This is an abstract of a recently published article[*] by the St. John’s Well Child and Family Center of South Los Angeles. Direct quotes are shown as italics.
The Well Child and Family Center is a pioneer in serving and hiring transgender people. This article was made available during a BWMTSC [†]chapter meeting.
During this moment in time heralded as the transgender1 tipping point, discussion about transgender people is entering mainstream discourse, now more than ever. Despite the surge in media attention regarding the transgender community and growing acceptance of transgender identities, systemic and societal barriers remain, such as lack of access to health insurance, stigma, lack of sensitivity and cultural competency, that contribute to persistent, unmet health needs for transgender individuals.
The local speaker gave an overview of the difficulties she had as a trans women which mirrored many of the studies concern. As gay men our group was faintly aware of the difficulties of these people but was brought into focus more. This is of importance since people of color are in the majority in this cadre and have HIV issues too.
According to the Centers for Disease Control, transgender women have HIV prevalence rates 25 times higher than the general population.
What was not as well known by our group transgender individuals have higher rates of transient housing, lower rates of education, have difficulty finding steady employment. Some transgender people have to resort to sex work. The incarceration rate of transgender individuals is much higher than the general population, with 42% of transgender women of color reporting previous incarceration.
1 For purposes of the article, the word ‘transgender’ reflects the mission of inclusivity, non-judgment and affirmation of multiple transgender identities and includes but is not limited to the following identities: transgender, two-spirit, genderqueer, genderfluid, non-binary, agender, third gender, bigender, transfeminine, transwoman, transfemale, transmasculine, transman, transmale, masculine of center, gender non-conforming, gender questioning, et cetera. The University of California, Riverside recently hosted the First Asterisk Trans* Conference; February 27-28, 2015, where organizers provided their definition of a term now appearing Trans*, “Trans* affirms all people who transcend gender norms” (http://asteriskconference.blogspot.com/p/faq.html). St. John’s Transgender Health Program utilizes the term trans* in order to reflect our mission of inclusivity, non-judgment and affirmation of multiple transgender identities
What needs to be done?
Transgender people need acceptance, respect and preservation of dignity, Often patients cannot or dare not speak freely about their experience, health concerns and health-related behaviors without fear of inciting barriers to obtaining the transgender-related health care services they need. We need more providers to address this.
We need to remove the delay in approval for and receipt of transgender-specific care among patients who are insured through Medi-Cal managed care health plans.
They have failed to take a supportive stance on the delivery of time-sensitive and medically necessary care that they are obligated to provide to their transgender identified beneficiaries.
The California Department of Health Care Services requires them to cover gender surgery and hormone therapy. Likewise, insurance plans should add hormone therapy to a list of “life-
time approved” medications. However, the phrasing has allowed health plans to decide that a transgender person’s gender-affirming surgery may be considered “cosmetic” rather than “medically necessary,” and thus, would not be covered by insurance. Because gender-affirming surgeries for transgender patients are medically necessary and not “cosmetic in nature,” this language creates barriers to access to care and must be clarified. Gender identity should be protected from discrimination into the non-discriminatory hiring and employment.
Finally, a strong facilitation of legal name and gender change processes should be started. Too often when a transgender person changes name on forms and identity cards it very difficult for them to do so.
Legal name and gender change can increase an individuals’ comfort with accessing healthcare and employment as fears of discrimination, being called by the wrong name, and being confronted about gender identity are assuaged.
The National Association of Black and White Men has a proud record of supporting people at the margins and this should include the transgender community.
Note: St. John’s officially launched THP in January 2013 with 9 patients. Within 15 months, the program has close to 500 patients accessing care on a regular basis. Demand has been so high that St. John’s must expand its THP to additional days and health center site.