Transcript 16. Thinking positHIVely EATG

Trans* Population
in a health context
* Transgender and Gender Nonconforming (TGNC) Communities
TRANS* POPULATION IN A HEALTH CONTEXT
REACTIONS TO TRANS
Migth reflect:
• Stigma within the medical community
• Misunderstanding, generating some discomfort or lack of tact
• Healthcare provider’s lack of knowledge (specificities and needs) which
may affect their access to care
• Pervasive stigma and discrimination attached to gender nonconformity
affect the health and wellbeing of Trans people across their lifespan
Must be taken into account:
• The trans-identity diversity and mainly the individual’s self-gender
definition
• Intersectionality: biological sex, type of TGNC identity, sexual
preference, ethnicity, geographical localization
TRANS* POPULATION IN A HEALTH CONTEXT
TRANS REACTIONS
Healthcare impacts
Reluctances:
• to find and to remain in a healthcare service;
• to talk about sexual health and proctologic, urologic, gynecologic
disorders or body transformations
• to disclose their non conformed gender identity/their HIV status
Leads to:
• Delayed access to care
• Resort to non-professional care (e.g., silicon pump parties)
• Self-medication drugs (hormones, corticoids, benzodiazepines antibiotics,
etc) in the various galenic forms and frequently in high concentrations,
leads to undesirable and drugs interactions effects
TRANS* POPULATION IN A HEALTH CONTEXT
RISKS OF… CROSS-SEX HORMONES THERAPY
• High concentrations, self-medication or inadequate medical prescription
(with or without ART) for TSW
• Psychiatric/ psychological evaluation/ screening neuro-cognitive disorder
• Implants of soft tissue fillers (industrial silicone) without medical
supervision
• chest binding
SEX REASSIGNEMENT SURGERY (SRS)
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BAD OBSERVANCE OF POSTOPERATIVE INSTRUCTIONS MAY LEAD TO:
Infectious complications
Fistulisations
Neovagina’s canal stricture/obstruction and/or urethral stricture
TRANS* POPULATION IN A HEALTH CONTEXT
RISKS OF TRANSMISSION
HIV / STI / VIRAL HEPATITIS
• Screening: Tb, syphilis, gonorrhoea, HPV, chlamydia, HCV, HBV et HAV.
Barriers to optimal health outcomes among HIV patients with multiple comorbidities
include:
• Being diagnosed with HIV infection late in the course of the disease
• Lack of a social and emotional support à e.g., increases STI
• Polypharmacy
• Physical limitations
The hiv status increases health disparities:
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Lack of insurance or underinsurance for health services
Lack of knowledge among health care providers and support staff
Insensitivity, hostility and discrimination
Non-observance of ART
Transgender SW women are more concerned
TRANS* POPULATION IN A HEALTH CONTEXT
RISKS OF CONSUMPTION… OF TOBACCO, ALCOHOL, PA Substances
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Smoking tobacco/cannabis PLHIV increases
≈13X the lung cancer risk
• CV risks (+oestrogens)
– Alcohol risks increases with oestrogens and ART interactions
– Sleeping pill (BZD/opioid) over consumption
– Coke may cause heart stroke without atheroma
MENTAL HEALTH PSYCHOLOGICAL/PSYCHYATRIC SUPPORT
Take into acount:
• Native language and cultural aspects
• Style and history of life
• Precariousness and mobility
• Individual trans-identity process
• Somatic comorbidities
• Avoid leaps or preconceived ideas
• Trans persons in prison
TRANS* POPULATION IN A HEALTH CONTEXT
CHALLENGES TO CONSIDER REGARDING GENDER IDENTITY
DEFINITIONS
• Awareness of various stakeholders: reception staff, social workers and
paramedical and medical caregivers to the particularities of Trans persons
in compliance expectations.
• Ensure proper appellation/Civil state desired by the person.
• Trans people, despite some stigma experienced also need to be aware of
the constraints imposed by the administrative procedures, schedules and
appointments.
• Social inclusion, awareness and tolerance to gender diversity should be
effective from the early stages of life in order to mitigate the adverse
effects of generated discrimination.
TRANS* POPULATION IN A HEALTH CONTEXT
INTEGRATED CARE
INTER- AND PLURI-DISCIPLINARITY
Primary care:
• Health promotion, diseases prevention, health maintenance, counseling,
patient education and empowerment.
• Integrated Health gender care in HIV care (vice-versa)
Coordination of services across patient care continuum:
• Trans women population living with HIV require extensive care
coordination as consequence of complications related with gender
transition’s and other co morbidities or chronic diseases.
• Official survey, Evidence-based HIV prevention, education, care and
treatment intervention for TSW, inclusion of gender health in care providers’
curriculum are urgently needed
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TRANS* POPULATION IN A HEALTH CONTEXT
PREVENTION CAMPAINS AND RISK REDUCTION
•Screening for HIV infections/viral hepatitis and STIs should be done with
SUITABLE information
• Succinct and clear written messages
•Peers must be trained and sensitized to oral dissemination of prevention and
harm reduction messages in sexual transmission and use of drug equipment
and sharing personal hygiene material or filler injection by HIV / Viral
Hepatitis / STD
• Disclosure of devices PrEP (pre-exposure prophylaxis) and PEP (post
exposure prophylaxis) must be prescribed by approved/ qualified doctors and
should never be used for self-medication
• Active militancy against any type of discrimination
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TRANS* POPULATION IN A HEALTH CONTEXT
ACKNOWLEDGEMENTS
GAT – Portugal Grupo de Activistas em tratamentos
www.gatportugal.org
EATG
www.eatg.org
www.ageingwithhiv.org
Dr Anaenza Maresca (Hospital Embroise Paré – Paris)
Françoise Gil
www.esf-editeur.fr/detail/775/prostitution---fantasmes-et-realites.html
Jo Bernardo
[email protected]