Vanguard and Vision for Transgender Health

“In my generation, a lot of us didn’t make it to 50. You don’t see a lot of trans elders – they either died in the streets through violence or alone with AIDS or HIV…We used to slink around in back alleys to get a [hormone] shot.”

Tiffany Woods directs TransVision, a program of Tri-City Health Center in Fremont dedicated to transgender health at a time when, despite increasing visibility and even celebrity status, transgender (trans) people continue to face incredible stigma and safety issues.

TransVision opened its doors in 2002 for HIV Prevention Services and added trans specific primary care services in 2010, providing care to now more than 370 transgender patients. With its own private entrance and a team of transgender staff, TransVision offers primary care and trans-specific care to its clients.

What does it mean to be trans? According to the Human Rights Campaign, “The transgender community is incredibly diverse. Some transgender people identify as male or female, and some identify as genderqueer, nonbinary, agender, or somewhere else on or outside of the spectrum of what we understand gender to be.”

At TransVision, the lobby welcomes clients with information, with the Trans flag, colorful posters and a memorial wall to those lost to disease, violence and self-harm. Several staff members, some of them former clients, are HIV County certified testing counselors and test for HIV and Hepatitis-C on demand.

One staff member scrolls through the TransVision Facebook positive reviews and messaging traffic with providers. Facebook is a way of meeting clients where they are. Given the dangers that trangender people can face when traveling in public spaces, staff recognize social media as the most effective way of getting new clients, responding to them and keeping them in care.

Once at a community health center, clients often discover health challenges they didn’t know they had.  Woods shares an example. One patient was diagnosed with Stage 4 Lymphoma and has just begun chemotherapy. Follow up care did not stop there. “She would like her mother who is in Jalisco (Mexico) to come to support her. She has a passport but no visa – we can write a letter validating and verifying her diagnosis and that she needs support as she goes through chemo, but the whole visa process is above my work.” Here is where Tri-City Health Center’s partnership with other community groups was critical. “I sent an email to …East Bay Community Law Center who also started a new trans program.  We’ve always referred clients there for immigration and HIV…”

Strengthening TransVision services means protecting privacy while also raising the visibility of the patient population. Trust requires privacy and a safe space, and from its lobby to the exam room, TransVision exudes community and belonging. But accounting for patients – their numbers, how they identify their gender, their housing and employment status – matters when going for funding and for scaling up trans health services.

Barriers Remain

While more clients get insurance now with Affordable Care Act, they face other barriers to care. Stable housing stands out as a major obstacle. “My provider comes in three times a week and asks, ‘Do you have any resources for housing?’  These may be patients that we wouldn’t think traditionally would have housing issues, they’re homeless now, or marginally housed. There are still huge amounts of unemployed,” says Woods.

Clients are not only transitioning gender, they are often transitioning  from other countries.  Clients coming from Mexico are used to easier and faster access to hormones and may be unaware of the associated health risks. “They’re used to having immediate access through street drug trade or through pharmacies in Mexico.”  For them, the testing regimen and required appointments in Alameda County throw up an additional barrier to care. TransVision conveys  to them that it’s worth it to go through these steps, and we’ve tried on our end to streamline the process.”

From the back alleys to flowers and balloons

TransVision gives Woods and colleagues hope amid the many barriers and the ongoing tragedies and struggles her clients face. “There was a 19-year-old from Santa Clara County who couldn’t find any care there and came here to start his transition. We had International Day of Visibility in March and we had balloons in the clinic, pan dulce and fresh fruit, and he was getting his first shot on that day. And he felt like we did all this for him, for his new birth. And all I could think was this young kid – he’s 19 – and we got all this cake, we got balloons and he’s getting his shot and that’s the success that I’ve worked for in my life. No more slinking around, walking in proudly and saying, “This is what I am.”

The National LGBT Health Education Center is offering training in providing  trans health services through the Project ECHO model. Trans ECHO aims to form a network of health centers and faculty expertise to increase clinician access to knowledge and to provide culturally-responsible, comprehensive, primary care to transgender and gender non-conforming patients.