Current Guidelines for Gender Affirming Care for Transgender Individuals

Background and goals: The guidelines for transgender care are evolving and incorporate a multidisciplinary team approach. These roadmaps entail an understanding of gender development, mental health, and sociocultural factors in individual and family lives, as well as the specific medical needs in the process of transitioning and ongoing treatment. New research is continuing to update the best evidence-based practice. Multiple professional health organizations have published guidelines. The World Professional Association of Transgender Health has pioneered the Standard of Care, currently version seven. Other leading organizations have their own publications with an emphasis on specific relevant medical needs. In this paper, The World Professional Association of Transgender Health Standard of Care and the recommendation of multiple psychiatric and pediatric organizations are reviewed to provide an overview. Discussion: Most current guidelines have similar recommendations in providing care for transgender individuals. The more recent data has shown the benefits of medical transitioning in youth and updated recommendations in this age group. Healthcare professionals are encouraged to stay up to date with these current guidelines. Further research is recommended.

HIV Testing Preferences Among Trans Men and Trans Women: A Retrospective Study of Client Records from 2017 to 2019 in a Community-Based Transgender Health Center in Metro Manila, Philippines

Background: Transgender individuals are considered as high-risk for contracting HIV infection. Integrating HIV testing and counseling (HTC) services into current transgender health programs is necessary to increase its uptake. Our study aimed to describe the characteristics of trans men (TM) and trans women (TW) who accessed HTC services in a community-based transgender health center in Metro Manila, Philippines, and to examine the relationship between gender identity and their HIV testing preferences. Methods: We conducted a retrospective study of TM and TW seeking care from 2017 to 2019. Medical records of clients were reviewed to ascertain their age, gender identity, year and frequency of clinic visits, lifestyle factors, and HIV testing preferences. The effect of gender identity on HIV testing preferences was estimated using a generalized linear model with Poisson distribution, log link function, and a robust variance, adjusted for confounding variables. Results: Five hundred twenty-five clients were included in the study, of which about four out of five clients declined the HTC services being offered. In addition, the prevalence of non-uptake of HTC services was 48% higher [adjusted Prevalence Ratio (aPR): 1.48; 95% Confidence Interval (CI): 1.31–1.67] among TM compared to TW. Clients who initially consulted in 2017 had a 25% higher prevalence of refusal for HTC services (aPR: 1.25; 95% CI: 1.08–1.43) than clients who initially consulted in 2019. Approximately 4% and 11% of the TM and TW, respectively, who accessed the HTC services were reactive and linked to antiretroviral therapy treatment. Conclusion: HTC service uptake of TM and TW is low. HIV program implementers should strategize solutions to reach this vulnerable population for increased and better HTC service uptake and linkage to care.

From Margins to Mainstream: Creating a Rural-Based Center of Excellence in Transgender Health for Upstate, New York

Transgender people face many barriers to healthcare, especially in rural America. The work to decrease barriers to care and address health care disparities for this population meets criteria for a wicked problem, each of which is unique and has no clear solution. The barriers are related to the individual and society and are both formal and informal. The definition for a Center of Excellence in healthcare is loose, but these organizations aspire to serve as specialized programs that offer comprehensive, interdisciplinary expertise and resources within a medical field to improve patient outcomes. With funding and leadership training from the Robert Wood Johnson Clinical Scholars program, a group of medical and mental health clinicians worked for three years with the goal of creating a Rural-Based Center of Excellence in Transgender Health embedded within a family practice to approach the wicked problem of transgender healthcare in their region. The goals of the center were six pronged: the provision of competent and affirming medical, surgical and mental health services, training for healthcare professional students, medical-legal advocacy and patient-centered research. The team created a strategic plan, with five strategic directions, including 1) developing infrastructure and organizational capacity, 2) expanding awareness, knowledge and skills, 3) fulfilling staffing needs, 4) ensuring gender-affirming care, and 5) advancing evidence-based care. I describe our work to bring transgender health from the margins to the mainstream for our region through implementation of this strategic plan.

Attitudes Toward Transgender Individuals Among OT Students and Practitioners

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. A correlational study determined if personal contact with transgender individuals and amount of transgender-specific education are correlated with OT students' and practitioners' attitudes and knowledge of transgender communities. Results indicate that contact and hours of education have a significant association with knowledge. Research into factors that relate to preparedness in working with transgender clients is a step toward addressing transgender health disparities. Primary Author and Speaker: Yan-hua Huang Additional Authors and Speakers: Nicole Villaescusa, Kendira Villalobos, and Laura Yamaguchi