Committee Members Present: Wilfredo Ortiz (co-chair), Lara Sallee, Elyse Graham,
Raymond Banks
Committee Members Absent: Darnell Durio, Clarence Smelcer, Robert Oropeza,
Kim Pickens, Brian DiCrocco,
Other Council Members Present: Billie-Jean Kanios
Council Support Present: Jack Newby, Richard Bargetto, Wilhelmina Parker, Skot
Jonz
1. Greeting & Refreshments
CM Ortiz called the meeting to order. He thanked Walden House for providing
space to hold the community meeting, and explained the function of the Community
Outreach & Advocacy Committee by reading the committee mission statement.
CM Ortiz explained that this particular meeting was set up to meet with members
of the transgender community to hear their concerns regarding delivery of and
access to HIV services.
2. Welcome & Introductions
CM Ortiz had all those present introduce themselves. Twelve members of the
public (some service providers) were present.
3. Open Discussion
An open discussion on HIV services, upcoming changes in services and client
needs, particularly those of the Transgender community
CM Pickens was not present, so CM Kanios stepped in to facilitate by beginning
with an explanation of community planning and opened the meeting to discussion.
Comments do not necessarily reflect the opinion of the Planning Council or
the transgender population as a whole. The following is a summary of comments
made during the open discussion by twelve members of the public who were present
for the community meeting:
• Hormones should be made available as part of primary care. This facilitates
access to care.
• Strong mental health care should be reinforced for the transgender community.
• Housing for youth ages 18-24 is critical as it helps prevent new infections.
Transitional housing will help keep kids off the streets and thus avoid high-risk
activities.
• A belief that transgender mental health issues and/or prostitution are
unwarranted stereotypes which often cause difficulty when seeking housing.
• There are many young transgender people on the streets. Most of the older
transgender people are either in prison, dead or have changed their lives.
• It is important to educate service providers to be more sensitive to
the needs of the transgender community.
• Discussion about the problems with black market hormones and sharing
needles
• Regarding the latino/a community, there are immigration issues which
cause difficulty for the latino/a transgender community to access services. There
is often fear of deportation.
• Often transgenders who are HIV+, accessing care for HIV is not a primary
concern.
• Some transgenders feel as if they are on trial everywhere they go, the
bank, store, on the bus. And this is no different when seeking health care or
other
services. Outside private space there is a feeling of being under constant
scrutiny. Some people may choose not to put themselves in a situation to avoid
further scrutiny, and may not seek ordinary forms of assistance.
• Discussion about workplace issues revealed that UCSF Trans program has
an all trans staff. Employing transgender people, especially if an agency is
serving
transgender clients should be a priority.
• There was considerable discussion about oppression and how that contributes
to other problems.
CM Bank suggested that those in attendance attend the upcoming prioritization
and allocation meeting.
CM Kanios reiterated, explaining that having the voices of the transgender
community to take back to the full Council is very important.
Regarding delivery of medical services, the following is a summary of comments:
•
Discussion about the concerns regarding mixing hormones and HIV medications
•
Acupuncture has helped relieve some of the toxic side effects and more acupuncture
services should be available.
•
There may not be sufficient numbers of transgender girls living with HIV to
do an adequate research study on the effects of how HIV medications affect
hormones.
•
There is a lack of mental health and nutrition care.
•
Primary care should be more closely monitored.
•
Unemployment is a big issue. When unable to find work, transgenders may be
forced to get involved in illegal and high-risk street activities.
•
Getting people in care and keeping them there is important.
•
MtF transgender show the highest rate of HIV infection among any other subgroup.
•
A provider reported that there are high rates of high-risk behaviors not reflected
in those testing positive for HIV, which probably indicates that many are avoiding
getting tested altogether.
•
Reckless behavior and risk-taking may be because some transgenders don’ t
have much else going for them, nothing to lose.
•
Discussion of biggest needs include: employment, finding someone who will respect
and love me. Oftentimes people will do anything, and take dangerous risks,
in order to keep affection. In search of love, understanding, and affection,
some will do anything.
•
Discussion about the expenses of transition ($5,000 for a boob job; $20,000
for a genital reassignment), in order to bankroll this kind of money, some
transgenders will do anything.
•
Transgenders know about prevention methods, but it is unclear if they are actually
practicing them.
Discussion about the transgender experience in prison and County jail:
•
Despite being HIV+ it is still possible to find love and affection while incarcerated.
Some transgenders may actually feel more comfortable in prison.
•
There are no condoms available in prison or jail, but this does not seem to
prevent sexual activity among inmates even those with HIV+.
•
For those in County Jail, accessing HIV services is very difficult. San Francisco
County jail is the worst.
•
Being on a sick call list can take a month or more to be seen.
•
If you are in the main jail and HIV+ you are given a general package of meds,
without concern for your regular regimen or other medications needed.
•
When in the main jail, transgender (MtF) are considered men, and they are referred
to as “sir” or “mister” while at the same time providing
hormones. This is a form of oppression that is difficult to survive.
•
Oppression is internalized from family and society and sometimes it gets to
be too much and you have to give in.
•
It is a constant struggle.
•
When leaving SF County Jail, after the oppression and being torn apart emotionally,
physically and otherwise) it is necessary to get some form of validation to
counteract the oppression. In doing so, those released from jail often “turn
a trick” before getting to Market Street.
•
It is sad there is no prevention in jail.
•
There is often difficulty when asking to be separated from the general population,
and it doesn’t matter if you are HIV+. Other people may know you are
HIV+ and still want to have unprotected sex.
CM Banks asked if housing and medications are provided when being released
from jail. The unanimous answer was “NO.” nothing is provided.
The group discussed the need for exit services.
•
There should be some system for transitioning out of jail so they don’t
go back to the streets.
•
Incarcerated transgenders are often labeled as having “special sexual
issues” and they are kept separate from the general population. It is
considered taboo for other inmates or guards to talk to or associate with a
transgender in jail.
•
There is hesitation to stand in line for medications because of peer pressure
and the fear of other people finding out about HIV status. An inmate will get
segregated if they ask for HIV services.
•
Abandonment issues and other deep-seated issues from childhood can often stay
with transgenders throughout their lifetime.
CM Kanios asked about how to improve the situation for the transgender community:
•
Low-cost or free psychological services
•
More social support and affirmation of transgender identity is the key to well-being.
•
Recommend transgender social activities, trips, art shows and other activities
to socialize and network.
•
Support groups help empower and provide support.
•
If taken out of their element, many transgenders do not do well and they tend
to stay within a very restricted geographical area.
•
Discussion about the difference between transgender lifestyles on the East
Coast compared to San Francisco.
•
Group discussed various issues and concerns with regard to attending school.
•
For many transgender issues to be solved is beyond the reach of the Planning
Council.
CM Ortiz discussed that many of the transgender issues discussed, such as self-hatred,
seeking acceptance, oppression, and others are similar to the issues he encountered
as a gay man.
4. Explanation of Community Outreach & Advocacy Committee and
the HIV Health Services Planning Council
Basic explanation of purpose to this committee, our working groups and the
Advocacy Project. Short explanation of the reasons why the Council exists and
what we do.
Richard Bargetto discussed his role as part of the Advocacy Project and explained
how HIV+ clients of Ryan White funded services can come to him if there are
any problems accessing services. A summary of comments by some of the public:
•
Being an HIV-negative transgender highlights the need for more services for
people who are not HIV+ in order to help them stay HIV-negative. Being HIV-negative
it often feels like falling through the cracks as far as receiving services.
•
It is sad that HIV-negative people are envious of HIV+ people and sometimes
deliberately become infected simply to access services.
CM Ortiz encouraged those present to attend Planning Council meetings to voice their concerns, otherwise there is no way of knowing what those concerns are or doing anything to resolve problems.
5. Future HIV Services Funding
Explain CARE Act reauthorization process.
Where we are.
CM Sallee provided an amazing presentation on the CARE Act reauthorization
process and the importance of being aware of pending changes. She reported
that the Ryan White CARE Act is an ideal model for a system of care and could
be easily adapted for a universal care program.
6. Practical Tips for Advocacy: Let’s write our Congressional
Representative
Jack Newby discussed the importance of writing congressional representatives
and other elected officials. He provided simple guidelines for how to structure
a letter and strongly encouraged people to take action.
7. Thank You- Evaluation
Thank members of the community for attending and encourage their future participation
in our community processes (attending Council meetings, Council membership
and/or other HIV advocacy).
CM Ortiz thanked everyone for attending, and gave special thanks again to Walden
House and to Billie-Jean Kanios for stepping in to facilitate the meeting.
The meeting adjourned at adjourned at 7:20 pm.
Community Outreach & Advocacy Committee Mission Statement: To ensure that the voice of the community and consumers are part of the work of the Council. The committee will ensure that consumers and other community members have the opportunity to give input to the Council, be educated on the issues that affect the HIV/AIDS community, and are empowered to be a voice for the needs of the HIV/AIDS community that can affect positive change and ensure public policies that enhance the lives of people living with HIV/AIDS.
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