1. end+disparities Learning Exchange: Transgender Health January 19, :00-2:30 pm ET Michael Hager & Judy Popkin, NQC Cecilia Chung & Teo Drake, Learning Exchange Spokespersons Nala Toussaint, Callen-Lorde Health Center Milo Vieland, Howard-Brown Health Center
Michael
Welcome to our January webinar focused on transgender health!
This is our first month that focuses on one of our four populations. Stay tuned for more information on our other population focus months at the end of today’s webinar.

2. Before we start… Please type your name, organization, city and state in the chat room
Michael
Please note that this webinar is being recorded for later replay by those who missed the call.
Before we start our webinar, let’s take a moment and ask participants to introduce themselves via our chat room, which can be found on the right hand side of your screen, just underneath the participants section. There is a small box labelled Chat.
Please enter your name, organization, city, and state so others can see who we have on the call today.

3. Ground Rules for Webinar Participation
Actively participate and write your questions into the chat area during the presentation
Do not put us on hold
Mute your line by pressing the microphone button to the right of your name
Please complete the post-webinar evaluation
This call is recorded for replay for those who missed the webinar
Michael
Ground rules for todays webinar:
- Actively participate and write your questions into the chat room; we have several staff and consultants who will answer your comments – I want to thank them and HAB representatives
- Please mute your phone line; you can press the microphone button to the right of your name
- Please complete the post-webinar evaluation, which will be sent to your at the conclusion of the webinar. We look forward hearing from you.
- As stated earlier the call will be recorded for replay for those who missed the webinar

4. Chep Maritim, RN, MPH, MS, MBA
Nurse Consultant, HRSA-HAB
Michael introduces Chep and Clemens
Michael turns it over to Chep to provide words of welcome
Chep turns it over to Clemens to provide words of welcome
Clemens Steinbock, MBA
Director, NQC

5. The end+disparities Learning Exchange a 9-month initiative that promotes the application of improvement interventions to reduce HIV-related disparities in four key subpopulations while building and sustaining a community of learners among Ryan White HIV/AIDS Program recipients. The Learning Exchange offers informational opportunities by content experts and utilizes the power of peer learning to facilitate local improvement efforts on eliminating HIV-related disparities.
Michael

6. Communities of Learning: collaborative, QI campaign, Regional Groups
Consultation: On/off-site coaching of recipients to advance their clinical quality management programs
Together, we can make a difference in the lives of people with HIV. NQC provides assistance to RWHAP recipients to improve HIV care since gaps in HIV care still exist and advances are uneven across HIV populations.
250 recipients participated in 28 Regional Groups
51% of all recipients joined the largest HIV QI campaign; viral suppression increased from 70% to 76%, a statistically significant improvement
Training and Educational Fora: monthly webinars, advanced trainings, online QI tutorials
40% of RWHAP recipients received TA and 95% would recommend TA to others
40 online QI tutorials are available; over 35,000 have been taken so far
Intensity
Information Dissemination: monthly newsletters, websites, publications, exhibits, QI awards
Michael
NQC is funded by the HRSA HIV/AIDS Bureau since 2004 and provides technical assistance to all RWHAP recipients to build their sustainable clinical quality management programs. Over 90% of all recipients have accessed intensive NQC offerings and take advantage of our various services. The Learning Exchange is an extension of these offerings.
As you see in this graphic, NQC provides opportunities
To participate in monthly webinars to learn more about QI – next week’s webinar focuses on the 2016 NQC Award winners
To attend our 4 3-day face-to-face training programs or take one of 40 online tutorial we have available
To request onsite assistance by our pool of QI experts
To join one of our 28 Regional Groups, a local community of learning
If you would like to learn more, please visit our website at NationalQualityCenter.org.
over 90% of the 587 RWHAP recipients accessed NQC services
~1,300 individuals (61% of recipients) graduated from 45 three-day advanced trainings
NationalQualityCenter.org |

7. Agenda Welcome & Introductions Transgender Voices in Healthcare
NHAS Transgender Health Indicator
Resource Sharing!
Q & A Session
Michael

8. Learning Objectives
Name the ways in which the transgender community is diverse
Describe the new transgender health indicator being developed
Name two resources RWHAP recipients (hospitals, health centers, health departments) can employ to care for transgender people
Michael

9. Transgender Voices in Healthcare
Judy
Introduce Cecilia and Teo
Cecilia Chung is the Senior Strategist of Transgender Law Center, Co-Chair of the Amsterdam-based Global Network of People Living with HIV, member of the Global Reference Group of Positive Women and an internationally recognized civil rights leader who advocates for HIV/AIDS awareness and care, LGBT equality, and social justice. Cecilia has been a vocal advocate for transgender women and people living with HIV. Cecilia has received numerous awards for her work, including Levis Strauss & Co. Pioneer Award, Human Rights Campaign Community Service Award and the inaugural Cleve Jones Award from the San Francisco AIDS Foundation. As an Asian transgender woman living with HIV, she has dedicated herself to ending stigma, discrimination, and violence in all communities.
Teo is a spiritual activist, an educator, a practicing Buddhist and yogi, and an artisan who works in wood and steel. A blue collar, queer-identified trans man living with AIDS, Teo’s activism exists at the intersections of gender, sexuality, race, class, ability, and spirituality. He serves on the faculty and board of Off the Mat, Into the World, the national advisory board of the Transgender Law Center’s project Positively Trans, and is a founding member of the Transforming Hearts Collective. His writing can be found in the anthology Yoga and Body Image and at the blog

10. Cecilia Chung Learning Exchange Spokesperson Cecilia
Provide a sneak preview of your story and that you are excited to share more on next week’s partners in+care call. Explain a little bit about your motivations for joining end+disparities and what you hope can come from it.

11. Positively Trans Video Library Resources Cecilia
Describe Positively Trans and the video library. We have time for 1 or 2 examples from the library. Direct Michael which items to click to preview for the audience to pique their interest to come back to explore on their own.

12. Teo Drake Learning Exchange Spokesperson Teo
Provide a sneak preview of your story and that you are excited to share more on next week’s partners in+care call. Explain a little bit about your motivations for joining end+disparities and what you hope can come from it.

13. Nala Toussaint Callen-Lorde New York, NY Judy – introduce Nala:
Nala Toussaint is prevention coordinator for Transgender Services at Callen-Lorde Community Health Center in New York City where she works with trans women to support their health and well-being. Nala has done extensive work as an outreach liaison, conducting safe sex intervention activities for youths and coordinating educational and job development services at renowned LGBT public service organizations. Building on her educational success, she plans to pursue a master's degree in social work and business.
Nala’s notes for the audience:
I started as a PrEP Specialist in March 2015 contributing to over 1,800 patients  accessing PrEP and then promoted to Prevention Coordinator of Transgender services in June of 2016 where I contribute to  Me, Myself, and I (MMI) program;  which is  for TGNC (Trans and Gender Non-Conforming) people of color ages
We, at Callen- Lorde focus on creating safe space therefore patients feel comfortable with our staff and agency. We encourage patients to open up and be honest about their experiences, and through this we are able to train our staff how to foster a safe space. 
What we learned?
When you acknowledge, validate, and try to address the social, economic and cultural barriers that present themselves, you have a higher success rate and can gain trust from the community.
Challenges
TGNC folks; especially of color are still apart marginalized communities and deal with life-threatening issues such as racism, homophobia and transphobia; which also shows up internalized , homophobia and transphobia, hyper masculinity, violence, and police brutality on a daily basis. It’s difficult to try to get an individual to adhere to treatment when they are also dealing with more pressing life issues. We must continue to take these issues into account when attempting to serve these community. It’s important that we, the healthcare systems, continue building safety or solidarity.
What Worked ?
Use preferred names and pronouns
Pronoun Matter  we have stickers where patients can write their preferred gender pronouns so that when staff she the stickers they can refer
Don’t make assumptions about sexual orientation and/or gender identity
Remember, identity is different from behavior
Consider using terms like “front parts” and “back parts” for genitalia
Train all staff on LGBTQ inclusion
Front desk, customer service, security, contracted staff…
Establish gender-neutral bathrooms
Display posters and educational materials representing diverse individuals
Differentiate between gender and sex assigned at birth on patient forms
Collect data relating to LGBTQ patients and their health
How?
Counseling Approaches
“Sex neutrality”
Sex is an inherently neutral thing—it’s not good or bad except for how we experience it
Clinical and non-clinical staff must be comfortable discussing sex practices and drug use in-depth
Non-judgmental attitudes during counseling
Affirm current methods of risk reduction
Reflect patient’s language
Example of Screening and assessment
What brings you in today?
What gender do you consider yourself to be? What is your sexual orientation?
What gender are your partners?
What kind of sex do you have? Oral, anal, vaginal; Top/Bottom/Both?
Where/how do you meet your partners?
Have you been tested for HIV before? When was the last time?
Is there anything that happened recently that worries you in regards to your HIV status?
Do you use drugs/alcohol? How do you feel about your drug/alcohol use?
What are some ways that you protect yourself against HIV?
Do you know about PrEP? Tell me about what you have heard.
Reframing Questions about Sexual Health
Instead of:
How many people have you had sex with?
Try:
Can you tell me about how many partners you’ve had since your last test? An estimate is ok.
Do you have receptive anal sex?
Which body parts do you like to use when you have sex?
Hiring Trans Identified staff ; investing in those staff
Lastly, The most important ways to provide Health Care to TGNC community are to have TGNC community leading the conversion about what is wanted and needed for their health.  This also means having TGNC of folks especially of color as staff and in managerial roles. 

14. Milo Vieland Howard-Brown Health Chicago, IL Judy – introduce Milo:
Milo Vieland is a Ryan White Part D Case Manager at Howard Brown Health in Chicago. Milo works with trans and cis women of any age and male identified youth under 25 living with HIV to support them in managing their medical care, connecting to resources, and working towards self-managed care. Milo plans to pursue a career in health law to continue his work as a trans health advocate.
Milo’s notes for the audience:
What health equity problem have you tried to solve for your transgender patients, clients, and community members?
What resources or strategies did you find helpful toward closing disparity gaps for transgender people?
Major barriers to healthcare for trans people:
Access to competent/affirming medical providers
Finding a medical provider with trans health knowledge/competency can be incredibly challenging. Howard Brown works to provide affirming, competent care to trans people by providing a safe and affirming environment for patients, and works hard to make sure patients feel comfortable coming into the clinic. Providers learn from trans patients and value their trans health knowledge.
Resources/strategies for improving provider competency: hire trans staff; trans 101 trainings where needed, more in depth/specific trainings where possible, like hormone dosing protocol and safety trainings for providers, basics of document change processes for case managers; build an employee culture of prioritizing trans health; post trans-specific materials in the clinic.
Access to accurate information
Processes for obtaining transition related care are often confusing and unclear – for example different clinics and providers have different guidelines for hormone administration. Patients often come to Howard Brown asking for a therapy appointment because they think they need a therapy letter before they can access hormones, when really at Howard Brown we don’t require a letter, you just need to see your medical provider. Insurance coverage for hormones and surgeries is also very confusing and difficult to navigate, as are name and gender marker change processes. Trans people get a lot of trans health knowledge from personal experience and sharing experiences with other trans people, so providing accurate information isn’t just helpful on an individual basis, it is also a public health strategy.
Resources/strategies for improving access to accurate information: hire trans staff who can relate to trans patients, understand their experiences, and make them feel comfortable sharing and asking questions; require that providers working with trans patients maintain a working knowledge of terminology, insurance coverage guidelines and practices in their state, etc., provide educational materials with information about how to navigate systems/access resources related to trans health.
Access to resources/financial accessibility of services
Financial accessibility is a major issue for all aspects of trans health governed by the medical system. Hormones, needles, surgery, document changes, clothes, transportation, food, hygiene products, etc. are all expensive. Trans people, particularly trans people of color, experience high rates of financial instability and poverty, so making trans care financially accessible has to be a priority.
Resources/strategies for improving financial accessibility and access to resources: Hire trans staff who can lead the discussion on priorities for accessibility; Howard Brown works to close this gap by utilizing a 340B program at our partner pharmacy to help people access cheap hormones; offering a drop in night twice a month for TGNC clients to see a medical provider, have a free meal, get hygiene supplies and bus cards, and access a clothing swap and needle exchange; connecting clients living with HIV to case management services; utilizing IL ADAP which covers hormones; offering a sliding scale for uninsured patients.
What advice do you have for others who are trying to bring health equity to the transgender community?
Hire trans staff! - Especially trans people of color – make sure your organization reflects the populations you serve; invest in trans staff and have trans people in positions of leadership
Take the lead from trans patients! – Trans people know ourselves best, and have often been in the position of teaching our medical providers how to care for us; respect trans community health knowledge
Be a patient advocate! – There is only so much you can do strictly through service provision and our healthcare system is not designed to work for trans people; advocate for structural change wherever possible

15. National HIV/AIDS Strategy: Transgender Health Indicator
Cecilia
Walk us through the NHAS indicator.
When was it developed and who was involved?
Who will use this indicator when and how?
What is the benefit of this indicator?
Ask Michael to navigate to the website where the audience can learn more on their own? 15

16. Resource Sharing! What has worked for you?
Judy
Let’s have a conversation about what has worked to improve linkage, retention, and viral suppression for you as a transgender health provider.
What health equity problem have you tried to solve for your transgender patients, clients, and community members?
What resources or strategies did you find helpful toward closing disparity gaps for transgender people?
What advice do you have for others who are trying to bring health equity to the transgender community?
Ask Cecilia, Teo, Milo, and Nala if there are any resources they recommend and ask if they want Michael to show folks where they are located online.

17. Q&A Session
Judy
Now we open the discussion to general inquiries for the next 30 minutes. This is only needed if it wasn’t mixed in with the Resource Share!

18. Next Steps and Activities in end+disparities
Coming Up!
Next Steps and Activities in end+disparities
Michael

19. Partners in+care Roundtable Discussions
Each date is a clickable link with additional information to save in your calendar!
January 26: Transgender Health
February 23: MSM of Color Health
March 23: African-American and Latina Women Health
April 27: Youth (13-24 years) Health
May 25: Sustaining Our Gains
June 22: Greater Than the Sum of its Parts
Michael
Each month we focus on another topic. Partners in+care roundtables will occur on the fourth Thursday of the month from 1-230pm ET.
When we develop content for consumers to join the discussion, we’ll be sure to focus in on our challenges and opportunities in each area and will explore ways consumers can get involved in the work. The main toolkit available to us is the Partners in+care toolkit presented today, but there is plenty of room to introduce new tools and resources that are of interest to you

20. end+disparities Learning Exchange Webinars
Each date is a clickable link with additional information to save in your calendar!
January 19: Transgender Health
February 16: MSM of Color Health
March 16: African-American and Latina Women Health
April 20: Youth (13-24 years) Health
May 18: Sustaining Our Gains
June 14: Greater Than the Sum of its Parts
Michael

21. Office Hours Opportunities
February 17: Provider Focus Group– MSM of Color stigma
February 24: Consumer Focus Group– MSM of Color stigma
Office Hours discussions are informal opportunities to dive deeper into the issues
They are participant led and directed based on YOUR questions!
Michael
Office Hours discussions are informal opportunities to dive deeper into the issues
They are participant led and directed based on YOUR questions!
Occur on various Fridays from 1-2pm ET (check the calendar on our website for exact dates and topics!)

22. Closing Remarks Michael then to Clemens and Chep Clemens Steinbock
Chep Maritim

23. end+disparities Video
Visit our NQC YouTube channel to see our 3min video about disparities in HIV care -
Michael
A reminder to check out our video and the website!
Another cool informational tool that we have developed is a short animated video about disparities in HIV care and outcomes. Please take a look and feel free to share with others. 23

24. We Want Your Feedback!
Please complete the evaluation that is being ed to you. This quick survey will allow us to hear from you and make changes to upcoming webinars.
Michael

25. THANK YOU!
Michael

26. 212-417-4730 NationalQualityCenter.org Info@NationalQualityCenter.org
Michael 26