Avenues for action for the provision of care and the promotion of well-being Walter Bockting, PhD Past President, World Professional Association for Transgender Health Coordinator of Transgender Health Services Program in Human Sexuality Professor Department of Family Medicine and Community Health University of Minnesota Medical School

Blueprint for the Provision of Comprehensive Care for Trans Persons and their Communities in Latin America and the Caribbean 1. Terminology, definitions, description of the population 2. The health situation of trans persons in the region 3. Determinants of health and socio-cultural, legal, and structural barriers to comprehensive care 4. Advocacy, public policy, training, and research 5. Comprehensive care, prevention, and support 6. Working with gender variant children and adolescents

Care, prevention, and support Infrastructure and settings; coordination of care Reception, first encounter, and first clinical evaluation The Oral Health Practitioner’s office as a point of entry into the health system HIV and STI testing, counseling, and treatment Addressing mental health concerns Alcohol and other substance use and addiction Coping with stigma, discrimination, and violence and the promotion of resilience Addressing the consequences of physical violence Specific health care related to gender affirmation (including hormone therapy and surgery) Trans-positive interventions (child, family, school, early medical intervention)

Algorithm for management of minority stress

Provide information on results, side effects, reversibility, social impact. Verify patient’s decision to undergo hormonal treatment. Explain procedures and obtain consent Referral to medical practitioner Inhibition of endogenous hormones Peer education and support DECIDED UNDECIDED Hormone replacement Emotional and social support Follow-up Incl. possible surgical procedures Algorithm for hormone therapy

Recommendations for members of health care teams Develop the technical skills and cultural competency necessary for providing appropriate health promotion, prevention, care, and support services to trans persons Respond to the health care demands of trans persons by providing the highest attainable standards of care Ensure that trans clients are addressed with due respect, using their preferred name and pronouns that correspond to their gender identity Organize facilities (including restrooms and inpatient accommodation) in a way that acknowledges the gender identity of trans clients Ensure the provision of biomedical interventions for gender affirmation (including hormonal treatment and surgery) by qualified professionals Be aware of the risk of generalizations and preconceived assumptions about and/or prejudices against trans persons

Recommendations for policy and decision makers in the health sector Recognize and address the negative impact of transphobia on the provision of health care services Ensure that provision of care to trans persons be comprehensive and not just limited to HIV/STI care, including all areas related to personal wellbeing Recognize that biomedical interventions for gender affirmation are not merely cosmetic but a matter of medical necessity Ban the practice of so-called “reconversion” therapies that aim at changing a person’s gender nonconformity or non-heterosexual sexual orientation Adapt existing algorithms for the provision of care of trans persons to reflect national standards and specific realities of relevant populations Ensure that recommendations are based on evidence as well as on the expressed needs of trans persons themselves

Recommendations for managers of public services across different sectors Implement and enforce zero tolerance policies with regards to transphobia in public services Implement measures to ensure respect for the use of names and gender markers that differ from a person’s official identity documents

Recommendations for members of academia and professional associations Publicly endorse and promote knowledge of the fact that gender non-conformity does not in itself represent a pathological condition of any kind Intensify research aimed at expanding knowledge about trans populations, their needs, demands, common health problems, and social determinants of health Clearly define samples and results of investigations as pertaining to trans populations, avoiding the conflation of data with gay, lesbian, bisexual or other populations Address gaps in medical research, e.g. in relation to side- effects and their effective remedy associated with the use of hormones and soft-tissue filler injections and the interaction between the use of hormones and established algorithms for the treatment of HIV and other conditions

Recommendations for governments Undertake measures and campaigns with the goal of reducing verbal, emotional, and physical violence against trans persons Ensure that trans persons have access to identity documents that adequately reflect their gender identity Ensure that public health systems provide quality services that are accessible and acceptable for trans persons Guarantee the uninterrupted access to care by persons deprived of liberty Collect, collate, and disseminate relevant data and strategic information that may serve as a reference for the improvement of programs and services directed at trans persons

Recommendations for bi- and multi-lateral organizations Support global, regional and national efforts to fight transphobia and other expressions of hatred, ostracism, or intolerance Gear resources towards capacity-building to address the needs of trans persons in the health sector and other areas of public policy, including legislation and law enforcement

Recommendations for leaders and members of CBOs Proclaim and advocate for the respect of the human dignity of trans persons Develop community organizations and networks at local, national, regional and global level Remind national authorities of their international commitments to the protection of human rights Participate in local, provincial, and national legislative health commissions to ensure equitable and appropriate provision of high-quality health care Provide peer support to trans persons who deal with stigma, family rejection, harassment, anxiety, depression, or other hardships Develop educational processes and materials for educating peers on issues relevant to personal wellbeing, such as the risks to health associated with self-administered hormones or soft-tissue filler injections as well as nutrition, use of cosmetics, dressing, and safer sex Promote the development of leadership and other skills that contribute to the realization of personal capacities Develop competencies that would enable representatives of trans communities to participate in public discussions, conferences, and social gatherings Develop vocational training programs to facilitate entry into safe and reliable lines of work

Thanks to all the organizations who sponsored and supported the development of the Blueprint and this session.