The Tangerine Clinic: Integrated Healthcare Services for Transgender People Reshmie Ramautarsing, M.D., Ph.D. PREVENTION | Thai Red Cross AIDS Research Centre reshmie@prevention-trcarc.org Mexico City, 22 July 2019
Disclosures Gilead: travel support, speakers fees Alere: speakers fees
Thailand’s new HIV infections by route of transmission Needle sharing 1,314 (5%) Male-male sex 14,700 (53%) Est. 29,626 new HIV+ Casual sex 2,396 (8%) Spousal 7,226 (26%) Sex work 2,245 (8%) 2015-2019
Transgender Women in Thailand: Population Size Estimation and HIV
Stigma and Discrimination in Healthcare Settings ** ** * Sources: *Thai Transgender Alliance and Transgender Europe, 2015 ** Report of a pilot: Developing Tools and Methods to Measure HIV-related Stigma and Discrimination in Health Care Settings in Thailand and; the HIV Stigma and Discrimination Survey Guidelines and Procedures Manual, International Health Policy Program, National AIDS Management Center (NAMC) Thailand, Ministry of Public Health (November 2014).
The 1st National Trans Community Consultation The Dialogue: Trans Communities and Health Provider (September 17, 2015)
Tangerine Community Health Clinic: Transgender-led, hormone-integrated sexual health clinic
The Comprehensive Health Service Package for Transgender Women HORMONE SERVICES SEXUAL HEALTH SERVICES HIV testing, syphilis testing PrEP and PEP Same-day ARV treatment, CD4 count and viral load testing Condom and lubricant Anal and neovaginal Pap smears STI treatment High Resolution Anoscopy and Neovaginoscopy Vaccination for hepatitis A, B and HPV Counseling on gender transition Hormone prescription Hormone level monitoring WELL-BEING SERVICES Mental health support and referrals Referrals for gender affirming surgery Referrals for legal services Botox & skin care
Tangerine’s Performance (November 2015 – April 2019)
TGW Client Characteristics
Male sexual partners of TGW
Male sexual partners of TGW: 21 couples
Sexual and Gender-Based Violence (SGBV) among transgender clients at Tangerine Clinic
Keys to Success
The Tangerine Academy The technical assistance platform for the development and sharing of tools and learning resources to support further roll-out of HIV and health service models for transgender people. The Academy’s Three Schemes
Conclusions and challenges ahead Trans-led, integrated services works Low PrEP uptake Limited reach to subgroups: young TGW, TGW sex workers Inadequate psychosocial support and mental health counseling Hormone services not supported under UHC Drivers of HIV-epidemic in TGW clients
Acknowledgements