1. The Tangerine Clinic: Integrated Healthcare Services for Transgender People
Reshmie Ramautarsing, M.D., Ph.D.
PREVENTION | Thai Red Cross AIDS Research Centre
Mexico City, 22 July 2019

2. Disclosures
Gilead: travel support, speakers fees
Alere: speakers fees

3. 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%)

4. Transgender Women in Thailand: Population Size Estimation and HIV

5. 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).

6. The 1st National Trans Community Consultation
The Dialogue: Trans Communities and Health Provider (September 17, 2015)

7. Tangerine Community Health Clinic: Transgender-led, hormone-integrated sexual health clinic

8. 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

9. Tangerine’s Performance (November 2015 – April 2019)

10. TGW Client Characteristics

11. Male sexual partners of TGW

12. Male sexual partners of TGW: 21 couples

13. Sexual and Gender-Based Violence (SGBV) among transgender clients at Tangerine Clinic

14. Keys to Success

15. 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

16. 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

17. Acknowledgements