PrEP for Transgender Women - AIDS Institute Clinical Guidelines

October 2018

This forum was the fourth in a series and a continuation of efforts to engage community and policy stakeholders in support of Governor Andrew Cuomo’s plan to end the HIV epidemic in New York State. A key component of the governor’s plan is to increase access to and uptake of PrEP among people who are at high risk of acquiring HIV infection.

PrEP implementation for adults was addressed on August 26, 2015, when the New York State Department of Health AIDS Institute (NYSDOH AI) convened a forum, attended by healthcare providers, consumers, community stakeholders, and state and local health officials, to discuss the use of PrEP and PrEP quality of care for adults in New York State. On November 18, 2015, a forum on implementation of adolescent PrEP was convened to address challenges and opportunities specific to the youth population. The third in the series, PrEP for Women, focused on identifying challenges that must be addressed to increase women’s access to PrEP and their willingness to use it to protect themselves from acquiring HIV.

Available materials from the PrEP for Transgender Women Meeting:

Challenges Unique to Transgender Women

Among presenters, panelists, and meeting participants, there was broad agreement that transgender women in New York State are particularly vulnerable to HIV and particularly in need of access to PrEP. Speakers noted the steady increase in new diagnoses of HIV among transgender women, particularly among transgender women of color and younger transgender women.

Key Issues and Priorities for Change

All acknowledged that issues of social oppression, discrimination, and inadequate service delivery pose the greatest challenges in improving access to and uptake of PrEP among transgender women in NYS. Toward that end, participants stressed the importance of ending institutionalized transphobia and embracing the reality that a transgender person is entitled to the same quality of care as all other people. That focus is reflected in the key issues and priorities for change identified by meeting participants.

1. Improve care and service delivery environments to expand access to PrEP for transgender women:

Ensure cultural competency among all who interact with transgender women so they can expect safe, gender-affirming care always.
Increase funding for transgender-centered services and expand the number and diversity of settings that provide PrEP and other healthcare for transgender women.
Increase opportunities for transgender people to work in care- and service-delivery settings and foster commitment to hiring and training transgender people for this type of work.
Create marketing and messaging specifically designed to reach transgender women.

2. Reduce social oppression, discrimination, and stigmatization to increase uptake of PrEP among transgender women:

Enforce anti-discrimination laws already in place to protect the rights of transgender people; facilitate passage of new laws that offer further protection.
Tailor services to meet the social, economic, and healthcare needs of transgender women; PrEP will not be a priority for transgender women in need of housing and food security, transportation, and basic healthcare.
Decriminalize sex work and protect sex workers’ rights. Sex work is survival for transgender women and others who face social and structural barriers to employment.
Focus on occupational safety in discussions of PrEP; HIV risk is an occupational hazard for sex workers.

3. Improve awareness and knowledge of transgender women’s healthcare needs:

Require training in best practices in care of transgender women for all medical care providers.
Offer non-clinical care in the same settings as clinical care, as wrap-around services.
Promote research on PrEP efficacy in transgender women.
Bundle hormone therapy with PrEP, always.
Expand advertising, education, and payment options for PrEP and ensure that all campaigns and materials are transgender inclusive.

Summary Report

October 2018

This report summarizes speaker presentations and panel and participant discussions at the first statewide forum on PrEP implementation for transgender women in New York. This meeting was hosted by the New York State Department of Health AIDS Institute (NYSDOH AI) on April 10, 2018.

Read the report now (PDF)

Speaker Bios

October 2018

Johanne Morne, MS

Ms. Morne currently serves as Director of the New York State Department of Health (NYS DOH) AIDS Institute. The AIDS Institute has a broad mission including hepatitis and sexually transmitted disease (STD) services, surveillance, opioid overdose prevention, and non-HIV Lesbian, Gay, Bisexual, and Transgender (LGBT) services into its structure. The AIDS Institute formulates policy related to HIV, hepatitis, STDs, drug user health, and LGBT health and human services; initiates, develops, and evaluates programs for the delivery of HIV, hepatitis, and STD prevention, healthcare and supportive services as well as drug user health and LGBT health and human services; establishes clinical standards and oversees quality management; educates healthcare providers and the public; and guides regional and statewide planning. In its more than 30-year history, the AIDS Institute has provided leadership in NYS, at the national level, and internationally. Ms. Morne’s leadership advanced the State’s deliberations related to Undetectable=Untransmittable and led the NYS DOH to sign on to the U=U consensus statement. New York was the first state to do so. Ms. Morne currently serves as a board member of the National Alliance of State and Territorial AIDS Directors (NASTAD). Ms. Morne is also an honoree in the 2017 POZ 100: Celebrating Women. Prior to joining the State Health Department, Ms. Morne served as quality manager of psychiatry and HIV services at a Designated AIDS Center hospital and director of community-based HIV services at a federally qualified health center. Ms. Morne’s professional and clinical experience is in public health and behavioral health, particularly within communities of color.

Oni Blackstock, MD

Dr. Blackstock is Assistant Commissioner for the New York City Department of Mental Health and Hygiene’s Bureau of HIV/AIDS Prevention and Control. She is a primary care physician, HIV specialist, and researcher who has developed, implemented, and evaluated innovative community and clinic-based programs to promote HIV treatment and prevention. Dr. Blackstock is at the forefront of local efforts to increase access and uptake of biomedical HIV prevention technologies among cis and trans women who engage in transactional sex or inject drugs. She received her undergraduate and medical degrees from Harvard University, and her MHS from Yale School of Medicine in the Robert Wood Johnson Foundation Clinical Scholars Program. She trained in primary care internal medicine at Montefiore Medical Center in the Bronx and completed a fellowship in HIV medicine at Harlem Hospital.

Gus Klein, MSW

Gus Klein is a doctoral candidate in Social Welfare at the CUNY Graduate Center and a research associate at the Hunter HIV/AIDS Research Team. He conducts community-based participatory research on health disparities in the transgender and non-binary communities. He is also a social worker who has been working with diverse communities in a variety of settings for the past 20 years.

Asa Radix, MD, MPH, FACP

Dr. Radix is the Senior Director of Research and Education at the Callen-Lorde Community Health Center and a Clinical Associate Professor of Medicine at New York University. Dr. Radix has over 20 years of experience providing HIV care, primary care, and hormone therapy to transgender and gender non-binary people. Dr. Radix has contributed to multiple national and international guidelines in transgender health and is currently Co-Chair of the World Professional Association of Transgender Health (WPATH) Standards of Care version 8 working group and a member of the HHS Panel on Antiretroviral Guidelines for Adults and Adolescents.

Zil Goldstein, FNP-BC

Zil Goldstein is an Assistant Professor of Medical Education at the Icahn School of Medicine and the Program Director at the Center for Transgender Medicine and Surgery at Mount Sinai. She has served as a clinical specialist in transgender and HIV health at multiple institutions, and, with over 10 years of experience in managing the healthcare of transgender individuals, has played an instrumental role in building transgender services throughout the Mount Sinai Health System.

Melanie Dulfo, LMSW

Melanie Dulfo started as a Peer Educator in HIV prevention and is now the Director for Community Health Education at Apicha CHC. She launched linkage and navigation services for Apicha CHC’s HIV prevention projects, including linking and coordinating clients to PrEP treatment and has learned many lessons in integrating services, from outreach to retaining people in care.

Timothy Au, LMSW

Timothy Au, Program Manager for Support Services, assists the Support Services department in overseeing of programs implementation, including supervision of the PrEP navigation services and Trans Health Care Services. Mr. Au holds a Master’s degree in Social Work and has obtained license from the New York State Board of Education as a Licensed Master Social Worker. Mr. Au has over 7 years’ experience in case management of clients living with HIV/AIDS as well as managing case management services.

La’Mia White-Revlon Aiken

Also known as Mother, La’Mia White-Revlon is the Voice for her fellow brothers and sisters. From her humble beginning over 20 years ago in church serving as a youth Minister as a teen, leading up to her service as an Elder as an adult, La’Mia has always been determined not only to be visible but vocal for her peers’ rights to be heard. Upon entering the LGBT community in 2004 she founded The House of Encore. The House of Encore would be the platform in which La’Mia would use to reach a target population desperately in need representation. With the goal of making a meaningful difference, La’Mia joined forces with In Our Own Voices, where she started off as volunteer and worked her way up to a Peer Educator, Facilitator for “T-SISTA,” and Ball Promoter for our annual Black and Latino Gay Pride. Now as a full-time employee, to date La’Mia is continuing with her passion by getting involved in issues surrounding transgender equality and awareness and HIV/AIDS prevention. She is working diligently to end the HIV/AIDS epidemic by 2020 in NYS.

Agenda with Links to Slides

Welcome and Introductions:
Laura Duggan Russell, MPH, Senior Program Coordinator, Office of the Medical Director, NYS DOH AIDS Institute
Opening Remarks:
- Johanne Morne, Director, NYS DOH AIDS Institute | View Slides
- Oni Blackstock, MD, Assistant Commissioner, Bureau of HIV/AIDS Prevention and Control, NYC DOHMH | View Slides

PART I: INVITED SPEAKERS

Facilitators and Barriers to PrEP Among Transgender Women in New York City | View Slides
Gus Klein, MSW, Hunter HIV/AIDS Research Team

Sexual Health for Transgender Women | View Slides
Asa Radix, MD, MPH, FACP, Senior Director of Research and Education, Callen-Lorde Community Health Center; Clinical Associate Professor of Medicine at New York University

Gender-Affirming Clinical Care for Transgender Women
Zil Garner Goldstein, FNP-BC, Assistant Professor of Medical Education; Program Director,
Center for Transgender Medicine and Surgery at Mount Sinai

Questions & Answers

PART II: WORKING LUNCH WITH PANEL DISCUSSION

Real-World Experiences in Implementing PrEP for Transgender Women

Melanie Dulfo, LMSW, Director of Community Health Education, Apicha Community Health Center, New York, New York & Timothy Au, LMSW, Program Manager for Support Services, Apicha CHC, NY, NY | View Slides
La’Mia Aiken, TransCare Advocate, In Our Own Voices, Albany, New York | View Slides

Questions & Answers

PART III: ROUND-ROBIN BREAKOUT SESSIONS

Participant Discussions: Attendees will circulate through three 25-minute breakout sessions to discuss their experiences with the following key topics in PrEP implementation for transgender women: 1) Access to PrEP; 2) PrEP Retention; 3) PrEP Public Health Program Design. After 25 minutes of discussion in one session, participants will be directed to the next session until everyone has had the opportunity to participate in each of the three sessions. After a short break, we will gather to report out and identify priorities for policy and change.

PART IV: PRIORITIES FOR POLICY AND CHANGE: REPORTS FROM BREAKOUT SESSIONS

Report Out: Successes, Challenges and Priorities for Change
Session leaders will report out to the whole group with the goal of identifying the top 3-5 items in each of the following areas:

Issues and challenges unique to PrEP implementation
Keys to success, including best practices for engagement
Policies needed to increase PrEP uptake
Priorities for change to guarantee success in the next 3 years
Based on concerns and solutions identified are there suggested policy changes/program changes/interventions?

Next Steps and Closing Remarks: Laura Duggan Russell

Resources

October 2018

PrEP/PEP Directories