Infectious Disease Advisor: How can the research group or provider contact the transgender population?

Ms Sullivan: The key is connecting with organizations that have an impact within our community and people who have clout within the community. When you reach out to these organizations, you are showing that you want to be a part of the community and support it proactively. Also, you can help one person at a time and they might – by word of mouth – tell plenty of people about it. But what really matters is when you are an organization or a clinic and you are going out to our community members and saying, “Hey, we want to help. We want to service your community. What do we need to know? How can we help you?” Once you have done that, the next step is becoming culturally sensitive. There are plenty of organizations that offer that service and it is just taking the time and care to put the effort forward. 

Infectious Disease Advisor: What specific strategies are needed to better equip physicians who may not be familiar with the care of transgender people or evidence-based research regarding treatment of HIV in this patient population?

Ms Sullivan: Physicians care, but they are not always culturally sensitive. That is the biggest problem right now. Becoming familiar is a choice. Just like back when there was the fight for women’s rights and the fight for African American rights, people chose to become aware of those issues and to treat those individuals with respect. Physicians need to understand that they should ask about a person’s pronouns: if you don’t know, ask. That is the most significant first step that you can take. For many trans/GNC individuals, pronouns can be ubiquitous reminders that others do not value their gender identity. Using the correct pronoun is important because it validates a person’s own decision about his or her gender identity.

When being asked questions about hormones, treatments, or surgery by a transgender, intersex, or GNC person, if you don’t know, then say, “Let me look into that,” and then actually look into it and then give them the answer that you have found.

When it comes to HIV-based research regarding treatments and population, we as trans/GNC people know that we are at the highest risk.  And as transgender women, or transgender women of color, we know that we are astronomically above everyone else.

Regarding treatment, it is about being trans-positive and staying in that space. As a person who is HIV positive and a transsexual female, I am alive today because of efforts by researchers at the AVRC such as Dr Morris and yourself (Dr Gianella) to further the scientific understanding of HIV. But we need to keep in mind that no matter what, we need to respect all people. That will change the way we view research and clinics, and ultimately how we are going to change the infection rate.

Infectious Disease Advisor: What is your role in Dr Morris’ PrEP program? 

Ms Sullivan: I was brought on to help them connect with and reach out to the trans/GNC communities in San Diego, which was a great move on their part. They recognized the need to bring on somebody from the community who is integrated and well versed in the nuances of our diverse people. We have seen how effective it has been so far in their study. As soon as I tell people about what we’re doing here, they want to join. They want to be a part of the process. They want to be a part of helping their community while staying safe themselves. So, I’m out there, pounding the streets and getting organizations and people to know about our study and bringing them in. That is my role and goal.

Click here to read part 1 of this series, in which Dr Gianella talks with Sheldon Morris, MD, associate professor of medicine at the University of California San Diego AntiViral Research Center, about an upcoming PrEP study in transgender individuals that will look at understanding HIV prevention within this population, uptake of PrEP, adherence to treatment, and other issues unique to this group.

Sara Gianella Weibel, MD, is an assistant professor of medicine at the University of California, San Diego Center for AIDS Research.

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