Raquel Sapién TransLatin@Coalition Global Network of People Living with HIV/AIDS, North America GNP+NA

1. Understanding Transgenders and Their Needs Raquel Sapién TransLatin@Coalition Global Network of People Living with HIV/AIDS, North America GNP+NA

2. Transgender History • The Navajo tribe traditionally respected “two spirit” individuals who embodied more than one gender. Regarding them as able to “walk between worlds” and experience multiple realms of ordinary and spiritual reality. • India uses the term hijra to describe men who act and dress like women. • Fa’afafine is a term specific to Samoans who live as a third gender, a practice that was not discouraged or disparaged in traditional Samoan society.

3. Presentation Overview At the end of this presentation: You will know what the term transgender means and the difference and similarities between gender identity and sexual identity. Understand the lack of research on HIV Medications & Hormonal treatment in transgender women. Federal guidelines to recognize transgender individuals. What studies on transgender people are available . How people can advocate for specific research for transgender individuals

4. Transgender Research • The general lack of inclusion of gender-variance variables in health surveys/forms makes collecting true estimates of the transgender population and the transgender HIV+ population that much more difficult. • Though research has been made for prevention and care of HIV+ transgender individuals, little research has been lent to studying the possible interactions for those transgenders on HIV cocktails and hormone cocktails.

5. Hormone Research • In studies done on menopausal women and research on birth control pills containing estrogen or progesterone have shown that they interact with HIV medications. • Some HIV drugs can cause decreased or increased levels of hormones. • Estrogen can cause reduced levels of some HIV drugs and put you at risk for viral rebound or drug resistance. • Thus proves the need to research HIV cocktails and hormone cocktail interactions in HIV+ transgender health and well being.

6. Benefits of Prescribing Hormones • Body changes can give hope to the hopeless. • Avoidance of black market hormones. • Usually beneficial psychological changes. • Incentive to increase other healthy behaviors such as smoking cessation, adherence to treatment of chronic illness and decrease in harmful drug use. • Lack of self medication. • More willing to keep medical appointments.

7. What is Gender? • The sex of an individual, based on reproductive Anatomy. “ • gender” refers to an individual’s self-representation and includes the array of social beliefs, norms, customs, and practices that define “masculine” and “feminine” attributes and behavior. • Sexual identity, especially in relation to society or culture. • The classification of the sex of a person into male, female or intersex.

8. Sex and Sexual Orientation. • The property or quality by which organisms are classified as female, male on the basis of their reproductive organs and function. • The condition or character of being female or male; the physiological, functional, and psychological differences that distinguish the male and the female • The direction of one’s sexual interest towards members of the same, opposite, or both sexes. • The clear persistent desire of a person for affiliation with one sex rather than the other.

9. Definition of Transgender • Transgender is an umbrella term that identifies those individuals who do not conform with the sex that was assigned at birth. • Being a person who identifies with or expresses a gender identity that differs from the one which corresponds to the person’ sex at birth. • People who are categorized as transgender: Transsexual, transvestite, cross-dresser, intersex. • There is also other nouns used such as gender queer and gender bender, etc, they all are self identification.

10. Transgender Health Basics • Mortality not increased in a large Dutch cohort treated with hormones. • Suicide number one cause of death specially for youth, confirmed in several studies. • Suicide, violence, victimization, and neglect (due to real and perceived medical discrimination). • Lack of providers educated or willing to educate themselves on transgender care. • Risks related to hormones: street hormones, shared or unsafe injections and medical complications.

11. Transgender Research • Because of the small reported number of transgender persons in the US and elsewhere, little effort has been made to create a new demographic category for the purpose of epidemiology (for tracking HIV and other health conditions). • The Male to Female Transgender populations who have been tested for HIV are included with men who have sex with men (MSM) in epidemiological data collection, making it difficult to prove the existence or number of HIV+ transgender. • Just as the Female to Male transgender is included with women.

12. Transgender Recognition • The federal government does not recognize transgender people. • Few states like CA do include transgender as a demographic category to collect HIV/AIDS data. • Individual agencies should create their own tools to capture transgender data. • It is important for government agencies to recognize and understand the transgender population in order to have a better sense of the need for programs and/or funding. • It is important to evaluate transgender programs in order to prove the continued need and progress.

13. What can you do to Help • Recognize distinctions between gender identity and sexual orientation. • Hormones and surgical interventions may or may not be desired. It is important to understand the diversity among the transgender community in both Male to Female (MTF) and Female to Male populations. • It is important to talk to clients about sexual practices in order to make a better assessment and understand your client’s needs. Please don’t make sexual preferences or practices the focus of your intervention • Don’t be judgmental understand that some trans person may not want to open up to you because of his/her past negative experiences. • Understand different terms used to identify the Transgender population MTF,FTM , Gender Queer and Gender Bender.

14. What can you do to Help • Assess the transgender community and their needs within your own community in order to create programs. • Reach out to my trans sisters and brothers by recruiting a “Gatekeeper.” • Advocate on behalf of and or create surveys/forms which include gender-variance variables. • Educate yourself on transgender by interacting with the community, inviting them to functions. • Remember there is no such place as a city without transgender people! • Embrace us!

15. Questions Thank You Very Much! Raquel Sapién, CCDC Global Network of People Living with HIV/AIDS, North America GNP+NA Vice-President of the TransLatin@ Coalition/A National Transgender Planning Group raquelitalatina@yahoo.com

16. BLESS YOU!

17. Contributors • Healthcare of the HIV Positive Person by Barry Zevin, MD Assistant Clinical Professor of Medicine University of California in San Francisco School of Medicine. www.hivinsite.ucsf.edu. • Menopause by Shari Margolese, of The Well Project www.thewellproject.org • Transgender Health and HIV by Kimberly Keller, M. Sc. of The Body www.thebody.com