I consider myself a healer, an activist, a proponent of social justice and equity. These characteristics have rung true throughout my life during the civil rights movement of the sixties, while living through the Watts Riots, Rodney King upheaval in South Central Los Angeles and the integration of public schools in the LA Unified School District. My values and mission are a product of those experiences. I understood the trauma associated with living with racism and decided I would specialize in helping victims of injustice heal from the mental, emotional and physical wounds of discrimination and prejudice. Wounds that are continuously re-opened by hate, ignorance, fear and racism, resulting in the degradation of each trans woman’s and man’s self-esteem and health.
I thought that specializing in human behavior: identifying problem behaviors, evaluating the antecedents and precedents of trauma, labeling and recommending remedies, then walking through the healing process was the answer. I majored in Clinical Psychology and attended graduate school, completed complex training in mental health settings. But none of the training I experienced prepared me to partner in the healing process with transgender men and women.
Even as I confronted my own sexual orientation and submerged myself in the LGBT community, I found that this part of our community challenged everything I thought I knew about human behavior, sexuality, trauma, poverty, discrimination and exclusion. In order to be an effective partner in the healing of transgender people, I had to set aside my training, my ego, my social constructs and conventions related to gender identity, order and behavior. I was forced to step into an uncomfortable zone where solutions are not easy, where resources are few, where discrimination and prejudice is publicly displayed across race and sexual orientation; a place where all the social determinants of health reveal the poorest health outcomes. If my purpose is to heal others, this is a community where healing is needed the most.
For providers, in the absence of structure, rules, norms, and easily accessible resources, it is easier to apply a band-aid than to appropriate the needed time, resources and commitment needed to make a difference in high-risk, high-need communities. As a result of provider discomfort in serving this population, transgender people are often under-treated, ignored or forced to comply with treatment regimens that are not culturally competent or relevant.
A Trans Woman Gets Loud About Access to Culturally Appropriate Health Care!
Transgender men and women occupy the shadows in our clinics, treatment centers, churches and communities. This hidden population influences the cost of care; they cluster in the social service safety net. According to the World Health Organization, transgender women are about 49 times more likely to be living with HIV than other adults of reproductive age with an estimated worldwide HIV prevalence of 19%; in some countries the HIV prevalence rate in transgender women is 80 times that of the general adult population.
Transgender people have low rates of access to health and HIV/AIDS services due to a range of issues including violence, legal barriers, stigma and discrimination. A retrospective study of 5000 Kaiser patients has prompted debate among physicians regarding the higher risks associated with cardiovascular problems, such as stroke, blood clots and heart attack for transgender men and women as a result of hormone therapy.
Individuals who identify as transgender tend to experience higher rates of mental health issues than the general population. It is estimated that 41% of transgender men and women have attempted suicide. 18% report some form of anxiety. Transgender men and women also experience high rates of un- and under-employment resulting in social instability and homelessness. The mental distress reported by transgender men and women stems primarily in response to the discrimination, stigma, lack of acceptance, and abuse they face on a regular basis. Generally, across the healthcare and social service industry, sexual orientation and gender identity is not tracked contributing to the challenge of identifying the needs and supporting transgender people hidden within our communities.
Proud and Trans! Attendees strike a pose.
For those who consider themselves healers, community or social justice activists, proponents of health equity, it is hard to justify ignoring this important group of people whose health outcomes influence our ability to achieve the high quality of care we believe all people deserve; we can’t allow the rights and privileges afforded to us all to be eroded for transgender men and women by political and religious interest groups. It is easy to allow our discomfort with people or circumstances to influence our willingness to get involved. It is human nature to recoil from the unknown. The hesitation to partner with trans people is understood.
Maybe, the better solution is to allow transgender men and women to lead us to the answers, to guide us in how to help, to envision solutions that are culturally competent and relevant. Empowering transgender people, using our resources and skills to find answers and to impact change is the better partnership. This type of partnership eliminated my discomfort and resulted in an effective collaboration.