1. Welcome to the Acción Mutua web-seminar: Understanding Transgender Latinas and other Transgender Women of Color and their HIV Concerns
Presentation by seminar speaker (approx. 40 min.)
Followed by question and answer session (approx. 20 min.)
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Questions submitted prior to the web-seminar will be addressed first during the Q&A
For questions that arise during the presentation, click on the “hand” button and type your question or wait to be called on to ask your question over the phone during the Q&A

2. Funded by the Centers for Disease Control and Prevention
Acción Mutua is a capacity building assistance (CBA) program of AIDS Project Los Angeles in collaboration with the César E. Chávez Institute of San Francisco State University
Funded by the Centers for Disease Control and Prevention

3. Understanding Transgender Latinas and other Transgender Women of Color and their HIV Concerns
Presented by
JoAnne Keatley, MSW
Pacific AIDS Education & Training Center
University of California, San Francisco

4. This slide in background as Eda introduces Jeffrey and JoAnne
This slide in background as Eda introduces Jeffrey and JoAnne. (2 minutes)

5. Today’s Web-Seminar Objectives
Understand the impact of bias on the healthcare experiences and choices of transgender populations
Identify ways to design and deliver gender-appropriate and culturally competent services for transgender clients
Discuss strategies for effective outreach to and engagement of the transgender population
Slide 1C
Begin with this slide and go over quickly before the introduction slide. You may want to do the introduction slide before the Objectives.
Trainer’s goal is to get group buy-in right away. They must be engaged with the material and invited to care about the topic.
Welcome participants to ask questions and contribute thoughts throughout the workshop.
EXERCISE:
In 1.5 hour session: Ask audience what issues they would like to see addressed in this training? What are some of the questions or specific needs that you have?
Have participants call this out, don’t go around to all participants. Write key points on easel board.
In 3 hour session: Have participants write down something they would like to learn and something that they feel challenges them as a provider on this topic. Then have them pair off and discuss with each other for 3-4 minutes —to process after the 3-4 minutes, ask for volunteers to share. List 6 or 7 on an easel board.

6. Transgender?
When you hear the term “transgender” who/what comes to mind?
What do you know about transgender people?
What types of contact have you had with transgender people?
What more do you want to know about transgender people?

7. Gender & Sex “traditional” woman “traditional” man
BIOLOGICAL SEX (chromosomes, anatomy)
female intersex/hermaphrodite male
GENDER IDENTITY (psychological sense of self)
woman gender queer/neutral man
GENDER EXPRESSION (communication of gender)
feminine androgynous masculine
SEXUAL ORIENTATION (sex attracted to)
attracted to men bisexual attracted to women

8. Gender & Sex
Binary Gender System: The societal division of human beings into two, distinct categories of male and female.
Chromosomes: Genetic material that carry the genes that determine height, eye color, etc. Two of them are related to biological sex. XX and XY.
Intersex: Can include individuals who are born with genes other than XX or XY; may have ambiguous genitalia. ISNA : 1 in 2000 people have some form of an Intersex condition

9. Gender & Sex
“Biological Sex.” The sex assigned at birth typically based on examination of the genitals.
Gender Identity: Self-image or belief a person has about their gender as being female, male, or something altogether different.
Sexual Orientation: The internal experience that determines who we are physically and/or emotionally attracted to.

10. Transgender People
May undergo surgical and/or hormonal treatment to change their physical appearance and/or gender expression.
Often adopt a new name and lifestyle to reflect their gender identity.
Are sexually diverse, important not to make assumptions.

11. Epidemiology Rates of HIV infection estimates
13 – 68% for transgender women
2 – 3% for transgender men
Rates are higher for transgender people who are
Male to Female
Of Color
Engage in sex work
Use injection drugs

12. Gender-Specific % of HIV/AIDS Cases Younger than 30
Race/Ethnicity Male Female Transgender
HIV*
AIDS
African American
26.8
15.5
32.1
19.7
37.2
17.8
Asian/PI
30.9
16.1
42.1
22.3
52.4
31.9
Hispanic/Latino
40.0
23.0
47.9
29.6
52.0
31.0
Native American
34.5
21.9
35.6
24.1
28.6
N/A
White
21.6
12.2
32.9
20.7
32.7
18.4
*Includes only HIV cases reported via non-name code
Mathew Facer, Epidemiologic Studies Section, California Office of AIDS

13. HIV Risk Behaviors among MTF Transgenders of Color
Tooru Nemoto, PhD., Principal Investigator
Don Operario, PhD. Research Associate
JoAnne Keatley, MSW, Project Director
Center for AIDS Prevention Studies, UCSF
Supported by National Institute on Drug Abuse (NIDA)
(Grant No: ROI DA )

14. We examined HIV-related risk behaviors among samples of African American, Latina, and Asian Pacific Islander transgenders in San Francisco.
In our study we focused on specific HIV-risk behaviors such as:
Sexual Behaviors: primary, casual, and commercial
Health Outcomes: HIV/STD, depression, need and access to care
Substance Use: (lifetime, past 30 days), injection drug use, engaged in sex with primary, casual, or commercial partners while under the influence of any illicit drugs
Psychosocial Factors: transphobia, depression, self-esteem, gender identity, social support

15. Table 1. Demographics by Ethnicity
Total
(n=332)
N (%)
Afri.Am. (n=112)
Latina
(n=110)
API
Income source(s) in past 6 months
Full time job:
Prostitution:
Income in past 30 days ($)
0-499 :
1,000-1,999:
2,000 (and above)
92 (28)
170 (51)
64 (20)
110 (34)
70 (21)
84 (26)
18 (16)
56 (50)
15 (13)
51 (46)
31 (28)
24 (22)
79 (72)
36 (33)
35 (32)
15 (14)
22 (20)
50 (45)
13 (12)
47 (44)

16. Table 2. HIV/STD by Ethnicity
Total
(n=332)
N (%)
Afri. Am.
(n=112)
Latina
(n=110)
API
HIV Positive Status
86 (26)
47 (41)
25 (23)
14 (13)
Any STD, past 12 months
46 (14)
20 (18)
21 (19)
5 (4)

17. Major Findings
About three-quarters of the participants had recently engaged in receptive anal sex.
A significantly higher proportion (47%)had recently engaged in URAS with primary partners than with casual (26%) and commercial partners (12%).
Current URAS with primary and casual partners, but not commercial partners, was significantly and independently correlated with having had sex under the influence
HIV positive participants were 3.8 times more likely to engage in receptive anal sex as well as URAS with casual partners than HIV negative participants, controlling for other variables.

18. Major Findings, continued
Although only 12% had reported URAS with commercial partners in the past 30 days, this risk behavior was significantly and independently correlated with African American race (4.5 times more compared with non-African Americans) and lowest income level (less than $500 of monthly income).
Nemoto T, Operario D, Keatley J, Han L, Soma T. (2004). HIV Risk Behaviors Among Male-to-Female Transgender Persons of Color in San Francisco. American Journal of Public Health, Vol.94, No.7,

19. Barriers to Service Lack of information on risk for trans people
Misinformation within trans community
Low perception of risks
Data collection has ignored various trans identities.
Prevalence drives funding and programs
FTM incidence not well understood or explored
TG women continue to be counted in MSM category for funding and prevention programs
Slide 4E
Note the final point: That the CDC places Trans people in the MSM category. MSM, in HIV prevention, stands for Men who have Sex with Men. It is a term that was coined because many men have sex with other men but do not identify as gay. There is a distinct difference between gay man and MSM, with MSM being about behavior, not identity.
We discussed in detail in the last module the differences between sexual orientation and gender identity. It gets played out on a policy level that continues to undercount transgender people living with HIV and fails to fund programs that will focus on their HIV treatment and prevention needs.
Due to a lot of lobbying by transgender activists and allies in public health, the CDC and NIH have begun to look at data collection that allows for gender category distinctions. This will result in better data collection on risks, HIV prevalence and funding for prevention and services targeting transgender people at risk for and living with HIV.

20. Barriers to Care: Providers
Lack of knowledge and information
Personal discomfort
Lack of clinical research, literature
Lack of agency support
Not enough people doing the work
Religious/Moral concerns
Slide 5D
With the goal of providing care, we will first examine barriers to care.

21. Barriers to Care: Clients
Fear of disclosure/exposure
Social and geographic isolation
History of bad experiences with care providers
Intake forms, office environment, alienating process
Lack of insurance coverage
Trans-related care is often explicitly denied in insurance policies.
Slide 5E
Here are some of the barriers for patients.

22. HIV and Hormones
Re-work this slide
There are no significant drug interactions with drugs used to treat HIV.
Several HIV medications change the levels of estrogens.
Cross gender hormone therapy is not contraindicated in HIV disease at any stage.
Transgender patients need ongoing care, not just access to hormones.
Slide 2H
Not a lot of studies on hormones for gender reassignment.

23. Suggestions for Making Your Agency Trans Affirming
Don’t just add a “T”, implement non discriminatory policies and procedures.
Provide training for all staff; front office, managers, security guards, counselors, outreach staff
Make intake forms trans inclusive:
include “preferred name” not just legal name;
include more gender choices
Challenge transphobia—in staff and community
Have trans-inclusive imagery in waiting room
Use inclusive or gender neutral language
Create safe bathroom policies!
Hire Transgender people!!!!!!!!!!!
Slide 5J
Note to trainer: Depending on how much ground the group covers in the previous exercise, you may not need to show these slides.
Discussion points: With the increase in transgender visibility, and high rates of HIV, HIV positive transgender people are likely to show up in your agency.
In thinking about solutions, we also must look at institutional change. It is wonderful when individual providers grow and change and gain reputations among trans patients to be “the one to see” at a facility. But individual provider change can only help so many people, and also leads to frustration and burn out for that provider. We have to work towards agency and institutional change as well.

24. Costura y Charla (Spanish-language Sewing/Support Group)
Support group and skills-building class for Spanish Speaking transgender women
Facilitated by Transgender Health Educators and a Consultant

25. Costura y Charla continued…
During support sessions, participants received training in pattern making, design, cutting fabric, sewing clothes and alterations.
HIV/AIDS prevention, relationships with family, friends and lovers as well as other issues that effect the Latino transgender community.
Skill building as well as emotional support in a culturally appropriate environment

26. Costura y Charla

27. Costura y Charla

28. Costura y Charla

29. Thank You!
Comments & Discussion

30. Acción Mutua (Western region Latino CBA provider):
JoAnne Keatley, MSW
For more information on how to receive CBA services please contact:
Acción Mutua (Western region Latino CBA provider): or
Transitions (nation-wide transgender CBA provider):