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
Jung's Theory of Personality: Jung had discussed about certain concepts that are important in personality formation. Some of these concepts are archetypes, anima, animus, shadow, personal and collective unconscious, and ego.
Jung's Theory of Personality: Jung had discussed about certain concepts that are important in personality formation. Some of these concepts are archetypes, anima, animus, shadow, personal and collective unconscious, and ego.
Presentation on Child and Adult Attachment Theory. Also includes result of a small survey done with my friends. Part of the 'Personality and Development' course at IIT Delhi
On September 13, 1848, twenty-five-year-old Phineas Gage was working with a blasting crew when he was in an accident that drove a tamping iron through his head.
An overview of Sacchi et al's cognitive study into doctored photos and their effects on memory. Designed for Edexcel International A level students as a revision resource.
Presentation on Child and Adult Attachment Theory. Also includes result of a small survey done with my friends. Part of the 'Personality and Development' course at IIT Delhi
On September 13, 1848, twenty-five-year-old Phineas Gage was working with a blasting crew when he was in an accident that drove a tamping iron through his head.
An overview of Sacchi et al's cognitive study into doctored photos and their effects on memory. Designed for Edexcel International A level students as a revision resource.
Intro to Gender Minorities - Baltimore Police Dept., June 30 2016jayembee
This presentation was developed for the Baltimore Police Department, June 30, 2016. It covers the basics of sex, gender, gender identity, and sexual orientation; sexual development; health, social and legal challenges faced by transgender persons; and best practice tips for improving police interactions with transgender community members. Updated from the previous (March 2016) posting.
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
This is awareness campaign report during health teaching in a rural community within the Philippines to increase awareness of increasing trend of teenage pregnancy especially among low poverty income and less educated residents in a certain community in the Philippines
I was in a Capstone Community Psychology Class at the University of Cincinnati. In conjunction with this course, we worked alongside the Cincinnati Health Department to try to aid in their Sexual Health and Awareness Toolkit that they presented to local communities in the Cincinnati area.
Similar to Providing safe, affirming and evidence based care for transgender persons: The basics (20)
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
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.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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.
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Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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
8/5/2016Infectious 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
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4. Words, Definitions, Language Use
Talking Trans
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5. Sex, Gender, Sexual Orientation 5
8/5/2016Infectious 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
6. Gender Words
Transgender
Describes a person whose gender identity and assigned sex at
birth do not correspond. Also used as an umbrella term to
include gender identities outside of male and female. Sometimes
abbreviated as trans.
Gender non-conforming
Describes a gender expression that differs from a given society’s
norms for males and females.
Cisgender
A person whose gender identity and assigned sex at birth
correspond (i.e., a person who is not transgender).
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7. Binary Gender Model
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Biological Sex: hormones,
genitalia, reproductive
organs, secondary sex
characteristics
Gender Identity:
“I am…”
Sexual Orientation:
erotic, emotional attraction
to others
MaleMale FemaleFemale
MasculineMasculine FeminineFeminine
WomenWomen MenMen
Gender Expression:
mannerisms, role, social
context
ManMan WomanWoman
*GENDERLINE*DONOTCROSS!
8. Impact of Gender Binary View
Assumes, reinforces, and privileges
Cisgender identity
Heterosexual “norm”
Assigns and distributes gender-exclusive roles,
mannerisms, clothing, relationships, and other social
capital
Invalidates
Identities and expressions that do not conform to societal
sex/gender expectations
Equality of transgender individuals
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9. Gender Continuum Model
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Biological Sex: hormones,
genitalia, secondary sex
characteristics
Gender Identity: “I am …”
Sexual Orientation:
erotic, emotional
attraction to others
male female intersex
man bigender nongender
women men both neither other
Gender Expression:
mannerisms, role,
social context
masculine feminine androgynous neutral
woman
asexual
10. Gender Grammar
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PROBLEM CORRECTION REASON
“transgendered”
(adjective)
transgender
Only adjectives that are derived from nouns
and/or verbs (unlike transgender) end in “ed”.
“transgendered”
(verb)
transition
Only verbs can have “ed” added onto the end of
the word to become a participle. Transgender is
an adjective, not a verb. One does not
transgender, they transition.
“a transgender”,
“transgenders”
a transgender
person,
transgender people
Transgender is not a noun. “Jake is a
transgender” is not only grammatically
incorrect, it can also be offensive.
“sex change”,
“sex reassignment
surgery”, “gender
reassignment
surgery”
gender affirming
surgery, genital
reconstruction
surgery, genital
reassignment
surgery
Surgery does not change one’s sex or gender,
only one’s genitalia.
11. 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)
11
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12. Intentions vs. Impact 12
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13. Misgendering
Feels humiliating and disrespectful
Damages your rapport
Makes the person wonder if you are cruel or clueless
Can “out” someone and make them emotionally or
physically unsafe
Can contribute to someone being so uncomfortable they
do not get the care they need
13
Pronouns are aPronouns are a
Really BIG DEALReally BIG DEAL
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14. HIV Disparities in
Transgender Populations
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15. 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
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17. Ascertaining Transgender Status
1. What is your current gender identity? (Check
and/or circle ALL that apply)
☐ Male
☐ Female
☐ Transgender Male/Trans man/FTM
☐ Transgender Female/Trans woman/MTF
☐ Genderqueer
☐ Additional category (please specify):
________________________________
☐ Decline to answer
2. What sex were you assigned at birth? (Check one)
☐ Male
☐ Female
☐ Decline to answer
• Not all under the “transgender umbrella” self-identify as
transgender
̶ Anatomy, sexual practices, and sexual identities ≠ gender identity
• Current best practice: ascertain identity via the 2-step method1
1. UCSF Center of Excellence for Transgender Health. 2016. Available at http://www.transhealth.ucsf.edu/trans?page=lib-data-collection.
2. Mulatu M, et al. 2015 NHPC, Atlanta GA, December 6-9, 2015. Abstract 1559.
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18. New HIV Positive Tests among
Trans People, 2009-2011
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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.
19. HIV Prevalence: Trans Masculine
Systematic review (2012-2015)
6 U.S. prevalence studies
0.4% - 4.3% (n=1)
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
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20. 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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21. 8/5/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
HIV Care and Viral Suppression 21
HRSA RSR data 2014
22. Baltimore Data: Trans Women
Baltimore BESURE data (49 trans women)
Cross-sectional anonymous behavioral surveillance survey
Data collection: June 2004 – April 2005
Designed as MSM study, wanted to be inclusive of trans
Transgender women participated, questions not ideal
Led to development of transgender supplement
Baltimore Transgender Supplement (40 trans women)
Data collected 2004-2005
Locally sponsored supplement
Included only transgender women
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23. Baltimore Data: Trans Women
HIV Prevalence
Transwomen in NHBS (n=40): 42.5%
Transwomen in supplement (n=21): 33.3%
Unrecognized HIV infections
Transwomen in NHBS (n=17): 64.7%
Contextual Risks (Supplement)
45% got hormones from a non-medical source
45% self-injected hormones
NHBS 2004-2005, Baltimore EMA
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24. Context Matters
Why such high HIV prevalence
among trans women? 24
8/5/2016Infectious Disease Prevention and Health Services Bureau & Johns Hopkins Bloomberg School of Public Health
25. Stigma and Discrimination
US National Trans Discrimination Survey1
63% of trans people surveyed experienced an
act of discrimination, including
Lost job or eviction
School bullying/harassment
Physical or sexual assault
Homelessness
Lost relationship with partner or children
Denial of medical service
Incarceration
23% experienced a catastrophic level of
discrimination, ie, were impacted by
3 such events
1. Grant JM, et al. 2011. National Center for Transgender Equality and National Gay and Lesbian Task Force. Available at
http://www.thetaskforce.org/static_html/downloads/reports/reports/ntds_full.pdf.
2. Kellaway M, Brydum S. Advocate. Updated January 12, 2016. Available at http://www.Advocate.Com/transgender/2015/07/27/these-are-
trans-women-killed-so-far-us-2015.
21 documented trans
women were murdered
in the US in 20152
Image source: Advocate
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27. Trans Discrimination in Maryland
(n=132)
Workplace Discrimination
71% harassed on the job
42% fired, not hired, or denied a promotion
Discrimination at school
81% harassed, 38% assaulted, 16% sexual violence
Mistreatment in public spaces
54% were verbally harassed or disrespected in a place
of public accommodation or service, including hotels,
restaurants, buses, airports and government
agencies.
Hopelessness
43% reported attempting suicide at some point in
their life -- More than 26 times the rate of the
general population of 1.6%
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National Transgender Discrimination Survey, 2009
28. Trans Discrimination in Baltimore
(n=47), 2011
Problems getting a job 51%
Lost a job 40%
Denied or kicked out of housing 17%
Problems getting HIV prevention services 0%
Problems getting drug treatment services 2%
Problems getting health or medical services 23%
Every physically abused or beaten 26%
Ever verbally abused or harassed 77%
Ever sexually assaulted 27%
Ever arrested 17%
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29. 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
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. Grant 2011, Lambda Legal 2010
30. 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%)
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Grant 2011, Lambda Legal 2010
31. Health Policy & Research Update
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32. Changing Gender/Sex on Identity
Documents
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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.
33. 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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34. Reversing Decades of Health
Care Discrimination
From Maryland Insurance Administration, Bulletin 15-33, December 10, 2015
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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.
35. 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.”
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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
36. 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.
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to a job near you…
39. STROBE Study: Supporting Transgender
Research and Opportunity in the
Baltimore Environment
Funded by the Johns Hopkins Center for AIDS Research
http://www.strobebaltimore.com
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40. Baltimore Trans Community
Needs Assessment
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www.baltimore
btcstudy.com
Funded by the
Johns Hopkins
Urban Health
Institute
41. Count Me In, Maryland!
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Opened Sept. 2015
109 Responses with Data
42. 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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43. Best Practice Tips
For serving lgbtq clients
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44. Ally Skills
Deep listening
Embracing being “wrong”
Removing barriers
Educating other cisgender people
Interrupting homophobia/transphobia
Patient advocacy
Getting out of the way
44
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45. Trans-Affirming Clinic
Environments
Avoid Ma’am, Sir, Mr/Mrs/Ms
Use gender neutral forms of address
Use 2-step process to determine gender identity at
intake
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SHOW EXAMPLESHOW EXAMPLE
46. 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.
47. 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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48. 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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49. 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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50. 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
51. 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/
52. 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
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Questions?What else did youWhat else did you
want to learn about?want to learn about?
54. 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