Speaking at the second annual MLHS Midwest LGBTQ Health Symposium Oct. 6, transgender activist Joanne Keatley opened by recounting her memories of living as a trans person in the 1970s.
It was a difficult time, she remembered, and required difficult choices.
While I'm not proud of a lot of the things that I did over those 10 years, I'm very proud of the fact that I survived those 10 years," Keatley said.
She now lives in California, but spent many years in Chicago. She acknowledged the city did provide some dark memories as well as good ones; years ago, she was attacked with a crowbar. "The smile that I was born with was taken from me on the streets of Chicago," she recalled.
But those difficult years compelled Keatley towards a life of activism. She went on to found the Center of Excellence for Transgender Health in 2007 at the University of California at San Francisco. It's dedicated to helping transgender and non-binary individuals access culturally competent health services. The Center established protocols in 2011 for trans primary health care; those were revived just this year.
Numerous factors can complicate a visit to the doctor by a transgender individual. Doctors sometimes conflate trans persons with gay men. Trans patients are sometimes denied service or faced with embarrassing questions. Electronic medical records often don't have the means by which to indicate a person's gender identity.
Furthermore, few researchers have been able to get a solid answer about how many trans people there are in the United States. Keatley said she frequently cites a study from Massachusetts estimating the number at about 0.5 percent.
"That's not an insignificant number of people," she said. "The answer is that we need to do more meeting the needs of these people."
Keatley also discussed #TransEmpowered, an online campaign she worked on aimed at giving trans women a voice to share their own narratives about HIV.
Other sessions at the symposium, which was hosted by Advocate Illinois Masonic Medical Center and Howard Brown Health, addressed myriad issues in LGBT health.
Michael McFadden, a social worker at Callen-Lorde Community Health Center in New York City, discussed addressing pre-exposure prophylaxis ( PrEP ) with adolescent and adolescent clients.
"It's an exciting time to work with folks, but, at least for me, it can be terrifying," McFadden said.
Individuals in their teens and twenties frequently have specific needs that are often not acknowledged by the medical community. Most are trying to find a fine line to navigate between dependence on their family and a burgeoning independent identity. They are often highly peer-dependent and egocentric as well.
Among the barriers in discussing the PrEP intervention with clients in that age cohort are their own level of knowledge about PrEP; perceived costs; complexity of navigating the healthcare system, and competing circumstances from the patient's other life factors.
"This is tricky stuff to talk about," McFadden said. "We're not necessarily trained to speak about sex with people of that age."
Lisa Kuhns, research assistant professor and associate director of the Center for Gender, Sexuality and HIV Prevention at Ann and Robert H. Lurie Children's Hospital addressed initiatives that would encourage HIV-positive youth to adhere to their medication regimen.
"Forty percent of HIV-positive youth worldwide have suboptimal adherence, with North America being the worst," Kuhns said.
Among the factors impeding adherence are substance use, depression and anxiety and HIV-related stigma. Kuhns addressed efforts to overcome those with impacted clients through motivational interviews, adherence counseling and regular reminders with text messages.
Michael Newcomb, assistant professor of medical social sciences at Northwestern University further addressed the impact of interpersonal relationships on young LGBT's lives, describing how family support is the best predictor of good health.
"Other types of support do not compensate for that," Newcomb said. But he added that that support is often difficult to come by since parents usually do not share the LGBT minority status. Newcomb also addressed the impact of romantic relationships on young LGBT's lives.
Dr. Maya Green, site medical director of Howard Brown Health's 63rd Street clinic, addressed disparities in lesbian health. She pointed out that lesbians have a higher frequency of obesity, stroke and loss of function than their straight counterparts. As such its important for providers to not be afraid to ask about a woman about her sexual orientation and her sexual practices.
"It's important to approach our screenings based on the person in front of us," said Green.
She said, in a survey, about a third of lesbians feared that such disclosure will negatively impact their medical experience, while 30 percent of lesbians had experienced such negativity.
"We need to be upset about this and we need to make empower women to make changes in their lives," added Michelle Evers, a nurse practitioner at Howard Brown Health.
The morning keynote was introduced by Howard Brown Health Aging Services Education Director Cecilia Hardacker, Howard Brown Health President and CEO David Munar and Advocate Illinois Masonic Medical Center President Susan Nordstrom Lopez. Keatley was presented with the first annual Excellence in Health Award.
