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A New Model of Care: The Trans* Wellness Project

By Laura Sorensen, Trans* Care Coordinator, Mazzoni Center

Mazzoni Center is the only health care provider in the Philadelphia region specifically targeting the unique health care needs of the lesbian, gay, bisexual, and transgender communities. Founded in 1979, it is the oldest AIDS service organization in the Commonwealth of Pennsylvania, and the fourth-oldest in the nation. As the organization has evolved to meet the needs of our constituents, Mazzoni Center has combined HIV/AIDS-related services and health services and developed a reputation for excellence and innovation in service delivery.

While society has become increasingly accepting of lesbian, gay, bisexual and transgender (LGBT) communities, many LGBT individuals still continue to face discrimination, stigma, and violence that affect their daily living. This is especially true for transgender and gender non-conforming people.  Transgender communities face rampant discrimination and barriers in every area of life.

Transgender women face some of the highest rates of HIV (20.23%), higher rates of depression and mental health issues, greater risks of violence and abuse, and have far higher rates of attempted suicide (49%) than the general population. In addition to these health disparities, they are significantly more likely to live in poverty and to lack insurance coverage. Transgender women face other risk factors associated with poverty, such as obtaining transition-related medical care from underground markets and participating in sex work industries, which put them at greater risk for contracting HIV or other STIs.

Transgender women of color are a historically underserved population and face some of the worst health outcomes in the LGBT communities.  According to the National Transgender Discrimination Survey, 21% of Black respondents reported being refused medical care due to trans or gender non-conforming status, 34% reported postponing care when they were sick or injured due to fear of discrimination, 50% reported having to teach their medical providers about transgender care and 48% reported inability to afford medical care.

We applied for funding specifically to address the barriers that trans women living with HIV face to accessing and being retained in care.  We are so lucky to have included in last year’s AIDS United Retention in Care cohort.  With the help of these funds, we have established the Trans* Wellness Project, which is focused on meeting the self-identified needs of trans communities, using a holistic and multi-faceted approach.   

As part of the Trans* Wellness Project, we welcomed three peer outreach workers to our staff.  Working together with Trans* Care Coordinator, this team is focused on connecting with individual trans women through street outreach and education, talking one-on-one with the women they meet to let them know about our programs and services, along with other resources available to them in the Philadelphia area.  

We’ve also introduced a bimonthly drop-in health service, which we call the T.R.U.E. Care Clinic (Trans Resources, Unity, and Education).  This collaboration between the Trans* Wellness Project and Mazzoni’s primary care practice takes place on the first and third Friday evenings of each month, at an offsite location, designed to provide privacy and reduce stigma in a very insular community.  (For hard to reach populations, we have found it is important to offer multiple, flexible service delivery points with non-traditional operating hours). We provide free, comprehensive services including: primary medical care; trans-specific medical care; HIV medical care; rapid HIV testing and STD screening; risk-reduction counseling; substance abuse/mental health assessment and referral; health education; eligibility screening and application for public benefits, and information and referral.    

Patients visiting the clinic are greeted and have their intake completed by a member of the Peer Outreach Staff, who then provides a “warm handoff” to medical or social work staff.  We’ve created a relaxed environment where women know they can stop by to say hello to staff, load up on safer sex supplies, and see a medical case manager or clinician when necessary. 

We are in the process of enrolling 80 trans women living with HIV into our Retention in Care Project.  Participants are referred into this program through a variety means, including in-reach (referrals provided from clinicians at Mazzoni Community and Family Medicine, as well as through Medical Case Management, and Mazzoni’s Open Door Mental and Behavioral Health program), and outreach (contacts made by our Peer Outreach Staff or through linkages with other agencies).  These participants receive targeted care coordination, designed to increase retention in care and help remove systemic barriers to accessing services and medications. 

The funding from AIDS United has allowed us to engage trans women in every level of our service delivery.  At the very beginning of our project, we formed a Community Advisory Board, now called Sisterly L.O.V.E. (Leading Ourselves via Education).  Sisterly L.O.V.E. provides leadership opportunities that center the voices and experience of transgender women, especially women who are working in the sex industry, living with HIV, and those who have experienced homelessness or incarceration.  Our membership is comprises of a racially and ethnically diverse group of women, whose ages range from 20- 55 years old. 

As a program developed for transgender women by transgender women, Sisterly L.O.V.E. is best able to meet the unique and always evolving needs of this particular community.  Sisterly L.O.V.E. members and Trans* Wellness Project staff coordinate monthly pyschoeducational workshops for the larger community.  Previous workshops have included sexual health and pleasure, self-defense, health relationships, job readiness, and managing depression/anxiety.  These workshops and seminars drive the services that Mazzoni Center provides for trans women across our continuum of care.

Sisterly L.O.V.E. members been instrumental in providing key training and community outreach about the needs of transgender women.  For example, Sisterly L.O.V.E. members have worked with the Philadelphia Police Department, the City of Philadelphia, and the Washington West Civic Association to ensure that trans women are treated with respect on our city’s streets and in our neighborhoods.  Additionally, members have provided trainings for medical students and regional circuit judges on best practices for working with the trans* community.  Finally, Sisterly L.O.V.E. was able to respond to the violent murder one of our community members by hosting a ‘speak-out’ and vigil that received national news coverage, drawing attention to the violence that disproportionately affects transgender women.

 Mazzoni Center recognizes the importance of these efforts being driven by trans women, and how unique our program is in that regard.  As a result, Sisterly L.O.V.E. members have been providing capacity building trainings on how to increase leadership and engagement of trans women, which have been delivered at Creating Change (Houston), the Philadelphia Trans Health Conference, and the Allied Media Conference (Detroit).  Sisterly L.O.V.E. is a space where transgender women can mobilize around the issues affecting their community, building a strong coalition that is able to bring about a larger public awareness of the issues faced by trans women in Philadelphia on a daily basis.

We are extremely proud of this new model for providing HIV services to a dramatically underserved community.  By centering the voices and experiences of the women in our program in all that we do, we have been able to establish trust and build relationships, while being accountable to providing holistic and sensitive care to trans women living with HIV.  

Posted By: Laura Sorensen, Trans* Care Coordinator, Mazzoni Center - Tuesday, August 19, 2014

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