The Tangerine Clinic Integrated Healthcare Services for Transgender

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The Tangerine Clinic: Integrated Healthcare Services for Transgender People Reshmie Ramautarsing, M. D. ,

The Tangerine Clinic: Integrated Healthcare Services for Transgender People Reshmie Ramautarsing, M. D. , Ph. D. PREVENTION | Thai Red Cross AIDS Research Centre reshmie@prevention-trcarc. org Mexico City, 22 July 2019

Disclosures • Gilead: travel support, speakers fees • Alere: speakers fees

Disclosures • Gilead: travel support, speakers fees • Alere: speakers fees

Thailand’s new HIV infections by route of transmission Needle sharing 1, 314 (5%) 160,

Thailand’s new HIV infections by route of transmission Needle sharing 1, 314 (5%) 160, 000 140, 000 Male-male sex 14, 700 (53%) 120, 000 Est. 29, 626 new HIV+ 100, 000 Casual sex 2, 396 (8%) 80, 000 Spousal 60, 000 Sex work 7, 226 (26%) 2, 245 (8%) 2015 -2019 40, 000 0 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 20, 000 Sex Work Spousal Casual sex Male-male sex Needle sharing

Transgender Women in Thailand: Population Size Estimation and HIV

Transgender Women in Thailand: Population Size Estimation and HIV

Stigma and Discrimination in Healthcare Settings ** ** * Sources: *Thai Transgender Alliance and

Stigma and Discrimination in Healthcare Settings ** ** * Sources: *Thai Transgender Alliance and Transgender Europe, 2015 ** Report of a pilot: Developing Tools and Methods to Measure HIV-related Stigma and Discrimination in Health Care Settings in Thailand and; the HIV Stigma and Discrimination Survey Guidelines and Procedures Manual, International Health Policy Program, National AIDS Management Center (NAMC) Thailand, Ministry of Public Health (November 2014).

The 1 st National Trans Community Consultation The Dialogue: Trans Communities and Health Provider

The 1 st National Trans Community Consultation The Dialogue: Trans Communities and Health Provider (September 17, 2015)

Tangerine Community Health Clinic: Transgender-led, hormone-integrated sexual health clinic

Tangerine Community Health Clinic: Transgender-led, hormone-integrated sexual health clinic

The Comprehensive Health Service Package for Transgender Women HORMONE SERVICES SEXUAL HEALTH SERVICES •

The Comprehensive Health Service Package for Transgender Women HORMONE SERVICES SEXUAL HEALTH SERVICES • HIV testing, syphilis testing • Counseling on gender transition • Hormone prescription • Hormone level monitoring • Condom and lubricant • Anal and neovaginal Pap smears • High Resolution Anoscopy and Neovaginoscopy • Pr. EP and PEP • Same-day ARV treatment, CD 4 count and viral load testing • STI treatment • Vaccination for hepatitis A, B and HPV WELL-BEING SERVICES • • Mental health support and referrals Referrals for gender affirming surgery Referrals for legal services Botox & skin care

Tangerine’s Performance (November 2015 – April 2019)

Tangerine’s Performance (November 2015 – April 2019)

TGW Client Characteristics

TGW Client Characteristics

Male sexual partners of TGW

Male sexual partners of TGW

Male sexual partners of TGW: 21 couples

Male sexual partners of TGW: 21 couples

Sexual and Gender-Based Violence (SGBV) among transgender clients at Tangerine Clinic

Sexual and Gender-Based Violence (SGBV) among transgender clients at Tangerine Clinic

Keys to Success

Keys to Success

The Tangerine Academy • The technical assistance platform for the development and sharing of

The Tangerine Academy • The technical assistance platform for the development and sharing of tools and learning resources to support further roll-out of HIV and health service models for transgender people. The Academy’s Three Schemes

Conclusions and challenges ahead • Trans-led, integrated services works • Low Pr. EP uptake

Conclusions and challenges ahead • Trans-led, integrated services works • Low Pr. EP uptake • Limited reach to subgroups: young TGW, TGW sex workers • Inadequate psychosocial support and mental health counseling • Hormone services not supported under UHC • Drivers of HIV-epidemic in TGW clients

Acknowledgements

Acknowledgements