pleased to release the NIH AIDS Executive Committee (NAEC) FY 2019 Ending the HIV Epidemic (EHE) in the U.S. Report.
NIMH funding on PrEP use Among Adolescent Girls and Young Women in sub-Sahara...HopkinsCFAR
Dr. Susannah Allison. Dr. Allison is a Program Officer at the National Institute of Mental Health within the Division of AIDS Research. She oversees a portfolio of research focused on the prevention of HIV infection among infants, children, and adolescents as well as research to enhance health outcomes among youth living with HIV. She is also the training director for the division. Prior to working at NIMH, Dr. Allison worked with children and families infected and affected by HIV in Baltimore, Miami, and Washington, DC. She completed her doctorate at George Washington University where she received her Ph.D. in Clinical Child Psychology with an emphasis in child health psychology.
High Sensitivity HIV Testing and Translational Science around PrEPHopkinsCFAR
Joanne Stekler, MD MPH
Associate Professor, Department of Medicine
University of Washington
Inter-Center for AIDS ResearchAntiretroviralsfor Prevention Working Group
November 13, 2017
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
2. Today’s Objectives
As a result of participating in today’s presentation, you
will be able to:
Recall terms and definitions relevant to transgender
lives and culture;
List health disparities experienced by transgender
persons;
Identify best practices for providing clinical services to
transgender persons.
2
12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
3. Today’s Agenda
Words, Definitions, Language Usage
Transgender Health Disparities
Health Policy & Research Update
Best Practice Tips
Open Q & A
12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
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4. Intentions vs. Impact 4
12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
5. Words, Definitions, Language Use
Talking Trans
12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
5
6. Sex, Gender, Sexual Orientation 6
12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
SEX
(biological)
• CHROMOSOMES
• GENITALIA
• REPRODUCTIVE ORGANS
• SECONDARY SEX CHARACTERISTICS
GENDER
(psychosocial)
• IDENTITY: SELF-CONCEPT AS MALE /
FEMALE / OTHER
• EXPRESSION: COMMUNICATING YOUR
GENDER TO OTHERS
• ATTRIBUTION: WHAT OTHERS PERCEIVE
AND RESPOND TO
SEXUAL ORIENTATION
(biological &
psychosocial)
• EROTIC & EMOTIONAL ATTRACTION TO
OTHERS
7. Let’s Talk About Pronouns!
Binary pronouns
She, her, hers and he, him, his
(Xena ate her food because she was hungry.)
Common gender-neutral pronouns :
They, them, theirs
(Xena ate their food because they were hungry.)
Ze, hir
(Xena ate hir food because ze was hungry.)
Just use my name!
(Xena ate Xena's food because Xena was hungry)
7
12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
8. HIV Disparities in
Transgender Populations
12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
8
9. How many trans people are there?
Worldwide estimates
25 millions people1
Estimates range 0.1% - 3%
United States estimates
1.4 million people
0.6% of the population
Baltimore estimates
1,250 people (Wisdom of the Crowd)
912 (Service Multiplier Method)
1. Winter et al. The Lancet 2016;
2. Williams Institute 2016
12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
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10. New HIV Positive Tests among
Trans People, 2009-2011
12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
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New HIV+ test results highest in
trans people
2.4% among trans people
0.9% cis males & 0.2% cis females
Gender trajectory matters
2.7% trans feminine
0.5% trans masculine
New HIV+ highest in trans women
of color
54% African American
30% Hispanic/Latina
3-fold increase in new HIV+ tests
in trans women at 20 years
Habarta N, Wang G, Mulatu MS, et al. HIV testing by transgender status at centers for disease control and prevention-funded sites in
the United States, Puerto Rico, and us Virgin Islands, 2009–2011. Am J Public Health. 2015;105:1917–1925.
0
0.5
1
1.5
2
2.5
3
3.5
Cis Male Cis Female Trans
Female
Trans Male
13-19 20-29 30-39 40-49 50+
11. HIV Prevalence: Trans Masculine
Systematic review (2012-2015)
6 U.S. prevalence studies
0.4% - 4.3% (n=1)
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
4.00%
4.50%
5.00%
Laboratory Confirmed HIV Prevalence
Poteat et al. JAIDS 2016
Transgender MSM risk from cisgender
male partners
“I took a certain
pleasure in
informing the
gender clinic that
even though their
program told me
that I could not
live like a gay
man, it looks like
I’m going to die
like one.”
— Lou Sullivan, gay
trans activist, 1951-
1991
12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
11
12. Global meta-analysis of laboratory-confirmed HIV
(2000-11)
United States: 22% prevalence
34-fold greater than the general population
Systematic review and data synthesis (2012-2015)
Highest: 40% among trans women of color
Lowest: 4.5% in youth (16-24 years old)
Incidence estimate: 2.9 per 100 person-
years
Baral et al. TLID 2013, Poteat et al. JAIDS 2016
Alexis Rivera, transgender activist
Died from HIV at age 34 (2012)
Trans women who have sex with men have the
highest HIV burden of any key population
HIV Prevalence: Trans Feminine
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12
13. Context Matters
Why such high HIV prevalence
among trans women? 13
12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
14. Stigma is a Barrier to Care-Seeking
Delay getting health care due to
experiences of discrimination
28% delayed care when ill or injured
33% delayed or did not try to get preventive
care
Anticipate discrimination in health care
52% fear they will be refused care
73% worry they will be treated differently
89% feel that too few health care
professionals are adequately trained to
provide appropriate care for them
12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
14
. Grant 2011, Lambda Legal 2010
15. Stigma is a Barrier to Care Provision
Denial of medical care
19% in a US survey of 6450
27% in a US survey of 617
Uninformed providers
50% had to teach their medical provider
about transgender care
Discrimination from a provider
70% experienced some kind of
mistreatment, eg. providers
Refused to touch them/excessive precautions
(15%)
Blamed them for health status (20%)
Used harsh/abusive language (21%)
Were physically rough (8%)
12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
15
Grant 2011, Lambda Legal 2010
17. Changing Gender/Sex on Identity
Documents
12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
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Document Government
Level
Criteria
Birth certificate State Sworn statement from a healthcare practitioner stating you
have received treatment appropriate to change sex or have
been diagnosed with an intersex condition.
Driver’s License/ID
Card
State 3 letters: self, treating physician, treating psychotherapist
stating intention to undergo gender transition.
US Passport Federal A physician statement that validates that you have either
completed or are in process of treatment for gender
transition.
Social Security
Record
Federal • Full-validity, 10-year U.S. passport showing the new
gender;
• State-issued amended birth certificate showing the new
gender;
• Court order directing legal recognition of change of
gender; or
• Medical certification of appropriate clinical treatment for
gender transition in the form of an original letter from a
licensed physician.
18. LGBTQ Civil Rights - Maryland
Maryland state law prohibits discrimination in employment,
housing, credit and lending, and public accommodations based
on sexual orientation or gender identity or expression.
Anti-Discrimination Act of 2001 (Sexual Orientation)
Fairness for All Marylanders Act, 2013 (Gender Identity and
Expression)
Maryland public schools are prohibited from discriminating
against students based on sexual orientation or gender
identity/expression.
They must also adhere to a statewide bullying and harassment
prevention policy that is inclusive of bias based on real or perceived
sexual orientation or gender identity/expression.
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19. Reversing Decades of Health
Care Discrimination
From Maryland Insurance Administration, Bulletin 15-33, December 10, 2015
12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
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The formerly permissible exclusion which reads
“treatment leading to or in connection with
transsexualism, or sex changes or modifications,
including, but not limited to surgery,” which is
found on pages B49 and B50 of the 2017 benchmark
plan and originally permitted by COMAR
31.11.06.06B(32), is required to be deleted as
federal guidance has determined that this type of
exclusion is a discriminatory benefit design
prohibited by 45 CFR § 156.200(e).
Small Employer Essential Health Benefits, item 12, page 6.
20. HHS Final Rule on Sec. 1557
Issued May 13, 2016 : Effective July 18, 2016
Provides protections based on race, color, national origin, sex,
age, and disability. Protections for LGBT people come under
the category of sex discrimination, which includes gender
identity and sex stereotyping.
Applies to all federally-supported health programs and most
health insurance and coverage, including Medicaid, Medicare,
AIDS Drug Assistance Programs (ADAP), and individual
insurance plans purchased through a state or federal health
exchange.
Beneficiaries cannot “be excluded for participation in, be
denied the benefits of, or otherwise be subjected to
discrimination under any health program or activity to which
[the rule] applies.”
12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
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Affordable Care Act Fact Sheet: What the Section 1557 regulations banning
discrimination based on gender identity mean for you. Transgender Law Center, 2016
21. New Rules: Collection of SOGI
Data
ACA contains language supporting the collection of sexual
orientation and gender identity data, to further research
to end health disparities (Sec. 4302).
HHS issued new rules on Oct. 6, 2015 that require
collection of SOGI data in clinical settings in EHRs
(effective 2018).
CMS and ONC-IT requires EHRs to allow users to record,
change, and access structured data on sexual
orientation and gender identity.
12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
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to a job near you…
23. 12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
2015 U.S. Transgender Survey 23
James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). Executive Summary of the Report of the
2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.
32%
8%
limited consumption of food or drink to
avoid having to use public restrooms
had a urinary
tract infection,
kidney infection,
or other kidney
problem in past
year from
avoiding
restrooms 25%
55%
health insurance
refused to cover
transition-related
surgery
experienced a problem in the past year
with their insurance related to being
transgender (denial of gender related
care as well as routine care)
N = 27,715
25. Insert palm card here
12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health 25
26. STROBE Study: Supporting Transgender
Research and Opportunity in the
Baltimore Environment
Funded by the Johns Hopkins Center for AIDS Research
http://www.strobebaltimore.com
12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
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27. Baltimore Trans Community
Needs Assessment
12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
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www.baltimore
btcstudy.com
Funded by the
Johns Hopkins
Urban Health
Institute
28. Count Me In, Maryland!
12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
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Opened Sept. 2015
109 Responses with Data
0.% 10.% 20.% 30.% 40.% 50.% 60.% 70.%
Feminine
Masculine
Genderqueer
Agender
Two Spirit
Additional
Percentage
Percentage
29. Transgender-Inclusive HIV
Surveillance
Voluntary “Change Your Record”
Secured online site
Form allows changes to multiple data variables
Separate collection of Sex at Birth and Current Gender
Paper version will also be available
Local health departments
HIV Clinics
Targeted Health Provider Re-Report
Request update of Sex at Birth and Current Gender for HIV caseload
Educational component over summer (videos, webinars)
Community
Health providers
Implementation
Pilot late 2016
Statewide roll-out early spring 2017
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30. Best Practice Tips
For serving lgbtq clients
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12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
31. Ally Skills
Deep listening
Embracing being “wrong”
Removing barriers
Educating other cisgender people
Interrupting homophobia/transphobia
Patient advocacy
Getting out of the way
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12/16/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
32. Trans-Affirming Clinic
Environments
Avoid Ma’am, Sir, Mr/Mrs/Ms
Use gender neutral forms of address
Written gender-neutral salutation is Mx.
Use 2-step process to determine gender identity at
intake
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EXAMPLE NEXT SLIDE
33. Example: Two-Step Gender
Question
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1. What is your current gender identity? (Check and/or circle ALL that apply)
☐ Male
☐ Female
☐ Transgender Male/Transman/FTM
☐ Transgender Female/Transwoman/MTF
☐ Genderqueer
☐ Additional category (please specify): ________________________________
☐ Decline to answer
2. What sex were you assigned at birth? (Check one)
☐ Male
☐ Female
☐ Decline to answer
UCSF Center of Excellence for Transgender Health. 2016. Available at
http://www.transhealth.ucsf.edu/trans?page=lib-data-collection
34. Trans-Affirming Clinic
Environments
Do not assume gender identity or sexual orientation
How do I know which pronoun to use
(eg, he, she, they)?
Ask politely
What is the presenting gender?
Echo the language you hear
Make an effort to use the correct pronoun consistently
Anatomical terms – what words to use
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35. Trans-Affirming Clinic
Environments
Use preferred pronouns and name
Ask for patient preference, in private, if unsure
Include preferred name on chart and train staff
Defer unnecessary questions and exams
Build rapport before performing genital exams
Avoid satisfying your curiosity
Conduct sensitive genital exams only when
necessary
Always explain the purpose of the exam
Use gender neutral terms
Ask patients what words they prefer
Acknowledge barriers and offer solutions
Stress of stigma and discrimination
Limitations of medical knowledge
Offer to find out and get back to patient
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36. Improving the HIV Continuum for Trans
Women
Barriers to Engagement & Retention in HIV Care
Avoidance due to stigma and past negative experiences
Prioritization of hormone therapy
Concerns about interactions between HIV meds and hormones
Facilitators of Engagement & Retention in Care
Providers knowledgeable about trans-related medical issues
Able to provide and integrate hormone therapy and HIV care
All staff respectful and sensitive to trans issues (eg. IDs)
Correlates of Adherence and Viral Load
Less stress due to trans discrimination (adherence and VL)
Adherence to hormone therapy (adherence)
Sevelius, Ann Behv Med, 2014; Sevelius, AIDS Care, 2014
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37. Gender Affirmation and HIV
Care
Top 5 Health Concerns of HIV+ trans people,
in order
1. Gender-affirming and non-discriminatory care
2. Hormone therapy and side effects
3. Mental health care, including trauma
4. Personal care, eg. nutrition
5. Antiretroviral therapy and side effects
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Deutsch 2015 (preliminary
self-report data presented
at NHPC); Positively Trans
Survey, n = 157
TW whose HIV primary care provider is also their hormone prescriber,
more likely to:
Have an undetectable viral
Have an HIV primary care visit in the previous 6 months
38. Transgender Response Team
If you share our vision of a Maryland where new HIV
infections are rare, and where transgender and
gender nonconforming children, adolescents, adults,
and their families, participate fully as equal citizens
in safe, supportive communities where culturally and
linguistically responsive services and supports are
available, accessible, and appropriate, then join us!
To find out how, contact:
Jean-Michel Brevelle
Sexual Minorities Program Manager
Prevention and Health Promotion Administration
Maryland Department of Health and Mental Hygiene
500 North Calvert Street, 5th Floor
Baltimore, Maryland 21202
(410) 767.5016 Office
jean-michel.brevelle@maryland.gov Email
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https://sites.google.com/site/trtnetwork/
39. Transgender Action Group
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Coalition of transpeople, service
providers, non-profits, and
volunteers organized in Fall 2012,
meetings 2nd Thurs @ noon
Outreach to trans sex workers
every 2nd and 4th Fridays, 12-4AM
Provides
Legal services
Housing and employment counseling
Safer sex materials and information
Referrals for HIV testing and other
services
http://www.tagoutreach.net
41. Please fill
out and
turn in your
evaluations
Don’t
hesitate to
contact us
if you have
questions.
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Tonia Poteat, PhD, PA-C, MPH
Assistant Professor
Department of Epidemiology
Johns Hopkins Bloomberg School of Public Health
tpoteat@jhu.edu
Jean-Michel Brevelle
Sexual Minorities Program Manager
Center for HIV/STI Integration & Capacity
Maryland Department of Health and Mental Hygiene
jean-michel.brevelle@maryland.gov