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Virginia health initiative opening doors for transgender residents.

Health advocates in Virginia are paving new and progressive inroads to bring health care services to transgender residents, the great majority of whom face discrimination, disadvantage and threats of violence on a regular basis.

With the support of state health agencies, Virginia health researchers conducted a statewide assessment of transgender health needs--a first for any state--and are translating the data into programs aimed at creating a welcoming health care system for a population often overlooked and other times, completely dismissed. The assessment, the "Health, Health-Related Needs and Lifecourse Experiences of Transgender Virginians," which was released in January, is the culmination of three years of research by the Virginia Transgender Health Initiative Study, yielding data ranging from tobacco use rates to incidence of sexual assault to trends on HIV risk perception. Conducted for the Virginia Department of Health and Virginia HIV Community Planning Committee, the assessment is part of Virginia's strategy to pinpoint effective HIV prevention tactics--as transgender people are at particularly high risk for HIV infection--but its success is likely to reach far beyond the field of HIV.

"This study helps to shoot down mythologies about transgender people" said Judy Bradford, PhD, director of Virginia Commonwealth University's Community Health Research Initiative, which conducted the survey. "People are just living their lives, but many are living their lives in situations of being closeted and hidden ... which makes it very difficult for people to live healthy and productive lives."

Many previous transgender health studies have focused on metropolitan areas, but the Virginia assessment included transgender people from rural, urban and suburban areas as well as people of various racial and ethnic backgrounds, constituting a sample size of 350 people, Bradford said. The study was designed with the help of Virginia's Statewide Transgender Task Force, which formed at the study's start, but lives on today to ensure that the final data continue to improve health conditions for transgender residents.

"I'm an advocate of community-based participatory research, that the population that's going to be studied are full partners in every step in the research," Bradford told The Nation's Health.

After more than three years of planning and study, a picture of transgender health and life has emerged that is often plagued with prejudice and stigma, societal factors that affect people's health and their willingness to engage in risky behaviors. According to the assessment, a quarter of study participants reported being homeless at some point in their lives and 13 percent reported being fired from a job due to their transgender status. Forty percent of participants reported being physically attacked since age 13 and almost two-thirds reported thoughts of suicide during their lifetimes. While 73 percent of participants said they had health insurance, almost a quarter said they had experienced discrimination by a health care provider.

"Often health care providers do not react in a professional manner, so many (transgender) people don't get care unless it gets critical," said Jessica Xavier, MPH, a co-investigator of the study and staff member at the Community Health Research Initiative.

For example, Xavier said, only one-third of female-to-male survey participants--people born female with male identification or expression--reported having ever received a pelvic exam. Because many female-to-male transgender people do not undergo genital surgery, gynecological care is a lifetime need, yet many are apprehensive about disclosing their transgender status and thus avoid care. But in addition to the cultural competencies needed to create welcoming health care settings for transgender people, technical competencies are also a huge issue, she said. The urge for physical transformation is so great for many transgender people, Xavier said, and health care providers who turn away transgender people seeking hormonal therapy, "will basically be putting them into unsafe situations because they will self-medicate or engage in injection silicone use (on their own)." Fortunately, however, results from the Virginia study are being used to educate providers around the state.

Already, the Virginia Department of Health has funded two statewide training sessions for a range of health care providers on transgender health issues and effective HIV prevention techniques. The study also spurred the creation of a resource directory of transgender-friendly health care providers in Virginia as well as a transgender-specific clinical risk assessment tool.

And there are hints that Virginia will become a model for other states. According to Elaine Martin, director of community services within the Division of Disease Prevention at the Virginia Department of Health, the department has received inquires about the initiative from health providers in Ohio, Hawaii, Florida and California.

"As public health workers, we indeed believe in meeting the health care needs of everyone in our service communities, and some of those subgroups and subpopulations pose greater challenges to us than others," Xavier told The Nation's Health. "But as committed professionals, we are dedicated to the wellness of our population and we can overcome just about anything, as we've showed in Virginia."

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Author:Krisberg, Kim
Publication:The Nation's Health
Geographic Code:1U5VA
Date:May 1, 2007
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