1. Give a summary of the health

1. Give a summary of the health disparity presented in the article. 2. Describe your reaction to the article. TRANSforming Healthcare: Transgender Cultural Competency for Medical Providers Transcript [Written] Transgender—when a person’s gender identity, gender role, or gender presentation differs from the one assigned at birth. Jackson Brown: There was onetime in particular where I went to get STD testing, and the woman was like, “I’ve never met a transgender person, ever. I don’t usually work at this clinic, I do pediatrics. I don’t know what to do with your body—like you know, if you were a guy I would just have you stand here; if you were a girl I would have you lay down on the table.” She’s like, “But I don’t know what to do with you.” And she was right up front about it. And I was like “Uhh,” and I didn’t know what to say, I was like, “I don’t know how to do your job. I don’t know what you’re looking for, I don’t know what you want me to do.” And she didn’t know what to do either, so we were just kind of like, “Mmm, take this.” And then I left. And I was pissed that I didn’t get healthcare—I didn’t receive any healthcare. [Written] “Individuals who do not conform to the traditional concepts of sex and gender are likely to be at risk for many health-related problems, including…discrimination within the treatment setting.” American Journal of Public Health, 2001. Yosenio Lewis: I always knew, there was never any for me as to maybe I’m this, maybe I’m that. Even though as I got older, my body was different from what I had imagined it to be. In my mind I was always a little boy, and I was always treated like a little boy by just about everyone in my family. Tamara Ching: I became aware that I was different when I was probably about two years old. I’ve always identified myself as being female in spirit. Kien Chou: I identify as transgender. I actually don’t necessarily identify as male or female. But I definitely move more toward, if you want to call it a spectrum, but more towards a masculine identity. But not necessarily as one or the other. I remember when I was about three or four years old growing up in Louisiana, I got like a great bowl cut, and I was walking around and everybody kept asking me if I was a boy or a girl, and I would answer as a boy. And then I think that kind of threw my mom off, so she kept putting dresses on me. Danielle R. Anderson-Castro: First I wanted to be a woman, then I realized that I could never really be a biological woman, and then I came to the other side where I realized, why do I even have to be? And finally, I realized I’m a transgendered woman, and that’s great. I think there’s nothing wrong with me. What’s going on here is that something is wrong with the world. TRANSforming Healthcare Lori Kohler, MD: I think transgender people in general are very fearful of going to a medical provider. It’s very vulnerable—you don’t know if you’re going to be flatly rejected, or if someone’s going to laugh at you, if someone’s going to over-sexualize you, or someone’s going to want to do an exam just to see your genitals, just to satisfy their own curiosity. There are lots of humiliating experiences that people have, and those get shared with other trans people—and people end up avoiding medical care all together. Danielle: Myself, I went in once for…What did I have, like bronchitis. And I disclosed that I was transgender, and the next thing I know, I’m in the ER. I went to the ER for services, because I had a high fever, and I didn’t feel comfortable in going to the doctor’s regularly, because there was nothing trans specific here. And I ended up under a spotlight with my legs wide open, and a group of doctors looking at my vagina because they all were curious to understand what my body looked like, but I initially went in for bronchial stuff, so there’s no congruence there for providing care. Kien: So it had been a while since I have gotten the junk checked out, and I really felt like I needed to get like an annual in order to just to do my own kind of health maintenance. I was waiting for a while, the practitioner came in, and she’s like “oh, how long has it been since your last exam—your last pelvic exam?” And I said “Oh, it’s been probably over years maybe.” She’s like “Wow,” she was like astounded. And she’s like “Well welcome back to being a woman.” And I was like…I was a little bit taken aback. I feel like in that case she assumed that her identity as a woman was going to be my identity as a woman, just because I was in that clinic and getting the particular exam that I was getting. But that’s not true, I can identify as I want to, I can identify as transgender, I can identify as male. And I can still go in and get that exam, I can still have a period, but I’m still male, I’m still transgender. I can be whoever I want, so don’t place your identification with your gender onto me. Yosenio: Every single time I go to see somebody, I have to come out, and I have to educate them on what I’m talking about when I come out. The assumption is that if I say, “I am a transsexual,” then I must be a male to female. And the first is, “well you know, why don’t you try to talk a little higher so that people…” and “You should get that stuff off your face. Who’s going to believe you?”, and “You don’t sit dainty-like, I don’t understand.” So, then I have to explain the existence of FTM’s. And then I have to explain that we aren’t all doing certain things. But I remember one time I had pneumonia, and the x-ray tech kept, I don’t know how, oh, because he had to read my file. And he started asking me questions, first of all he started saying “Miss Lewis,” and I said, “It’s not Miss Lewis, it’s ‘Mister.” But then also asking me a , “So you’re taking testosterone, and what effect do you think that might have had on your pneumonia?” And me saying “None, I don’t think it had any effect.” Lori: Medically, to provide cross-gender hormones is incredibly simple, but transgender people don’t just need just hormones, they need full scope medical care just like everyone else. And if they take hormones, it doesn’t mean that the rest of their lives are any more complicated from a medical perspective, and we should stop being so afraid to address transgender people’s needs. Issues Surrounding STD and HIV/AIDS Care Yosenio: Well, you have to admit that you’re having sex. And you might have to admit that you’re having unprotected sex, and you might have to admit that you’re having the type of sex that your body parts would indicate you would not be having, or that your identity would indicate that you would not be having, and some people, it’s hard to do that. Dafna Wu: I think it’s important if you’re talking about things that have to do with genitals, like if you’re worried, if someone says, “I’m having burning when I pee.” Or, you know…”There’s blood in my stool,” or something, then you need to talk about potential exposures and move into this sort of sexually transmitted infection area, and at that point you need to ask what you need to assess for risk of exposure, so you need to say what kind of sex do you have, what goes in what body parts, and what body parts do you insert in someone else’s body part. What body part is going into your body parts? Yosenio: If I’m a gay man I need to know again, what is vaginal sex? Because I might be having that, but I don’t call it that, because I’m penetrating my gay FTM lover, but we don’t call it a vagina. It’s just the other hole. Lori: It’s important to ask people how they identify for themselves, and how do they identify their body parts, especially say, for instance, if you’re going to do a pap smear or a “vaginal exam” for a transman, you say to them, “I need to do a genital exam. How would you like me to discuss your body parts? Because I want to tell you what I’m doing when I’m doing that exam, but I want to make sure that I respect you in the process.” Recommendations: Creating a Transgender Friendly Environment Yosenio: The first time that—my first doctor, my primary doctor, when I told her “I’m bleeding a lot, I don’t know what’s going on here. I feel horrible, I’m in a lot of pain, I can’t concentrate—blah blah blah.” And she said “Okay, so clearly there’s something wrong with you, we need to get to the bottom of this. “I’m going to order some tests. I want to tell you what I think it might be. I want to tell you what the protocol that we might have to go through.” That to me, was a very positive experience, and it was because she was so open with me—she was so willing to accept that there was something wrong, that I wasn’t just crazy, and that I wasn’t just trying to get free surgery. Because she did that, I felt comfortable coming out to her. And then she felt comfortable saying “Okay, you’re going to “have to help me to understand some things, and you’re going to have to help me to make sure that I say the right words, and I hope that you will forgive me if I don’t—and we still need to do blah blah blah blah.” That was the—out of that whole thing, around getting the hysterectomy, that was the most positive experience that I had ever had, and to this day, I hold that doctor up as the best doctor I ever had because she cared, and she treated me with respect. Train All Staff Tamara: Well we know a doctor or a healthcare practitioner is transgender sensitive if we come in a dress or wearing makeup, fingernail polish, or looking feminine in gender, and we put our name down like “Stephanie” or “Cecilia, then say “Yes ma’am,” instead of saying “yes sir.” Dafna: So training, getting everybody trained on every level and it doesn’t matter if the provider is trained, if the client has to go through three levels, which often you do, you need to say hi to the registration person, you need to talk to the person who’s going to take your blood pressure, you need to talk to the nurse, whatever—if those people aren’t on board, it doesn’t matter, because by the time you get to the provider you’re already traumatized, and you want to leave and you have no trust whatsoever, so it’s important that the entire clinic’s staff is up to speed. Respect Confidentiality Danielle: I think confidentiality is a big thing for the transgender community, and all communities affected by HIV and STDs, or any clinic—making the person feel welcomed is one thing, but asking them personal questions in an area that isn’t confidential is another. One of our clinics locally has actually asked clients about their gender identity in front of other people, and I think it’s scary to self-disclose in a world where we’re so discriminated against, and it’s important to do that behind closed doors. Change Intake Forms Jackson: I think that having the option to choose a box other than male or female is probably good. I mean I’m comfortable with choosing a male box, but nothing says you’re welcome here, more than “pick your gender,” do you know what I mean? Danielle: Change intake forms to be transgender friendly, from not just having male and female, even if their computer systems don’t allow them to input the data, perhaps just changing the form to be more accepting. Provide Nongendered Bathrooms Dafna: A huge point is bathrooms. If someone’s gender isn’t straight up male or female, or they’re in the middle of transitioning, or they just need to make that choice every time they need to use the bathroom, it’s really, really helpful to have I guess the word is “unisex bathrooms,” but we like to say “non-gendered bathrooms.” So, at our clinic, we close one of the bathrooms, and we use the women’s bathroom that has three closed door stalls, and we put a big sign on that says, “everybody’s bathroom.” Lori: So the most important thing to remember about working with transgender people, is that this is not a fad or a faze that people are experiencing, that the transgender community overall is incredibly medically under-served, and very much in need of competent and open medical care. Dafna: So, I always tell people when someone comes to you and you’re uncomfortable, pay attention to your own discomfort. You can’t pretend that you’re not uncomfortable if you are. But outside of that, prepare yourself and train yourself by talking to other providers that do this. Take it upon yourself to read and learn from trans people, and there’s lots of literature out and sort of first-person kind of accounts, like “this is what it was like for me,” so just like you would learn about, not to pathologize it, but if you were going to go do diabetes care, you need to go learn about diabetes, you need to educate yourself. Danielle: There is a huge importance for providers to understand that…when someone comes in for a cough or a cold, you don’t want to do a pelvic exam to ensure that they’re having a healthy vagina. It’s met the client where they’re at, meet the client where they need the health care provided. Save your curiosity. It’s important to not see transgender people as objects of study. We’re humans and we require adequate care and competent care.

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