Creating Environments of Care With Transgender Communities

Abstract

Partnerships between transgender individuals and community health nurses have been a primary source of monitoring and responding to the impact of the HIV epidemic on transgender communities, specifically transgender women. This article provides two perspectives: first, from a transgender service provider, and second, from a public health nurse, on forming partnerships that brought consumers and providers together to create environments of care in which many transgender persons living with and at high risk of HIV were able to engage with medical providers who believed in their right to self-determination. The process led to an increased understanding of HIV prevention and treatment needs, better individual-level health outcomes, and institutional change, including the creation of a transgender medical clinic serving homeless transgender individuals in greater Boston.

Predisposing, reinforcing, and enabling factors of trans-positive clinical behavior change: A summary of the literature

“…Finally, trans-positive care may be seen as an important practice of preventative medicine in that HCPs who support gender minorities are likely to develop a clinical relationship of trust, rather than one of avoidance, which may lead to greater use of health care services and in turn improved health outcomes for this population (Hagen & Galupo, 2014). A trans-positive care approach has been accepted by a diverse community of researchers and practitioners (Coleman et al, 2011;Lev, 2009;Thornhill & Klein, 2010;Vanderleest & Galper, 2009) and major health authorities such as the American College of Obstetricians and Gynecologists (ACOG, 2011).…”

“…While Thornhill and Klein (2010) have discussed positive individual-level health outcomes of implementing environments of care with trans persons living with HIV, scant research exists that has explored the institutional and clinical conditions under which trans-positive care is likely to emerge. Lysenko (2009) asserts that simply taking a trans-positive stance is not enough to improve the clinical treatment of trans populations.…”

“…This is troubling, as trans and gender-nonconforming people (herein referred to interchangeably with "gender minorities") experience many population-specific health concerns that require interventions from physical and mental health care providers (HCPs). For instance, compared to cisgender (non-trans) adults, trans people experience elevated rates of unemployment and poverty (Conron, Scott, Stowell, & Landers, 2012), increased substance-related issues (Keuroghlian, Reisner, White, & Weiss, 2015;Nuttbrock et al, 2014), low rates of cancer screening (Vogel, 2014), and greater risk of contracting HIV (Thornhill & Klein, 2010;Bauer, Travers, Scanlon, & Coleman, 2012). Poor mental health outcomes are also notably high among trans populations.…”

Recruiting, Linking, and Retaining High-Risk Transgender Women Into HIV Prevention and Care Services: An Overview of Barriers, Strategies, and Lessons Learned

“…The shared experience of being a trans woman can facilitate the ability to establish trust and rapport swiftly; this experience, which must be phenomenologically experienced to appreciate and understand, cannot be fully realized through any amount of staff sensitivity training. Employing trans women from the local communities is a proven successful method for recruitment (Barrington, Wejnert, Guardado, Nieto, & Bailey, 2012; Reback & Fletcher, 2014), and is one of the most impactful and important factors in reducing the trepidation that high-risk trans women feel in speaking to staff about important HIV prevention and care services (Thornhill & Klein, 2010). …”

“…Employing HIV-infected trans women who have overcome their personal barriers to receiving HIV care, who are medication adherent, and have achieved virological suppression can serve as role models and provide invaluable social support (Thornhill & Klein, 2010). Furthermore, a structured Peer Health Navigation program can work with HIV-infected trans women to remove as many barriers as possible.…”