Presentation by seminar speaker (approx. 40 min.)

1. Welcome to the Acción Mutua web-seminar:Understanding Transgender Latinas and other Transgender Women of Color and their HIV Concerns Presentation by seminar speaker (approx. 40 min.) Followed by question and answer session (approx. 20 min.) *************************************************************************************** • Please press *6 on your telephone keypad to mute your telephone line (to un-mute your line, press *6 again) • If you are experiencing difficulty with your phone connection, dial *0 for the conferencing service operator • Questions submitted prior to the web-seminar will be addressed first during the Q&A • For questions that arise during the presentation, click on the “hand” button and type your question or wait to be called on to ask your question over the phone during the Q&A

2. Acción Mutua is a capacity building assistance (CBA) program of AIDS Project Los Angeles in collaboration with the César E. Chávez Institute of San Francisco State University Funded by the Centers for Disease Control and Prevention

3. Understanding Transgender Latinas and other Transgender Women of Color and their HIV Concerns Presented by JoAnne Keatley, MSW Pacific AIDS Education & Training Center University of California, San Francisco

5. Today’s Web-Seminar Objectives • Understand the impact of bias on the healthcare experiences and choices of transgender populations • Identify ways to design and deliver gender-appropriate and culturally competent services for transgender clients • Discuss strategies for effective outreach to and engagement of the transgender population

6. Transgender? • When you hear the term “transgender” who/what comes to mind? • What do you know about transgender people? • What types of contact have you had with transgender people? • What more do you want to know about transgender people?

7. BIOLOGICAL SEX (chromosomes, anatomy) female intersex/hermaphrodite male GENDER IDENTITY (psychological sense of self) woman gender queer/neutral man GENDER EXPRESSION (communication of gender) feminine androgynous masculine SEXUAL ORIENTATION (sex attracted to) attracted to men bisexual attracted to women Gender & Sex “traditional” woman “traditional” man

8. Gender & Sex • Binary Gender System: The societal division of human beings into two, distinct categories of male and female. • Chromosomes: Genetic material that carry the genes that determine height, eye color, etc. Two of them are related to biological sex. XX and XY. • Intersex: Can include individuals who are born with genes other than XX or XY; may have ambiguous genitalia. ISNA : 1 in 2000 people have some form of an Intersex condition

9. Gender & Sex • “Biological Sex.” The sex assigned at birth typically based on examination of the genitals. • Gender Identity: Self-image or belief a person has about their gender as being female, male, or something altogether different. • Sexual Orientation: The internal experience that determines who we are physically and/or emotionally attracted to.

10. Transgender People • May undergo surgical and/or hormonal treatment to change their physical appearance and/or gender expression. • Often adopt a new name and lifestyle to reflect their gender identity. • Are sexually diverse, important not to make assumptions.

11. Epidemiology • Rates of HIV infection estimates 13 – 68% for transgender women 2 – 3% for transgender men • Rates are higher for transgender people who are • Male to Female • Of Color • Engage in sex work • Use injection drugs

12. Gender-Specific % of HIV/AIDS Cases Younger than 30 Race/Ethnicity Male Female Transgender *Includes only HIV cases reported via non-name code Mathew Facer, Epidemiologic Studies Section, California Office of AIDS

13. HIV Risk Behaviors among MTF Transgenders of Color Tooru Nemoto, PhD., Principal Investigator Don Operario, PhD. Research Associate JoAnne Keatley, MSW, Project Director Center for AIDS Prevention Studies, UCSF Supported by National Institute on Drug Abuse (NIDA) (Grant No: ROI DA11589-05)

14. We examined HIV-related risk behaviors among samples of African American, Latina, and Asian Pacific Islander transgenders in San Francisco. • In our study we focused on specific HIV-risk behaviors such as: • Sexual Behaviors: primary, casual, and commercial • Health Outcomes: HIV/STD, depression, need and access to care • Substance Use: (lifetime, past 30 days), injection drug use, engaged in sex with primary, casual, or commercial partners while under the influence of any illicit drugs • Psychosocial Factors: transphobia, depression, self-esteem, gender identity, social support

15. Table 1. Demographics by Ethnicity

16. Table 2. HIV/STD by Ethnicity

17. Major Findings • About three-quarters of the participants had recently engaged in receptive anal sex. • A significantly higher proportion (47%)had recently engaged in URAS with primary partners than with casual (26%) and commercial partners (12%). • Current URAS with primary and casual partners, but not commercial partners, was significantly and independently correlated with having had sex under the influence • HIV positive participants were 3.8 times more likely to engage in receptive anal sex as well as URAS with casual partners than HIV negative participants, controlling for other variables.

18. Major Findings, continued • Although only 12% had reported URAS with commercial partners in the past 30 days, this risk behavior was significantly and independently correlated with African American race (4.5 times more compared with non-African Americans) and lowest income level (less than $500 of monthly income). • Nemoto T, Operario D, Keatley J, Han L, Soma T. (2004). HIV Risk Behaviors Among Male-to-Female Transgender Persons of Color in San Francisco. American Journal of Public Health, Vol.94, No.7, 1193-1199

19. Barriers to Service • Lack of information on risk for trans people • Misinformation within trans community • Low perception of risks • Data collection has ignored various trans identities. • Prevalence drives funding and programs • FTM incidence not well understood or explored • TG women continue to be counted in MSM category for funding and prevention programs

20. Barriers to Care: Providers • Lack of knowledge and information • Personal discomfort • Lack of clinical research, literature • Lack of agency support • Not enough people doing the work • Religious/Moral concerns

21. Barriers to Care: Clients • Fear of disclosure/exposure • Social and geographic isolation • History of bad experiences with care providers • Intake forms, office environment, alienating process • Lack of insurance coverage • Trans-related care is often explicitly denied in insurance policies.

22. HIV and Hormones • There are no significant drug interactions with drugs used to treat HIV. • Several HIV medications change the levels of estrogens. • Cross gender hormone therapy is not contraindicated in HIV disease at any stage. • Transgender patients need ongoing care, not just access to hormones.

23. Suggestions for Making Your Agency Trans Affirming • Don’t just add a “T”, implement non discriminatory policies and procedures. • Provide training for all staff; front office, managers, security guards, counselors, outreach staff • Make intake forms trans inclusive: • include “preferred name” not just legal name; • include more gender choices • Challenge transphobia—in staff and community • Have trans-inclusive imagery in waiting room • Use inclusive or gender neutral language • Create safe bathroom policies! • Hire Transgender people!!!!!!!!!!!

24. Costura y Charla(Spanish-language Sewing/Support Group) • Support group and skills-building class for Spanish Speaking transgender women • Facilitated by Transgender Health Educators and a Consultant

25. Costura y Charla continued… • During support sessions, participants received training in pattern making, design, cutting fabric, sewing clothes and alterations. • HIV/AIDS prevention, relationships with family, friends and lovers as well as other issues that effect the Latino transgender community. • Skill building as well as emotional support in a culturally appropriate environment

26. Costura y Charla

27. Costura y Charla

28. Costura y Charla

29. Thank You! Comments & Discussion

30. JoAnne Keatley, MSW Joanne.keatley@ucsf.edu 415.597.4960 For more information on how to receive CBA services please contact: Acción Mutua(Western region Latino CBA provider): 213.201.1345 or www.accionmutua.org Transitions(nation-wide transgender CBA provider): j.sevelius@ucsf.edu www.caps.ucsf.edu/projects/Transitions/