Clued Up A Clinic Familiarisation Intervention for Trans

Clued Up A Clinic Familiarisation Intervention for Trans People Nick Douglas, LGBT HIP Coordinator

Overview LGBT Health and Inclusion Project The intervention Evaluation Results Conclusions and implications New initiatives

Background LGBT Health and Inclusion Project (LGBT HIP) Evidence of need (Hounsfield, 2007, Browne 2008) Aims: Enable trans people learn about clinic services and use the clinic independently in future Provide an opportunity for the clinic to consult with trans people Intervention preparation Contact with the clinic Briefing about LGBT HIP Trans awareness training

Intervention and evaluation Intervention – two hour session Recruitment Food/introductions/ground rules Clinic tour – Q&As Consultation role-play Cancer prevention quiz Brief discussion Evaluation Staff training evaluation forms (=32) Participant pre and post intervention surveys (pre=15, post = 17) One-hour staff team interview (2 sexual health advisors, 1 health trainer)

Results Demographics Changes in Knowledge Attitudes Intended behaviour Training, information and services Qualitative feedback

Demographics

Knowledge Statement: I don’t know enough about how to avoid getting sexually transmitted infections 10 10 8 6 4 2 0 10 3 2 15 10 5 3 0 Neither Pre Disagree/Strongly disagree Post 14 10 10 2 0 5 Strongly agree/Agree Neither Pre Post 4 Strongly agree/Agree 8 3 0 3 3 Disagree/Strongly disagree 0 Neither Pre Statement: I would know how to get seen at the local sexual health clinic if I thought I needed to 0 17 20 4 Strongly agree/Agree 15 Statement: I don’t really understand what services a sexual health clinic provides Post Disagree/Strongly disagree

Attitudes and beliefs Statement: I think sexual health services have a good understanding of trans people’s sex lives and sexual practices 10 5 1 3 5 7 9 7 0 Strongly agree/Agree Neither Pre Disagree/Strongly disagree Post Statement: I do not generally feel comfortable about visiting a sexual health clinic 8 7 5 8 6 3 4 2 0 Strongly agree/Agree Neither Pre Disagree/Strongly disagree Post

Intended behaviour I am nervous about discussing sexual health issues with medical professionals Statement: I feel confident to talk about sexual health issues with sexual partner(s) 9 10 8 6 4 2 0 6 6 13 15 6 10 3 2 1 0 Neither Pre Disagree/Strongly disagree Strongly agree/Agree Post 6 5 5 6 3 4 2 Strongly agree/Agree Neither Pre Strongly disagree/Disagree Post Neither Pre Statement: I don’t feel confident about getting sexual partner(s) to have only safer 8 sex 0 3 5 Strongly agree/Agree 8 6 10 Disagree/Strongly disagree Post Do you intend to visit a sexual health clinic in the next six months? 9 10 8 6 4 2 0 7 5 5 3 Definitely/Probably not/Definitely not Pre Post Don’t know 3

Training and information

Services provided

What participants said… Staff training Communication - pronouns Privacy and confidentiality Gender presentation and perceptions Clinic processes and procedures Forms and administration “How useful is it to ask if I am a man or a woman? What they actually want to know is what my genitals are. So why not ask? This is a sexual health clinic. That might seem a bit of an abrupt question, but it’s going be a question that’s gonna come up later. And for me, I find that I’d rather they ask that than if they ask if I’m a man or a woman because that’s not really what somebody’s asking. ”

What the staff said… Staff trans awareness training essential Structure of the session – timing Having a range of staff involved Skilled and knowledgeable facilitation Following up and capitalising on the opportunity Understanding trans people’s experiences and struggles “I don’t think that I’d maybe fully appreciated people’s vulnerability, you know in the community, you know outside of the clinic and what people have faced and what they’ve been through. I think also from my own perspective I will be less hung up about trying to get the words right and just being, you know, up front, honest and asking if I don’t know something, asking them, asking that person. Rather than worrying so much about getting it wrong. ”

Conclusions Proof of concept – it can be done Too small numbers for strong conclusions but potential for gains in raising awareness about clinic services and increasing confidence in respectful, culturally competent treatment Gains less clear on intended behavioural outcomes Trans people want reassurance of staff training and more information in places accessible to them Also important to examine impact for staff We need this to be replicated elsewhere – promising intervention.

Getting it wrong, Getting it right “I saw this guy doing his gynae rotation who was clearly mortified to be dealing with me and he was bright purple the whole time and he kept talking about ‘um, down there’. . [I thought] if you say ‘front bottom’ I’m going to smack you!” “Once I went in I said I’m a trans guy, this is my situation, there was a sensitivity with the staff. . . Just the sensitivity and also the willingness to say: am I getting this right, have I, you know, is this an OK way to approach this? And it’s not necessarily knowing all the answers it’s being willing to ask for guidance and to say I’m not too sure of my ground, please bear with me. That I found really much more helpful to deal with than someone who doesn’t know and doesn’t care. ”

New Initiatives: Clinic T Pilot Lawson Unit, Claude Nicol Clinic, Brighton Every three months By appointment Full range of sexual health services LGBT HIP volunteers ‘greeters’

New Initiatives: THT Guides www. tht. org. uk/sexual-health/Resources/Publications/Transmen-Trans-Health-Matters www. tht. org. uk/sexual-health/Resources/Publications/Trans-Women-Trans-Health-Matters

Acknowledgements Many thanks to: Jonathan Roberts, Jules Davies, Claude Nicol Centre, Brighton Clare Mc. Ewan, Sussex Community NHS Trust Michelle Ross, Terrence Higgins Trust Phil Seddon, NHS Sussex LGBT Health and Inclusion Project Consortium Bridie Phillips, LGBT HIP Volunteer Ben Castle, LGBT HIP Volunteer Contact: nicolas. douglas@tht. org. uk www. lgbt-hip. org