If you´ve got it, check it: establishing a sexual health clinic for transgender clients at a New York City community health center
J. Johnson1, A. Radix1,2, J. Santos-Ramos1, N. Levitt1, H. Reynolds1, G. Mayer1, R. Mukerjee1
1Callen Lorde Community Health Center, New York, United States, 2Columbia University, Mailman School of Public Health, New York, United States
Issues: Transwomen (transgender women, MTF) are disproportionately affected by HIV with reported prevalence of 11-68% however few studies have investigated HIV prevalence or risk factors among transmen (transgender men, FTM). Transgender individuals face multiple organizational and structural barriers to healthcare services, such as discrimination by healthcare providers, non-reimbursement of hormone and surgical therapies and limited preventive health services, including targeted HIV-prevention interventions. Callen-Lorde Community Health Center (CLCHC) is one of the few facilities dedicated to the care of the lesbian, gay, bisexual, transgender (LGBT) community. Approximately 9% of patients identify as transgender. In 2009 CLCHC created a transgender sexual health clinic (TGSHC) to address the sexual health concerns of transgender clients as well as provide comprehensive HIV/STI prevention services in a trans-affirmative setting.
Description: The TGSHC is staffed by medical providers, HIV counselors and social worker/ transgender advocates. Clinic services are offered one night each week. Clients are offered HIV prevention and harm reduction counseling, HIV/STI screening, and counseling on hormone therapy and preventive health issues. Clinicians offer cervical, testicular and breast/chest cancer examinations following best practice guidelines. Patients wishing to pursue gender-confirming hormone or surgical therapy are linked to care. Trans-sensitive HIV prevention and health promotion materials were developed for the clinic. “If you have it, check it” brochures promote STI/HIV and cancer screening using trans-affirmative language. Patient satisfaction is measured with a 12-item questionnaire.
Lessons learned: 95% rate services as “very good” or “excellent”. 23% of clients are transwomen and 77% transmen. 40% of transmen report high risk activity, e.g. unprotected anal or vaginal intercourse with men (trans-MSM). 46% consented to HIV testing, all were negative.
Next steps: Trans-sensitive HIV prevention tools need to be developed, especially for the population of Trans-MSM who engage in high risk activity. Further investigation is needed to evaluate HIV risk factors in this vulnerable group.