Marcela Valente
BUENOS AIRES, Aug 22 2009 (IPS) – Keeping a hospital appointment in the Argentine capital is a far less fearsome ordeal for transgender persons, a sector of the population that according to doctors had dramatic statistics of illness, when they are accompanied by trained health promoters who, like them, have chosen a different gender identity.
It s easier to communicate among ourselves than with hospital staff, Valeria Ramírez, a transgender promoter with the city of Buenos Aires Programme to Facilitate Access to the Health System for the Transgender Population, told IPS.
In place since 2007, the strategy has increased the frequency of consultation and health check-ups by this marginalised community, as well as boosting the immune systems of those infected with HIV/AIDS.
Ramírez, who is also the coordinator of one of the centres run by the Buenos Aires AIDS Foundation (FBAS), meets transgender patients as they arrive at the Ramos Mejía Acute General Hospital, and accompanies them as they request appointments and have X-rays and other tests.
The plan emerged in order to improve the treatment rate of trans persons, who exhibited high levels of illness, Dr. Marcelo Losso, of the hospital s department of services for immunocompromised patients, told IPS.
According to a study by Losso s department in conjunction with other organisations, such as Ramírez s FBAS, the prevalence of HIV/AIDS and syphilis in this population is much higher than among the other patients who attend the hospital.
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Between 2002 and 2006 they examined 105 transgender sex workers, with an average age of 28. Their HIV prevalence was 27.6 percent, compared with 6.2 percent among non-transgender patients attending the same department.
In the case of syphilis, a sexually transmitted infection that is easily treated nowadays, prevalence in the transsexual community was 42 percent, compared to 18 percent in non-transgender patients.
The study, published in the Buenos Aires medical journal Medicina under the title Infecciones de Transmisión Sexual en Personas Transgénero y otras Identidades Sexuales (Sexually transmitted infections among transgender individuals and other sexual identities), found that the transgender group had comparatively low education and income levels and a relatively high incidence of alcohol and drug abuse.
Clearly, this group is not taking the necessary prevention measures, particularly correct, constant condom use, said Losso. But he put forward other reasons, too, that might explain the worrying indicators.
There s a difference between transgender and non-transgender sex workers. The latter have an HIV prevalence of 4.5 percent. The transgender group is evidently a high-risk population, and has very limited access to the health care system, he said.
They definitely do not find the hospital a friendly place, and the same is true of educational institutions and workplaces. When so many of them turn to prostitution for a living, it indicates that they have very few opportunities to find work elsewhere, he concluded.
On the basis of these findings, in 2007 the hospital created the Programme to Facilitate Access to the Health System, funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria.
The programme covers three areas, Dr. Javier Toibaro, of the department of services for immunocompromised patients, told IPS. Training of health personnel and the lay promoters is one area, and activities inside and outside the hospital are the other two.
Sociologists, anthropologists and sexual minorities organisations participated in the training, aimed at raising awareness among doctors and nurses who treat transgender patients, and identifying those most suited to the challenge.
Training was also provided for promoters from the Argentine Association of Transvestites, Transsexuals and Transgender Persons (ATTTA), who are on hand to meet patients from these groups when they arrive at the hospital and accompany them to different departments for tests or treatment, providing company and support.
But the doctors and promoters also reach out into the community. We go to neighbourhood centres with the specialist in infectious diseases, we take blood samples, respond to queries, and go back with the results of routine tests, Ramírez said.
This involves visiting the places where the target population lives, works or otherwise frequents. Apart from the tests and consultations they offer, the promoters also distribute condoms.
In Ramírez s view, the programme has had very good results, because it counteracts the discrimination that transgender persons dread, and that they say is expressed in insults, mistreatment, trivialisation of symptoms and other ways.
For instance, something that happens to us frequently is that although by law we should be called by our new gender name, we are asked for documents and they call us by the name matching our biological sex, which is unacceptable, Ramírez said.
Calling a transgender person by the name she has rejected is a bad start, especially when the patient is seated in a gynaecological waiting room awaiting hormone treatment, and is surrounded by women, she said.
The programme to facilitate access has resulted in a six-fold increase in the number of consultations per month. Toibaro said it has been very effective, with results that are over and above expectations. He said the patients immunological systems are strengthened now, which prevents or delays opportunistic infections that strike when defences are low.
The doctor said the results suggest that the appalling health indicators among this minority group are not related to their choice of gender, but to sociocultural factors of the type that this programme is trying to correct, such as violence, discrimination and lack of opportunities.
Once we went to a hotel in the Flores district where transvestites were living. They were mainly from Peru, and had certain conflicts with other groups. Besides me, our group included a nurse, two social workers and a lawyer, he said.
The questions they asked were all directed at the lawyer. And that shows that, while we are proposing health care and prevention for the long term, they are just trying to survive the everyday violence they face, Toibaro said.
