Chapters Transcript Video Caring for Ourselves: Owning Our Health Caring for Ourselves: Owning Our HealthOriginally Broadcast: Tuesday, April 272:00 PM - 3:00 PM EDT I'd like to welcome everyone to today's program caring for ourselves, owning our health. Today's program was created in partnership with creating Change and the National LGBT to Task Force. This virtual roundtable is an opportunity for an open conversation centered on transgender health and wellness, with a particular focus on HIV awareness and testing within our transgender communities. My name is diana Phyllis Olivia, and I'm the associate director of advocacy and community engagement for Gilead Sciences. Gilead recognizes how important is to elevate the voices of our transgender communities and to discuss how we can support them and help them gain access to care. Today's program will feature a panel conversation hosted by the Amazing Diamond Styles Diamond is the executive director of black trans women, inc and the creator and host of her own podcast titled Marsha's Plate, which explores the issues through a black transgender feminist lens. Today's program will conclude with a Q and a session where our audience will have the opportunity to ask questions to our speakers throughout the program. If interested, please click on the button below on your screen to ask good question during the program at any given time. Now, without further ado, please let me turn it over to diamond style so she can introduce our amazing panelists. Thank you and have a wonderful program. Oh my God, thank you. Thank you. Thank you. Thank you so much for that introduction Diana. I am so happy to be here and just to delve into the insight and the conversation with our exciting panelists. So let me introduce them to you. So Karen P. Todd is a black, non binary trans masculine person and a project manager at the Center for Sexuality and Health Disparities at the University of Michigan, a research group that seeks to reduce sexual and reproductive health inequities through rigorous academic scholarship curing curly works on projects related to intimate partner and sexual violence and trans communities as well as chest binding and masculine identity development in trans masculine communities. They will soon be starting their PhD program at the Population Health Sciences at Harvard T. H. Chan School of Public Health. This coming fall, congratulations. They will be focusing on transgender health and wellness. Welcome Dominique morgan is a community activist, educator, organizer, and the executive director of Black and Pink National Organization that seeks to end the violence that system impacted LGBT people and people living with HIV often suffer by focusing on advocacy, education, direct services and organizing Joaquin Carcano is a trans tejano from texas. Come on, I'm from texas al mexican border who was found a second home in Durham north Carolina. He's the director of community organizing for the latino Commission on AIDS Latinos in the South program, working regionally in nine Southern states and is on the board of directors for the LGBT Center of Durham and the Southern AIDS Coalition. He believed binaries are often suppress, suppress our creativity and our possibilities and encourage everyone to overlook the organization, organizing not to overlook the organizing power of the south. And so let's get started. Our first conversation will focus on the importance of supporting health wellness in our whole community. Let's talk about, What do you think as a Panelist? What do you think are the biggest obstacles facing transgender individuals in terms of accessing the care they need? Let's start with dominate. I would say some of the largest obstacles are these essential needs that folks talk about every day, but we are experiencing the need from our members in the community and for folks who are incarcerated, who are coming back to the community, they cannot be housed, they cannot find a job. They have never had any sort of quality experience around health care that prepares them to be the stewards of their health experience once they come to the community. Um these these systemic barriers that most people Are navigating, especially post-2020, are exacerbated when we're looking at these folks who who we are the most oppressed in our populations. And then you add the experience of incarceration, which is the population that I identify with. And and most of our clients at black and pink identify with these barriers can feel insurmountable and you will, it takes a lot of energy rest and and and really like self centered experience to walk into your doctor's office and demand what you want to be able to curate your experience and lead ID. And so if a person doesn't have a place to sleep, if they haven't eaten that day, you can't talk them about going to get an STD test, you can't talk them about prep. And so those are the main issues that we're seeing every day, that also are issues that we can address and we just aren't we aren't doing the job that we should be doing in my opinion. What about you, Karen? You know, I appreciate that. That what Dominique saying about, you know, it really stuck with me and you said, how can we think about trying to get people in their testing and get people into health care when it's like, folks are really worried about where they're going to sleep and what they're going to eat. Um and if they're gonna have a job right, or they're gonna get fired from their job. And I think that that's something um that I'm hopeful that I think research communities, particularly folks who are working with or in trans communities in research, I think a lot of that can sometimes feel like we're not getting at that right. Um like if we're looking for policy change and you know, we sometimes think this has to be this like slow way that we can come into actually making um making changes for these obstacles. But I absolutely agree with Dominique that I think these obstacles are beyond just um you know, the cultural competency of providers or um having access to health care generally. I think that there are there are there are other major obstacles um that in itself make health care and accessible for trans folks. And um yeah, I just really appreciate that you said that dominate because I think that these are conversations that and they're hard conversations that we need to have with folks about what are we prioritizing and why walking? Yeah, I think thank you all you know, setting up the stage of how can we even think about health care when our basic survival needs are not being met? Um You know, and when we think about health care, um I think part of the issue is that as trans folks, that our bodies rarely belong to us, You know, they're discussed in textbooks, they are debated in courtrooms as we're seeing currently. Um They're debated on the news. Um and so how do we access something when our body can feel so unfamiliar? Um because then going into healthcare office can be an incredibly vulnerable space. Um and it's opening up yourself to further discrimination, um further hate and confirming that your body is not yours, or the expectations continue to put on your body. Um and that's that's what I'm saying, you know, that sort of experience that it is, it takes a lot of um energy to just take that first step to cross into health care visit, you know, and I think we have this idea of people are um wanting to provide services to our community but how can we trust them? You know, what does it take to establish that relationship? Um and to really think about just because someone is, let's say trans affirming and some broad sense doesn't also mean that they are not going to be misogynistic, are not going to be anti black and so it's not always a safe space just because they're providing trans healthcare coverage or trans healthcare in some sense. Um and that so much of the focus is also on hormones, you know, and that is a huge need for many of us and often one of the big first steps, but we can have access to hormones, but the rest of our care is neglected. You know, every time I've gone to a specialist has been an incredibly devastating experience. And so I try not to go to any other steps, but the rest of our body is neglected. Um and so I think there's there's a lot of follow through that we need. Mhm. Karen, What are some of the common commonly held um when we talk about these comedy held ideas and understanding of sex and gender as binary concepts, how are these concepts impacting um transgender and gender? Nonconforming individuals who receive care. But also how can we how are are you getting this kind of information about their sexual health? From people who may not be as you said, um you know, to get past the cultural competency piece, How do how do we actually, where do they get there information from? Yeah, great question. I think the first part of that um this idea of conflating gender and sex, um I think can really really harm it harms all folks, right? It especially harms trans and non binary folks who s Joaquin is saying like, maybe hormones is that you're like, the first thing that you're looking for, or thing you're looking for at all is a trans and non binary person or gender nonconforming person. Um and I think often for non binary folks, especially gender, nonconforming folks who maybe seeking some sort of hormone treatment or some sort of affirmation in that way. Um it can feel like you can't access that because you are then expected. Oh, I'm going to go on hormones. You may have providers who are like, oh, you need to be doing this full regimen. You need to be taking it once a week or you know, every every three days or whatever. It has to be like, oh, you're going to be full trans, right? Like you got, you got to do this, right. Um and that can be really off putting for folks. Um in my own experience that has, I've had a really great provider um where I wanted to start off very slowly, right? I think I was at one point just kind of like half micro doses as folks may call it, where I was like taking half of a dose. Um but that was because she understood what it meant for my gender affirmation and what it meant for me to seek care and what I wanted that to look like. And I had the agency to say, you know, I wanted to look like this, but I wanted to happen over time because I have these anxieties and I have these feelings about gender. Um, and so for for one, I think that is really important to think about when people conflate sex with gender. Um, and also that also kind of really impacts people thinking, oh, well if you're trans, you must, you know, for me that must have meant I want to be as masculine as possible. Um or something like that, which is really unfortunate and really harmful. I think particularly to youth. Um, trans and non binary youth who are navigating their bodies and and their feelings. Um to answer the second part of your question around where are these youth getting information about their sexual health? Many of them um people that I work with are fighting and myself um through Youtube. You know, folks like to follow people's stories about, you know, how they have overcome obstacles or even their gender euphoria, right? I think that can be really important. We have folks who like document um their gender journey, which is can be really cool. Um and I think and on one hand at times that can also make people feel like this is what their gender journey needs to look like, right? And I think that there's a lot of white trans masc folks on those Youtube channels or in these spaces where that is what their gender journey looks like. And so that's what people think trans folks look like. Um So I think that youth are getting their information in ways that it's great that we have the internet. It also means that there is a face put to what you should look like as a trans person for youth um that I worry about sometimes that I really want folks to feel like. And youth particularly like I wanted to have resources where they can have the agency to think through and reflect on what that would mean for them. Absolutely. I think that's really a really key thing to talk about because I as a Youtuber, there's so many people and I've been on there for like 12 years. There's so many people that say I started sneaking and watching you at 11 years old and now I'm 24. So I know they are getting information from, you know, these more nontraditional ways. So I think it's important for parents, parents as well to be supportive apart a supportive part of the Children's life so they can steer any kind of information in the right direction. Dominique can you talk about the importance of providing gender affirming care for trans individuals? Including argues, I think the part that I've realized and I my medical and social transition started last March. So like I'm a year into this experience and in my past life as a, as a sex educator, I would speak about this based on trainings and books and kind of talking to young people, I think now, not only knowing the power medically and how affirming it is, um to really make sure that young people are growing up in a way that they feel like they're really empowered and how they are a part of a community. We oftentimes look at young people who are struggling around us and we we assume, and we um, we really put this perception that they just aren't, they don't care. I often believe we haven't showed them why they should care, right? How is this how is this black mind? How is this house mind? How is how is this school, a part of my history, whatever you want them to care about, it's important to get people invested and we don't, we don't think young people deserve that time and that um that that that breath of opportunity to be stewards of their experience. So we take that from them. But the personal perspective I've been able to bring to this in the last year is that you always think that you are working at your highest capacity and you look at situations where you're struggling and you will attribute it to, I just, I'm not capable. What I've realized in the last year is that I hadn't been able to unlock my full potential. So how did people ever expect me to be my best self? And I'm 39 years old now, right? When I think of someone who's 13, 14, 15, 16, when we know the data that shows most of these young people are, are often system impacted. So their own diversion, they're in some sort of probation program in Foster care youth detention group homes, right? They're already out of place and out of space. We're not allowing them to create safety inside that allows them to show up as their best self. I am better and everything else I do now because of my access to affirming healthcare. And I know if that's true for me in this very in this body that has a lot of privilege and a lot of access even with the oppressed identities I carry, I can't imagine an impact that would have of a young people and and that correlation of healthy, strong, happy, fully present young people, how that correlates to really healthy and happy parents and homes. Um, the last thing I will say is that we assume that parent and child relationships are automatic, they're not in any other relationship right? If both sides, if both pieces of this whole or at its healthiest or at its strongest or at its best, the relationship is going to be at its healthiest at its strongest at its best, right? So you can have these incredible parents, but if the young people are not being centered, if they're, if they're affirming healthcare is not being centered, you're also not giving this young person the opportunity they deserve to have a great experience with whatever a parental figure means to them. And I think that is a huge, huge, huge issue in our communities every day, that young people are not given the chance to show up as their best selves because we're often barriers, so affirming healthcare adding in a lot of comprehensive sex education. Um I think really positions are young people to just be big and powerful, express their big and powerful nous, we already know they are, but it allows it to really shine through, why can't there continue to be a lack of data on health of transgender individuals? Can you talk about whether or not or how that changes? What are some of the challenges in the data collecting in our communities and how can organizations who work with transgender communities help support improve data collection? Yeah, definitely. Um, before I answer that question, I do want to just touch upon the last one because I think there was something that really spoke to me. Um I think from from carrying Dominique, you know, they talked about having agency and being stewards of their experience. Um and I think youth are so curious and brilliant um and full of energy and have this whole world in front of them. And as they get older it shuts down and that that light kind of dims often and I think we both as trans people in our six counterparts need to really reflect on the conditions that caused them to shut down. And that's how gendered our world is of how often we cut you off from a full expression when my brother told me that his wife was pregnant, my request was I'm excited for you, please don't have a gender reveal. And he did it. But I think we encounter so much gender conditioning that dims that light. And so like I just want to put that out there for people watching to really to reflect on how is gender and that really gendered idea showing up in your lives and how are we reinforcing that on two Children and dimming that light of theirs. Um You know when it comes to data, I think it is changing because trans folks have been vocal we are demanding to be seen in data because as we know, unfortunately data gives us access to grants, it gives us access to research, It gives us access to programming. We have to prove that we exist to to pull funds to support our survival or needs um which is unfortunate and awful and it shouldn't be that way. But when researchers constantly you know, um cut us out from from our experiences um we can't demand things um when they won't even acknowledge us. So I think, you know especially when it comes to HIV of thinking about how you know just the term M. S. M. Is so harmful to people um exclusionary and and is really transphobic, you know and they're they're lumping in trans women with these terms and trans men in other ways are completely left out um of HIV research in other ways. So we as trans folks on binary folks are not even considers that sometimes as sexual beings unless it's in sort of this like transphobic way. Um So we're not showing up in the data. Um So I think it is changing because people are saying hold on can't lump us in this way, hold on this is not our gender. These are not the people were having sex with. Um uh so I have seen a change and and it's it's because of the labor of trans folks. Mhm. Karen. Yeah. Absolutely. I think and I think the reason it is changing is because like walking saying like trans folks are are speaking up and we're saying what we need and we're also leading these things right? And we're also like in the rooms and in the study teams and leading organizations as so many people here, the three of you all are right and directing and making these moves um and we know what we need and we know how to communicate with our folks, right? Because we know what it feels like when we're not communicated with or when we are not that the word agency just keeps coming up, but it's all about that really. Um and I just think that you can look around and you know, in my work I read a lot and I'm writing a lot and I can see folks who are trance um leading projects right? There's there's folks um there's a trance pulse of Canada um that just had a ton of trans folks on the study, including leaders on that study right. Of like people collecting data. That is important about a host of different gender um issues and health issues of in addition to HIV right, there's things there about incarceration and policing rates and um some of those more like systemic things that we need to know um and have data on. So like Joaquin saying we can actually have grant money for them and we can have money to then create policy and advocacy can be funded. Um You if we don't have that, we don't have the funding, right? And then so it's kind of like the cycle of like if we're not having good data collection and we're not having trans folks leading these things or um trans folks being a part of it. Um it's kind of trash and it doesn't work for anybody. So like what's the point? Absolutely. And and lack of data also leads to these crazy bands and legislations and laws all of the country that we have seen popping up because people don't have data and education. They don't even know trans people who are making these laws and pushing these things forward that harm um Children and adults alike in health care. So now I want to talk about specifically about some issues related to HIV in the trans community and audience. As a reminder, please submit your questions down. We have been doing the zoom thing for like over a year now. So there is a button down in the bottom that you can submit your questions and we will address them later on in our Q and a section later in the program. So back in what are some of the key challenges related to HIV in the community that you serve and what do you see as short and long term HIV goes for organizations that work with community that you work with? Yeah. So I want to start this. My answer is saying that uh recently my my boyfriend and I have started watching sex in the City all over again, which can be problematic, but also just like with one of the few shows, this is really Upfront about sex, which I love. And I think in this work I've been working in HIV for around 15 years now. Um part of the reason is we don't talk about sex and that's one of the big challenges is we want to talk every which way around sex. Um to talk about HIV and if we can't be honest about the sex we desire the sex were engaging in because those are often two different things or can be different things. We can't be honest about what we need to either um prevent HIV or to treat it if we're living with it. Um So I think one of the big things is we just don't talk about sex. Um you know, in terms of the trans community, in the latin X community, they think there are some parallels where were either hyper sexualized or were denied pleasure because we're not seen as worthy or we need to remain sort of chased. Um and it's just really harmful. And I think we often are raised thinking that we don't have access to pleasure um or intimacy. And so I think part of HIV prevention, if we're going that route is to talk about other avenues to intimacy and to pleasure. Um and that is an HIV prevention, you know, avenue that we could take it or not, and it's denying us so much. You know, sex is about shame or about consequences. You you know make it an SD I or HIV or you may end up pregnant. Um but if you're pregnant if you're in a marriage then it's celebrated. Um and so that's one of the big challenges is Talk About sex, they're doing it in the 90s music and here we are, 30 years later and it's been buried. And I think that is always my approach is let's talk about sex, let's talk about pleasure because we deserve access to those things and a full breath of what that means to our lives and we include HIV and that Absolutely and healthy conversations about those things will lead to better results. Can you talk about how concepts like treatment as prevention like undetectable equals un transmittable affects your understanding of HIV prevention. People living with HIV who take medications as prescribed and achieve and maintain they achieve and maintain a level of being undetectable, undetectable viral load can talk about these concepts and you know how that affects HIV prevention. Mhm I think you can do you know undetectable, it goes on transmittal bit on transmittable has been a huge tool um in terms of tackling stigma and also for many people I work with who are living with HIV or case managers who often have to either deliver the diagnosis or tell people about the legal implications, implementation, implementation implications of HIV. Um when it comes to HIV criminalization U equals U. Has been really liberating to say now I can pursue a relationship without having you know to think about this, to think that my body is not criminalized and I think any any chance we have to lessen interactions with law enforcement with the criminal, you know incarceration system is a win. I do think on the other hand it can't we have to be very delicate with it because it others people, it says you are not undetectable. And again it puts this burden and the shame on people of individual responsibility of saying why aren't you undetectable? Why aren't you taking your meds? You have, you have these tools and you're not you're not doing it right. Um and so we have to be very careful because if we want to promote U equals you, we also have to tackle the conditions that are affecting people's lives and the environment that don't allow them to become undetectable. You are. Do they have a ride? Do they have way to pay for meds? So I think when we talk about you, because we need to talk about those those conditions of people's lives Dominique, how can providers, community, even faith based organization work to address the self stigma of HIV of HIV diagnosis, which can impact mental, physical and emotional health and you know, even affect health outcomes. Can you talk about that? I think we just have to stop looking at one portion of a person's identity or experience and wanting to box the rest of their life, the rest of their experiences in that. Um and and what we absolutely what we put out there, people absorb and they believe and they take it on. Um and so there's there's this um very sad moment when the inappropriate um non valid narrative that's being pushed meets with the people who are navigating the experience and they then believe that. And then there's this experience and you see it around HIV and AIDS and I think specifically looking at the black community, black trans and queer folks, There's this idea that an HIV diagnosis or someone with AIDS in our community that it's a life stopping experience in two in 2021. Right? There is not um, there's not an open conversation, there is not a um a deep knowledge around U equals you and all these other campaigns or or young folks who want want to take prep and all these other in all these other things. There's there's a poster here, there's a conversation there, but no one's coming together to say, how do we do away with these false ideas of what this experience is like and how do we at the same time? How do we not tokenize and use the story of a few people um to try to put that on other folks or make that the attainable experience. Let's just talk about a multitude of experiences. I think what I realize is um people don't have a problem with folks who are living with HIV and AIDS. They have a problem with people who are poor, who are living with HIV and a is there a problem with people who are fat people with? They have a problem people that they don't want to have sex with, who are living with HIV and a I have a problem with the people that they can't get flied out with, them who have HIV and AIDS, right? They those sort of things are the issues not that experience. And so once we start there, the folks who are positioning themselves to combat this issue and inform people they're going to have to do away with that. I also think we're going to have to really investigate the inherent bias. Is that many people bring to that work? A lot of these folks approach these initiatives from a space of sympathy or pity. It's not really strength based approaches to talking to people about accessing care, navigating and making sure you're maintaining your medication. And also what Karen said is that also these are institutions that have called his caused historical harm in other ways. So, you then want them to not remember this piece over here to access this care and allow you to engage in solidarity around this important issue. So, we have to do away with a lot of the language and the conversations we have about the experience, and we have to be comfortable, um, at the end of the day, that people are sexual beings that that that that that we need to stop using fear language, especially for incarcerated people. The fight to get condoms in prisons across this country has been ridiculous. We don't we're not going to get prep inside of an institution. You think people are not having sex in these prisons? How are these institutions that are perpetuating this conversation that have access to the information and and and and have the have the really power to be an ally. How are you pushing back on institutions that have built every wall around the bodies of these folks who need this care also? So that's the last thing I'll say, like, we need to push ourselves past the kid at the church study. If you're working in high schools, are you working at are you working at the alternative school? Are you working to school where the kids are pregnant? If you're working with black and brown folks, are you working at these prisons? Because that's where you'll find most of us. If you're working with trans women, like, how are you coming to uh stop stop creating this narrative, We have to come to you and then when we get there, you're telling us, you know, take this pill and hopefully you'll have a good life. We have to change something at this point. Mm It's no coincidence that we keep hearing from our panelists concepts of bias and concept of intersectionality and just so many connected um oppression. Because all oppression is connected. If we're trying to get to the bottom of in in any issue that we're bringing up in in our social, economic, um politics in this country, you all oppression is connected. So you if you want to get to the bottom of it, you've got to address all of them simultaneously. It's not one at a time, It's not let's do them first is everybody has to come at the same time and I'm so glad that you all are hitting that on the head. Okay, Karen, in what ways have you seen social stigma act as a barrier to HIV prevention and treatment and what are some of the potential strategies for addressing this problem? Yeah. You know, I'm I'm actually still chewing. I think I want Dominique side because I feel like she answered this fully. I think that um this idea of not packaging people as like folks who live with HIV or folks who live with AIDS, right? Um, but then like understanding that a lot of that social stigma is also around other identities and like we don't exist in um you know, I don't walk through the door as just like black some days and then just clear some days and just trying some days where I walked through the door fully as me, as Karen, right? And so when I when I walk through the door and I'm seeking care, um the stigma that they can bend, like impact how I'm interacting with a provider, impact how I'm even thinking about if I want to seek out a provider for whatever, right? As Joaquin said, thinking about, do I really want to go see the specialist for, I don't know my elbow because then we're gonna have to have this whole other conversation um You know, or or see a specialist for something important is high blood pressure or things that really can impact, particularly black communities, right? We can't separate that from social stigma that we see acting as a barrier to HIV prevention because if we're thinking a holistically of a person's health um and dominate your sex education, sex education lenses, just like jumping out of me. And I love it. Um Like how how can we even think about potential strategies for addressing that problem if we're just keyed in on, um, what I think some folks might see. It's just HIV prevention, right? How can we get um, as important as testing is right? Because it totally is and as important as it is to have people linked to care. Um, I think the strategy is to address that typically lack those other lenses, right? Or lack the understanding that we need to work. Um, and maybe we don't have those answers that, but that's what the answers we need to find, right. But I think something that's so interesting to me about research and the communities that I work with and in and the folks I work with is we do have these conversations and sometimes it can be hard. It can be hard to think through what, what can we do, right? What can we do on a broader lens to address some of these like systemic issues. And, and it's not easy, but I really do challenge folks, particularly, I think in the spheres that I'm in to think about it more right? Like what are, what are we doing? You know, really working on at home testing or working on other HIV interventions where we're not including other things. Um, I was recently on a project where motivational interviewing was used, right? Trying to allow folks to have the agency right to think through like, okay, what are my like desires for sex, right? And pleasure. And how can I do that in a safer way? Um, you know, could I do it at home testing with a video counselor? Or could I do at home testing and someone sending me videos of how I can do it myself, right? Just because I don't feel like I have the access to actually go and like go to provider and sit there and have all these other things going on right. Um these other like stigma barriers that we're talking about. So I think there are some strategies and I think I think they are very useful. I do think that we can continue to make them better, right? We can continue to make them more holistic and health based. I want to go into a conversation because we keep bringing up agency and I really want to talk about the power of agency in regards to how um you know, we implement the power of our leadership when it comes to transgender initiatives. So can we talk about some of the benefits that like that just exponentially increases when we have leadership that represents the individual communities that we um that we are trying to represent and that we are trying to have a positive impact on walking. Yeah, I think it's about you know there's so much value to being seen but also to what is possible and I think when we we don't have um people to show us these like big visions of what we can be, like what potential exists in us that we don't explore that. And I think that's that's like a beauty of the trans community is that it's a gift to everybody whether you assist or trans or non binary that like there is um like this motivation to explore um this motivation to reach a new potential like Dominique said like I am reaching my full potential my capacity because I am stepping into this world as my full self. Um and so when we see people who own themselves, we it gives us a power like that power is shared, um and we carry that with us. You know, I think there's there's this idea of pride within our community of saying, you know, I um if I'm going to go out with my friends, like, you know, people may look at us, but we're going to look good while they look at us, and we're going to make sure people know who we are, I think again, we're giving people a gift of a possibility, you know, whether that's like, yes, you can wear this, you're allowed to wear this, you're allowed to express these things. Um And I think there's just so much untapped potential um that we are finally starting to break open because people are stepping out into this world, owning who they are, um without compromise without concessions. Um And it's how can you when someone walks down the road or down the street and you're out and you see that person um owning who they are? How can you not stand in awe? Like I want to reach that point. And I think it sparks a fire within us. Um Thinking about the youth, the youth are growing up and there's you know, more youth identifying as trans gender, non binary gender, nonconforming than ever before because they're seen of what's possible and what they're allowed to pursue. Um So I think it's beautiful. I think the trans community again is giving a gift to this world. Um and an exploration, exploration and curiosity. Um and really thinking about um you know what's possible for our own bodies and expression. Mm Especially within this past 10, 15 years. We have seen this like uptick in this renaissance in trans visibility. We know that visibility is really, really important. But we know that it can't stop there. It can't be. I love seeing the amazing women on poles. I love to see um Janet mock and Laverne I love to see Teak Milan, I love to see all this representation. But that visibility is just based in awareness is really, really important. That we that we also give people actual mechanisms that affect their lives. So Karen, can you talk about the importance of that? Yeah. You know um you know recently it was trans international trans day of visibility, right? And I think that's such a I had such an interesting relationship with that day and I think that maybe that will that will kind of answer the question um in my own way. But I think when I when I first heard about like okay trans visibility day or day visibility and like I just visible for who um and for why, um and I think that I have moved into this sense of like we get to like claim that as our own, like we can write, like we get to be visible as trans people, I don't um I think Angelica Ross once said like you may like assume me assist, like I may be sisters soon, but that's not how I actually want to be in the world. Um like I'm very proudly trans um and very proudly would like, like you to know that I'm trans um and I think that that can be in itself different for for many people right? There are some folks for whom, that is simply not what they want, nor is it safe, right, um or something that they would like in their lives. And so I think when we think about visibility, I think it just feels a little more complicated for me um around, like we need to see people out there doing their thing, we need to see these possibility models of trans people um in leadership and trans people and organizations and on tv and in communities, and I like sometimes we just want to exist right? Like I just want to walk down the street and go outside and hang out and like go to work and come home and be tired, like I just want to do that, and then then then that's it, um but I don't I don't always want to be um necessarily visible in ways that that makes me have to be out there all the time. And so I think it's interesting of like, who do we require to be visible and why? Um and what is visibility mean for cis folks, right? Like when why do we need to be visible to you? Or do you need to see me for me to have rights and agency and for me to deserve things? Um so yeah, I think I think that's kind of how I feel about it, I think I'm still working through it to be honest with you, and I kind of have some complicated feelings about it, so I want author you to answer this question because this is a really key question in this conversation, Dominique. I'm going to start with you. Can you talk about the importance of engaging community members in the planning and the design of programming to help meet our needs and our health needs, our wellness needs of our community. Can you talk about the importance of that? Yeah, one quick thing, I think we also need to make sure and recognize that representation is a double edged sword when it's in its greatness in its grandeur. Like we're trying to show people what it can be. But if you're putting people on platforms and you have so many of these leaders of these agencies who are not getting the proper salary, you're not funding their work appropriately, you're making them jump through five million hoops for $5,000. That that also is representation. And it's and it's scaring people and it's creating this idea that not only do we need to do a whole lot of work and lead this movement, you want us to do it from a space of scarcity. And I think that leads into community reflection of that community. It's so essential because we will reach this point where, you know, I come up with an idea of black and pink and I'm super excited about it, right? And I'm like, you know what, it's my job to do this, this and this, But it's so important for me to stop and breathe because what I've seen and what I've known as a person who was incarcerated for 10 years, a person who was using many of these services is that when it's just handed to me, I may take part in it, but it doesn't feel like mine and I really don't care about it. And I've recognized as a leader that if I really care about a project and I want this project to live past Dominique, I need to have community involvement because it's awesome if you're invested in your participating because I'm the E. D. I have no intention of being an easy for the next 10 years of my life. I do have intentions and desires for this project. This thing that I've created from my people to continue to live. And so communities is essential because it's, this isn't christmas, you just don't wrap things in packages and put it on the tree and people should just be happy for it, right. There needs to be engagement autonomy, which can make things feel difficult. But I think the difficulty we're feeling is that we're used to living in these bubbles and making these decisions and and silencing people. And so yes, that community not by in community involvement because community may not buy in, but at least, you know, like community, like, you know what, I we're not really into that. So when you put up the new water fountain or whatever, you're not gagged, you're not shocked that they don't live for it compared to if that's what you want to do, do it. And I often see folks who have not invested in community create something, put something out there, community doesn't see it, like they're not for it. And then that those people, that system will say, oh, this community doesn't want us doing anything, let's back up, let's no longer engage. And and and so so please, if you're going to engage in work with that sort of approach, do the due diligence to ask the people before. So you're not surprised. So you're not disenchanted and so you're not further harming the people that you say you want to serve in a servant leadership perspective? Okay. Yeah, I think I think dominates Exactly right. I think, you know, I have a research background before working with the latino Commissioner AIDS and um working with the latino community, folks live with HIV um and folks who are trans. And I think what we often see is people designing programs made for us um without any of our input and so they bring us these programs and say, okay, now we want to hire you for the rollout or we want to hire you for outreach and we're, you know, we don't have an opportunity to say you're these things were designed with a lot of assumptions about who we are and what we need and now you've wasted time and money and there's so much waste often in some of these programs saying if you would have come to us to begin with or not even come to us if you just fund the programs who are already doing because there's so much translate work trance founded work who have been doing this for years and years and here's a person who is not part of our community saying I have a great idea, I'm going to do this and just hire some trans folks to implement it for me when they're just replicating programs and doing it, you know, halfway through just rather than funding the programs that already exist. So again, there's so much waste. Um hiring people is a huge uh method of supporting our community, you know, employment grants, you access to housing to healthcare to ability. Um and so bring us opportunities for employment by funding the programs that we've already been doing with very few resources. Um if you don't want waste, if you want to see um long term success, if you really want to see our communities thrive, um divert that funding to the translate programs rather than designing programs that you think will work and fall apart very, very quickly. Absolutely. Uh we're going to go into our Q and A. But I want curing to add what to add what is and what's the important about including us in this planning and the design. Yeah, I think, um, it's interesting because I think in the spheres and the and the realms that I'm in, I can say that I've had mostly good experiences with that, right? And I think that when you're in academia or like you're in research, you can hire folks where you can hire folks to be on your projects. You can you can be in this educational pipeline to like access different things to like have that access because you get funded from different federal sources. I find that when we here and talk about community organizations or non profits in a way that's like they're doing very similar work if not the work, right? And like the funding is just so different. Um, right. And there's just so many different ways that these organizations and these individuals who are not only translate, but just like rooted in those communities, right? Like from the ground up everything about it. Um it's just situated in such a better way to provide services and to provide interventions and stuff like that. I I just it's so frustrating it because I don't think that I think that there have been great attempts and I think it does happen. But I don't know if there is actually a great model of researchers just like here, you know what, let's find the funding and like, we can get it because we have this access in this privilege to this like ivory tower. I want you all to do your thing. Um You know, I've seen I've seen it happen in the city um in the city of Detroit. Uh there's a group of wonderful trans women there who work out of different organizations and with different, I'm particularly thinking about one particular person who works at university um where like that they are so tight knit, like every decision that is made about that project and about the funding is collective and they work on this project, like they are hired in in this way and they are like working and getting paid for what they're doing now because I'm not those women, I'm not going to say that that is exactly like going as well as they would like because maybe it's not. But I think like from what I'm seeing like there there are models here that people got to get a little uncomfortable, right? Like if what we're talking about here is just funding and money and just like if you have the resources to allocate that because you know that the system is messed up and maybe you can't change the system, work it, right, leverage it. Um And so I'd like to see a lot more of that because I think when you have us in those positions and when you have us making that work and if we have the funding and we can make great things right, you give funding to Dominique right now right? She can find something that that she can make right and that she can make sure is accessible to many in all folks that she is working for and with right and and who we care about and who all of us care about here on this panel. Um So yeah, I think it's just so important to really invest, I think in our futures and invest in our work because we know what we know what to do, we just do. So I remember for me uh I was I was my podcast got an email from a research team that wanted to that was doing research and surveys about HIV. And they sent us a message because this leads into the first questions of our our Q. And A. So I'm telling that's why I'm telling the story. Um and they sent us a message and in the verb it's about the survey. It was M. S. M. And we were like yo there are we are a trans you you want us for our audience but we are a translated podcast with a trans masculine person to transfeminine people. And you in this language you are not even including trans men in this, who has sex with other men in this research model. And we push back on them. And because of that push back you, whoever designed designed this didn't even think about that aspect. You should have had trans people on the panel who were just deciding this. And because of that push back, that actually changed the survey, which was amazing. And so our first question in our Q. And A is from erin Aaron says I would love to hear more about HIV and STD I health issues uniquely impacting trans masculine folks and how we can help educate communities around them. Um I can go um yeah, I think part of it, you know, is that conflation of gender and sexuality, you know, um I like to tell people I've been every acronym of the L. G. B. T. Q. At some point in my life. So it's like here's here's my experiences. Um and I think what we're seeing more is that, you know, for trans folks, it's often predetermined who were having sex with, you know, um when I when I first um You know, came out as Joaquin, you know, you know, I was dating men, I came out as bisexual when I was 14. Um but people like if you were just going to date men as Joaquin, why didn't you just stay who you were? And I was like, that's not the point. Um I mean, it's just people will say wild things to you. Uh really lots of assumptions. Um and so when we're talking about some of this research, some of the sexual health that were largely left out of the knowledge of like even HIV history, like the legacy of HIV activism has really been granted to um game queer men, you know, and and but we know that's not who had only impacted, we know that, you know, trans women were all involved in the advocacy and in those protests. Um, and, you know, um, I'm blanking on his name, but there's a famous trans man who died from AIDS who, you know, was not often seen as a man, a trans man who who was having sex with men. And he said, you know, you would not say see me as a gay man, but now I'll die as one. You know, this was the early 90s. Um, and so we're not often given, like, again, agency over who are sexual partners are, you know, we see a lot of the T for T relationships, trans trans folks having, you know, relationships with each other. Um, we also don't talk about the implications of hormones in our body. You know, again, when we think about pleasure, we think about um what feels good to us, you know, like I'll be very honest that, you know the way testosterone has impacted my body, I've had a hysterectomy, the way that's impacted my body, condoms don't really feel good for me. But can I really talk about that? Honestly, when I'm going to get an SD I test, you know that, you know, disco V or like like other, you know, there's been lots of clinical trials that like leave transmission out of the research. Um You know, and so different medications were differently for different bodies and they only want to focus on Cis women, you know, and they're lumpiness in with that. And so again, don't have access to research, we don't have access to prevention methods. Um and people don't want to talk about who were having sex with, you know, and what feels good to us and so you know, trans men are having sex with men. Um We're on on the apps you know I see I see my my my community out there um but just like there's there's just so much work to do um and first of it is just again being able to talk about sex, being able to receive testing, you know trying to get an STD test can be really difficult. I've had to you know a woman came in um you know ready to do a swab for something that I did not have, I had to tell her you cannot put that in me because this will not work for my body and it was a very uncomfortable interaction. Um Yeah I think just more honesty about um people were having sex with. Yeah Karen, this is like a part two of that question. There have been a few questions that has been um presented about the turn em sm how can we work to transition out of that language away from that language? Um Uh huh. I get like you can stop using language at any time, right? But I think like what we've used is more of like a science bio kind of like basis for using this language. It's just outdated. Like when you when you learn that language is outdated, you just move on right? There isn't like a um there isn't a pause, right? You're hearing from communities. M. S. M. Is not what we want to hear. We also don't want to see trans folks lumped in. We don't want to see trans women lumped in with that term. We don't want to see trans masculine folks lumped in with just women's health needs, right? Like when folks are telling you that, then you just use more words, right? Like if you're if you're saying um men who are having sex with men, are you talking about gay and bisexual and queer men? Um are you talking about um trans masculine folks who are having sex with cis gender men? You need to be specific, right? Because we need to talk about, like, what he is saying that that has totally different implications for sexual health, right? Um Me being a trans masculine person. I have different um sexual um screening needs, right? Like I should be getting a pap smear and cervical screening testing every three years after the age of 21, right? Um and so like if I were to be lumped in with um for for lack of a better example for with M. S. M. Right? Men who have sex with men, are those things getting missed right? For trans masculine folks who could be who might need other screening. And so it's not just a um it might be an easy way to think about that. Or maybe it does make sense in your mind, like, oh these men are having sex with men, but you are very much missing out on um other folks who have different types of body parts and the history of that word as well as many of us know, has often equated trans women within that term. And so just because you know that, and because you know that trans women have very different health needs than gay or bi or queer cyst men, um we just need to move away from it, like we can we can do that. Um it might make your word count go a little up and that's okay, but you just kind of move away from it. So, Dominique we have a question from J. L what is the best and safest way to advocate for younger patients in a clinical setting in the context of family dynamic that are that might not be gender. Affirming, for instance, a parent who doesn't believe in transmits but a teenager. It's what their teenager is questioning. Um in texas, we can discuss family planning without parents prayers being present. But do you have any recommendations about non family planning discussions about sex and gender? I had the whole approach that I would not position a young person to have to figure out how to let me know they needed additional ally ship or solidarity from me in a situation I was proactive. I would rather put things in place for everyone who would engage when they would come in the clinic and see me. And then those young folks would decline and say, you know what? It's all right if they come in compared to, you know, you got to give me a wink. You gotta give me a nudge for me to then push your mother out. If a young person is over the age of 12 and their and their anything around their sexual health in their bodies, they have complete autonomy. So we really need to be comfortable telling adults no. We need to be comfortable building up spaces where young people are there Stewart and I think I know that sounds easy, but people struggle with it and we always want to do it retroactively and then it feels like it feels like such a heavy lift. Um Do you have a step if you, especially if you're like a youth center clinic, do you have a waiting room for parents or trusted adults? And do you have a space where young people can come before their appointment and they can decide if the parent wants to come? Um when you, when you're filling out the forms, are you giving the forms to the young people? And then if they need assistance, are they leaning into the trusted adult that's with them, Right. Um making sure that you are no matter what your gender identity orientation, when you're introducing yourself, you're setting the playing field. Hi, I'm Dominique my pronouns, are she and her? When you come in, you're the person with the authority in that space and you have the highest potential to shift something with that adult. That's with those young people and you may not shifted for when they're at home, but you'll there'll be a shared understanding of what that's like in clinic. And the other thing I will say is then other folks in your area need to agree that this is our level of care. So parents or trusted adults can't say, well, we don't like how they do it here. We're gonna take our kid here. No, this is how it is everywhere. This is the norm. This is how you engage. And so they take some coalition building. There take some shared understanding that takes some uncomfortable moments. But that's been the most helpful. Do not position young people to have to activate us or beg us to engage in ally ship measures that we know already and then be open and ready and excited for their stewardship through the rest of the process. Mm. Thank you. Thank you. Thank you. There was so many questions because we only have about two minutes. There was so many questions that we didn't get to. Uh, my email is open. If you have questions, you can send them to me, I don't mind. Um, so I like to thank everybody all of our panelists today for participating in our conversation. Thank you Gilead Sciences creating Change and the National LGBT Task Force for organizing this event and creating an opportunity for us to talk about these important issues. Thank you to everyone who has joined us today and as a heads up, you will be receiving a follow up survey. Please complete it because with your feedback, we will it will help Gilead as they continue to plan future programs together. Less works towards ending the HIV epidemic in our communities and thank you for joining us and thank you panelists. Created by