Whitman-Walker Adds Trans Clinic
Project to include hormone therapy; hepatitis vaccinations for gay men also expanded
[WASHINGTON, DC] - Whitman-Walker Clinic officials plan early next year to offer hormone therapy maintenance and more primary health care services for transgender residents who have limited access to care.
The "transgendered hormonotherapy clinics" will operate at the AIDS service organization's Elizabeth Taylor Medical Center and at the Max Robinson Center, in Northwest and Southeast Washington, respectively. These are Whitman-Walker's two largest sites.
Philippe Chiliade, the clinic's medical director, said the "risk- reduction" initiative came about in part because some transgender residents routinely put themselves at risk for contracting HIV by illegally buying hormones, such as estrogen or testosterone, and sharing syringes to inject them.
"If they are using hormones without medical supervision," he said, "we would prefer they use our services."
Clinic officials also plan early next year to expand their hepatitis A and B vaccination outreach efforts for gay men. Chiliade said the clinic now vaccinates 35 to 50 men per month against hepatitis.
The new initiative involves vaccinating up to 2,000 men a year and charging them a sliding-scale fee, based on their ability to pay. Patients who are HIV-positive are not charged for the vaccinations.
Michael Cover, clinic spokesperson, said the transgender project is specifically designed to meet the health care requirements of those patients who have the greatest needs. He also said hormone therapy services would not routinely be offered to individuals involved in the gender-reassignment process.
The pilot project will begin during the first three months of 2003. Chiliade said clinic officials hope to see 50 patients in the first year.
Earline Budd, program manager at Us Helping Us for transgender support services, said the initiative is desperately needed. Male-to- female transgender individuals often illegally buy estrogen and silicone on the street and inject it to change the appearance of their hips, breasts and face, she said.
"It's detrimental," Budd said. "Folks have died from silicone poisoning by having it injected into their arteries."
Dawn Harbatkin, medical director at the Michael Callen-Audre Lorde Community Health Center in New York, said people buy estrogen, progesterone and testosterone illegally from pharmacy employees or from patients who obtain the hormones with a prescription from their private medical doctor and then sell them.
"It's very hard to find care where a physician or a nurse practitioner is willing to prescribe hormones," she said.
Another challenge, Harbatkin said, is that transgender people have been "incredibly disconnected" from medical care in general because of bad experiences they faced at the hands of insensitive doctors.
Whitman-Walker officials are using the Callen-Lorde model as an example of what they could do to assist transgender patients in metropolitan Washington, D.C.
The Callen-Lorde center provided medical care for about 500 transgender patients in the past 18 months, officials said.
"Our goal is to get them to become involved in their entire health care," Harbatkin said, noting that this would include discussions that ranged from calcium intake and safer sex to tuberculosis and HIV prevention.
She said that 15 out of 90 medical appointments at the Callen-Lorde center each week are geared toward transgender care.
"Our waiting list involves waiting months and months for [transgender health] services," she said. "We cannot keep up with the demand for care."
From primary care to STDs
Like Harbatkin, Chiliade said transgender patients do not always have other safe and appropriate places they can go for compassionate health care.
The clinic's pilot project for transgender patients will include offering primary care, HIV-prevention programs, screening for sexually transmitted diseases and HIV, as well as providing hepatitis A and hepatitis B vaccinations. It also will include access to mental health services and case management.
Whitman-Walker officials have enlisted help with establishing the pilot project from the Sexual Minority Youth Assistance League and Us Helping Us, People Into Living Inc. Both community-based organizations work with transgender residents throughout this region.
Chiliade said clinic officials also hope to collaborate with a network of mental health providers willing to offer pro-bono services for transgender patients.
"It's really an expansion of services targeted at a specific community to meet many more of their needs," said Arthur Padilla, executive director of the Sexual Minority Youth Assistance League.
SMYAL is a service agency that works with lesbian, gay, bisexual and transgender youths between the ages of 13 and 21 who might have questions about their sexual orientation.
"We're really interested in being able to provide a more healthy, structured environment for young transgender youth -- specifically male-to-female," Padilla said, noting that members of this population tend to be more visible during their teen-age years than their female- to-male counterparts.
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Officials at SMYAL plan to refer transgender youths and young adults to Whitman-Walker's program for various health services and work closely with their case managers, he said. SMYAL will provide social and mental health services for transgender youths as part of this effort.
Of SMYAL's 1,100 members, Padilla said about 10 percent consider themselves male-to-female transgender individuals.
Us Helping Us, which primarily addresses the needs of black gay, bisexual and transgender individuals, has agreed to provide transgender clients who participate in the Whitman-Walker pilot project with HIV-prevention, mental health, and case management services.
Budd said many of the transgender clients who visit Us Helping Us often struggle simultaneously with being homeless, HIV-positive and having mental illness and substance abuse challenges.
She credited Jessica Xavier, a longtime transgender activist and Whitman-Walker employee, for encouraging clinic officials in the past year to expand the amount of health care services for this population.
"This has been a long time coming," Budd said. "For the first time the transgender community is not as invisible as we have been."