AIDS Project Worcester (APW) is an organization that provides AIDS service in central Massachusetts and had been around since 1987. APW is the second largest organization in Massachusetts that provides HIV/AIDS services in Massachusetts (About Us-APW. (2018). They have remained vigilant as an organization that meets new and changing public health issues across central Massachusetts which offer services to both HIV negative and HIV positive individuals. Their services provide medical care and support for people living with HIV/AIDS and those at risk of being infected with HIV or Hepatitis C (About Us-APW. (2018). They offer bilingual support in English and Spanish and with other translation services as well. The wide array of services they provide can be taken care of in home, hospital, respite settings, detoxification/substance abuse treatment programs, shelters, neutral locations, and other community settings (About Us-APW. (2018). In the year 2016 alone, that have provided support/services to over 400 people infected with HIV/AIDS and some 1200 of their family members. Many have also enrolled thousands into the statewide Overdose Education and Naloxone Distribution Program. More than 700 have also been enrolled in Worcester Syringe Services Program and tested hundreds for HIV/HCV and any other sexually transmitted infections (About Us-APW. (2018).
APW has long been a supportive agency of the LGBTQ community since the agency opened. They have supported the transgender community with a few services catered to their needs (About Us-APW. (2018). They have had a psychosocial support group called Transformations, they have had the transgender emergency fund, and they have taken part in a yearly event called Transgender Day of Remembrance. Transgender Day of Remembrance is an event in November 20th every year and it marks a day to remember those who are transgender and have died at the hands of violence (About Us-APW. (2018). The Transgender Emergency fund was a fund established by a previous employee who is transgender, and they established this fund to help serve the transgender populations vital needs as an at-risk community for homelessness, HIV infection, and high rates of discrimination (About Us-APW. (2018).
The purpose of this needs assessment is to fill the gaps in access to care for the at-risk transgender community. The transgender community is widely marginalized, often poorly understood, and often invisible, many providers lack training and professional resources needed to care for this community. APW looks at the needs of their clients through intake forms, and surveys they collect from their clients throughout the year. Once they have collected this data they present it to their stakeholders or funders the Department of Public Health in Worcester. This needs assessment will provide a comprehensive look at the clients APW does serve and fails to serve as an agency of various services including HIV/AIDS Prevention/screening, treatment of HIV/AIDS, housing, psychosocial support, and other medical case management.
The determinants of health for the transgender community are transgender women are at a higher risk for HIV infection. In one study over 56% of African American, Transgender women were found to be infected with HIV. Another 16% of Hispanic transgender women were found to be infected with HIV (Melendez, Rita M. et al. 2009). Almost 40% of transgender individuals also experience suicidal thoughts. Studies focusing on the issues of transgender care tend to be surrounding gender reassignment procedures, mental health, and HIV risk and infection (Melendez, Rita M. et al. 2009). Many of them isolated issues treated separately tend to yield inadequate results in terms of the health of the Transgender population, especially transgender women. There needs to be some form of comprehensive care that addresses these multiple issues. Transgender women also face a high risk of forced sex and domestic violence (Melendez, Rita M. et al. 2009).
Another study found that transgender individuals especially MTF individuals are more socioeconomically disadvantaged and have a higher prevalence of HIV. This study also found that transgender individuals are at high risk to engage in sex work, because of employment discrimination or because they lack the means to afford health care associated with transitioning. There is also an increased need for counseling and mental health treatment for this population due to the high risk of depression and suicidal thoughts (Clements-Noelle, K.,2001). To assess these problems associated with the Transgender community I looked to APW a comprehensive community health center in an area of HIV epidemic that has served the transgender population before but could use some modifications based on current data and situation.
From my observations in the clinic with testing no one really identified as a gender identity other than the one given to them at birth. They ask some specific questions about gender identity and sexual orientation every time you get tested. I also did not meet any clients who identify as transgender while working with housing clients. From Prior Observations when I came to APW as a client to meet with a transgender support group I found dozens of transgender individuals using APWs client services. However, that support groups retention rate has dwindled. According to APW’s Syringe Services Report through December 2017, they reported less than 0.1% of clients as other than male or female suggesting there was either an insignificant number of transgender clients who identified as such or they did not identify as transgender and choose to identify as either female and male. The encounter forms in the syringe services program do however offer the option to identify as transgender either MTF or FTM (Alstin, M.,2017). According to attendance records for the group transformations, they had a total of 145 transgender or non-binary/intersex individuals who attended group between March 2017 and September 2017 (Gartenlaub, L. (2017, September 11). They did not keep records for the transformation group this year and as of today, the support group is on suspension.
The information I have collected for this needs assessment will be shared with my supervisor once my final project is complete, and I have a presentation. I hope to work with the agency in securing funding for resources I need to do my program. I also hope to continue the program I have planned once the end of my internship is over. I also want to use the data collected to present to the department of public health in hopes of getting their support and approval of the transgender community’s needs. I have learned the needs and health determinants of the transgender community so that I have an understanding of the population this agency hopes to better serve. I think I offer a valuable insight, resources, and experience with the community, thus making me a suitable partner for this organization.
Moving forward with these observations and the data that was available from the agency I suggest an increase in data collection and outreach to the community of Worcester in the hopes of bringing back transgender clients who could use the vital services AIDS Project Worcester offers in a transgender friendly setting. I suggest a health promotion program that provides a brochure of information outlining determents of health for the transgender community and provides resources related to medical care. Then proceed with surveys to the transgender community in order to collect further information on the target population. In order to address certain unmet needs within a transgender community, an organization or provider needs to understand the physical and psychosocial support that Transgender individuals need in order to maintain overall wellbeing. Those providing such care should be aware of barriers to health for Transgender individuals and maintain a friendly willingness to serve the populations unmet needs if they wish to successfully prevent and treat HIV/AIDS in the transgender community (Williamson, C. (2010).
The next steps for my health promotion plan are to set a date for an event to gather the transgender community at the site location. Then asking the stakeholders AIDS Project Worcester and Department of Public Health for funding and approval for the event from the agency. After that, I will create a flyer to spread the information about the event through outreach and bring in potential clients to the agency. Then I will create an activity suitable to the transgender community so that we engage with one another in hopes of fostering relationships with the community. After that, I will make the brochure that outlines health promotion and determinants of health well also providing resources to the community. Then I will create a survey that collects broad information about the community, but also allows the agency to collect more suitable primary research for future reference. The last plan will be to set up the event on location and then complete the community event. After the event is over I will then gather the data collected and analyze it for my final project.
The determinants of health for the transgender community outline a need to focus on multiple forms of health from prevention of STIs like HIV/AIDS, assistance with housing, a psychosocial support group, access to transgender resources including medical providers, transportation and food. The brochure I will provide will touch base on all of those determinants of health and resources where they may confront any of these issues. The organizations I will provide information will include the agency I’m working for AIDS Project Worcester, but also local community organizations in the area they may provide services such hormones, primary care, psychological support etc.
For my literature summary, the factor that may contribute to my health promotion program is that this promotion is in a safe space and not in a typical medical provider setting which often makes transgender people especially women uncomfortable. One program done in a similar community setting in San Francisco did a health promotion programs using surveys and then workshops to reduce risks associated with transgender determents of health. They did behavioral risk assessments that looked at sexual behavior, substance use, attitudes towards substance use treatment, HIV knowledge, depression, self-esteem, and transgender community involvement. After they provided workshops on how to deal with sex, relationships, and health, reducing drug use and coping skills, and general life needs (Nemoto, T. 2015). For my program, I hope to achieve something similar I am going to provide a health brochure with basic information regarding general health, HIV Prevention, housing, and mental health issues. I will also provide participants with resources in the brochure to seek medical providers. Then afterward I will provide them with a survey to assess some information regarding demographics, certain health behaviors and knowledge of local transgender care/resources.
Another study I found for my literature summary is one that does an intervention regarding mobile phone devices in which health promotion reminders and tips were texted to participants in a study on HIV prevalence and mobile devices among young black gay men and transgender women of color. The website provides health information to reduce risky behavior and promote health/wellness among participants. They found a significant reduction in risky behavior and health outcomes after using this technology with the LGBT youth amongst a predominately black community (Hightow-Weidman, L. B, 2015). This study does not necessarily apply to my health promotion plan, but it could be used as a reference for reminders to clients to attend the support group every week. That was something done by the previous facilitator of Aids Project Worcester Transgender Support Group. Except for this time, it would include tips on reducing risky behavior or promoting healthy behaviors.
- About Us-APW. (2018). Retrieved October 2, 2018, from https://www.aidsprojectworcester.org/about-us/
- Alstin, M., Mehaffey, A., & Paquin, L. (2017). Syringe Services Report (pp. 1-9, Rep.). Worcester, MA: AIDS Project Worcester.
- Clements-Noelle, K., Marx, R., Guzman, R., & Katz, M. (2001). HIV Prevalence, Risk Behaviors, Health Care Use, and Mental Health Status of Transgender Persons: Implications for Public Health Intervention. American Journal of Public Health, 91(6), 915-921. Retrieved October 2, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446468/?tool=pmcentrez&report=abstract.
- Gartenlaub, L. (2017, September 11). . Unpublished raw data.
- Hightow-Weidman, L. B., Muessig, K. E., Pike, E. C., LeGrand, S., Baltierra, N., Rucker, A. J., & Wilson, P. (2015). HealthMpowerment.org: Building Community Through a Mobile-Optimized, Online Health Promotion Intervention. Health Education & Behavior, 42(4), 493–499. https://doi.org/10.1177/1090198114562043
- Melendez, R. M., & Pinto, R. M. (2009). HIV Prevention and Primary Care for Transgender Women in a Community -Based Clinic. Journal of the Association of Nurses in AIDS Care, 20(5), 387-397. Retrieved October 2, 2018, from https://gold.worcester.edu:2088/science/article/pii/S1055329009001034.
- Nemoto, T., Operario, D., Keatley, J., Nguyen, H., & Sugano, E. (2015). Promoting health for transgender women: Transgender resources and neighborhood space (TRANS) program in San Francisco. American Journal of Public Health, 95(3), 382-384. doi:10.2105/AJPH.2004.040501
- Williamson, C. (2010). Providing Care to Transgender Persons: A Clinical Approach to Primary Care, Hormones, and HIV Management. Journal of the Association of Nurses in AIDS Care, 21(3), 221-229. Retrieved October 2, 2018, from https://gold.worcester.edu:2088/science/article/pii/S1055329010000397.