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Transgender Patients Find Safe Haven at Bronx Family Practice

By Patrick Wall | July 30, 2012 1:31pm

LONGWOOD — With close-cropped hair, a few arm tattoos and an easy smile, Q resembles many other young men his age — which suits him well, except when he has to visit a gynecologist.

Q, who is 26 and lives in Co-op City, was born female but has been transitioning into a man over the past several years.

In March, when Q arrived at a doctor’s office for a scheduled pelvic exam, the staff were so visibly rattled by his male identity that Q fled the clinic.

“They should be a little more compassionate,” Q said recently. “You see an old lady walk in with something wrong with her, you’re not going to look at her any different. So why would you look at us different?”

The experience reminded Q why he prefers Community Healthcare Network's Bronx Health Center at 975 Westchester Ave.

That center and another location that the nonprofit network operates in Jamaica, Queens, have incorporated a program for transgender patients into their family clinics — an arrangement that the network says is the only one of its kind in the city.

The approach appears to be working.

This month, Dr. Luis Freddy Molano and Renato Barucco, who manages the Bronx transgender program, presented findings at the International AIDS Conference in Washington, D.C. showing that patients in the program tend to stay HIV-negative and engage in fewer risky behaviors.

“First of all, you create a sense of community where transgender folks feel welcome,” Barucco said Friday at the clinic at 975 Westchester Avenue. “Then you treat them medically.”

From 2007 to 2011, the prevalence of HIV among program participants dropped from 44 to 38 percent, and only one patient out of nearly 700 went from testing negative to positive for the virus.

An in-depth evaluation of 30 participants found they had decreased risky behaviors such as sex work and unregulated hormone injections, and had increased regular condom use.

The Transgender Family Program, which began at the South Bronx clinic in 2004 and was added to the Queens center in 2011, provides transgender patients with primary care, HIV treatment and hormone therapy, along with counseling and help with practical matters, such as how to change their name legally. The family clinics also host popular support groups that discuss a range of transgender health issues, from sexual safety to silicone injections.

Offering transgender services at family health centers prevents patients who want to pass as their chosen gender from having to visit gay and lesbian-focused clinics, which effectively outs them as transgender, said Barucco.

It also keeps spares them from the embarrassment of winding up at other health practices that are unprepared, or even unwilling, to serve transgender patients.

Barucco said that doctors who are unaccustomed to transgender patients can use the wrong pronouns, or insist on discussing patients’ gender identities even if their medical issues are unrelated.

He recalled one instance when male police officers chuckled as a physician asked a transgender woman who had been raped when she had her last period, spurring the victim to leave the hospital without an exam or HIV test.

“I could spend the whole morning telling you horror stories,” said Barucco, adding that many healthcare providers are well-intentioned but ill-equipped when it comes to treating transgender patients.

HIV prevention, whether through testing or peer-led discussions, is a major component of the transgender program.

Transgender people, especially those who are black or Hispanic, have some of the nation’s highest rates of new HIV infections.

While the percentage of HIV-positive patients in the transgender program has declined since 2007, more than a third of the participants are infected with the virus.

“It looks like the 80s all over again,” Barucco said Friday, scowling at an Excel spreadsheet where he tracks patient test results.

Still, testing and treatment for HIV is more widespread now than it was in the past, Barucco noted — an advancement he hopes will carry over to transgender health services.

“We need to get a point where all health centers will be able to provide trans care, like a lot of health centers are now able to provide HIV care,” he said. “It was not the same thing 10 years ago.”