4 minute read
III. Transgender Persons
from Guide to Developing and Managing Syringe Access Programs by Harm Reduction Coalition
by nextdistro
• Utilize sex working peers in outreach activities, support groups, “ladies nights” and/or other SAP activities.
Encourage sex workers to talk with, learn from and support one another. • Discuss the negative impact of sex workers undercutting each others’ prices as a means of discouraging this behavior and promoting supportive relationships. • When possible, offer the use of a mirror, toilet, shower, telephone and washer and dryer. • Support participants to report rapes, assaults and other violence, providing escorts to medical services and police when possible and appropriate. • Understand local laws pertaining to sex work and prostitution. • Support participants in reporting abusive law enforcement. • Collect street sex work-appropriate clothing donations as well as umbrellas. • When possible, provide foods that are rich in vitamin C (such as tomato soup, citrus and cranberry juices) to prevent bladder infections, bleeding gums and easy bruising. • If possible, provide workshops and training to help sex workers develop good street skills and self-defense as well as relaxation, meditation and creative visualization. • Support sex workers interested in leaving the sex industry, as well as those who wish to continue to work in it.
TrAnSgenDer PerSOnS
Transgender persons – including all individuals who in one way or another do not conform to traditional gender norms associated with their biological sex – are especially vulnerable to harassment, stigma and discrimination at all levels of social engagement. Transgender people are commonly rejected by their families and are routinely denied employment and other opportunities for social resources. This marginalization, along with high incidence of violence toward transgender persons, has serious impacts on mental health, self esteem and stability, often leading to increased rates of poverty, drug use, illicit hormone injection, sex work and HIV.
Discrimination against transgender people extends to traditional social and healthcare services. As a result of repeated insensitivity, transgender people may be reluctant to access these services. SAPs must work to ensure that transgender participants feel safe to access services without fear and with the knowledge that they will be respected and that their needs will be understood by all staff. Training is required to ensure that staff are educated about the diverse experiences of the transgender communities, including the complex intersection of issues on the biological, psychological and social levels. Staff must respect the personal choices of all participants; however privacy and sensitivity may be especially important when working with transgender participants.
Transgender persons are often at higher risk for HIV and HCV transmission on multiple levels. Hormone replacement therapy (HRT) requires routine injections of estrogen or testosterone administered intramuscularly, and can be very costly and is rarely covered by public insurance. This has led to an underground market and the common practice of self-administered hormone injection, which can be risky. In addition to complications related to the unknown quality and purity of hormones not directly obtained from a pharmacy, there can also be significant and serious side effects related to HRT that are best managed under professional supervision.
SAPs should consider the following measures to assist transgender participants engaging in prescribed or underground self-administered HRT: • Stock 3 cc syringes for intramuscular injection. • Educate participants about safer muscle injection, HCV and HIV prevention and other risks associated with improper injection. • Provide comprehensive information about side effects and potential drug interactions with estrogen-based (for male-to-female transgender (MTF) participants) and testosterone-based (for female-to-male transgender (FTM) participants) HRT. Health effects should be addressed at the physiologic and psychological level. • Work with participants to manage side effects of HRT. • If possible, develop relationships with doctors, physicians’ assistants and nurses willing to assist with Shot
Clinics – a dedicated time for people of transgender experience who are receiving prescribed HRT to come and have their shots administered or supervised by medical professionals. Shot clinics can also be used to teach people how to administer their own injections, as well as teach family and friends to assist with injections and provide a space for people to discuss any concerns relating to HRT. • Offer support groups for participants of transgender experience undergoing HRT.
Given the heightened challenges that transgender IDUs may have in accessing traditional sources of employment, sex work presents as a common alternative – especially for MTF transgender people. In addition to having multiple sex partners, MTF transgender persons may be more likely to engage in receptive anal sex, placing them at higher risk for transmission of HIV. Also, some research suggests that issues related to self esteem can lead transgender sex workers to engage in unprotected sex as a means of validating their chosen gender identity. SAPs should prioritize safer sex education and condom distribution. The section above on Sex Workers in this module offers additional suggestions.
Other considerations for SAPs working with transgender participants include: • Provide gender-neutral bathrooms. • Be sensitive to name and pronoun changes, as these may be in flux over a period of time. • Include transgender-specific categories on all forms (enrollment, data collection, etc.). • Prioritize hiring transgender staff. • Employ transgender peers to engage in outreach in clubs, on the streets and at other social service agencies. • Provide training for all staff, volunteers and peers on transgender issues. If possible, organize additional training for law enforcement and collaborating organizations. • Offer training and workshops on self-care, life skills and job training for transgender participants as needed. • Create trans-friendly provider directories, including lists of transgender/queer NA and AA meetings and other drug treatment providers. • Put affirming signs/symbols/pictures in your office or van, to signal that your program is transgender friendly. • Organize transgender-specific legal workshops for issues related to things like name changes and genderrelated bias crimes and discrimination. • Advocate for changes in policy to protect the rights of people of transgender experience.
