December 2, 2010
JoAnne Keatley: Providing Transgender Resources and Combating Prejudice
by Cristina Gonzalez
As a Latina and a transgender person, JoAnne Keatley has spent much of her life trying to fight bias and discrimination and give voice to her community. Now Keatley is the director of the Center of Excellence for Transgender Health at the University of California, San Francisco, where she works to create and expand positive and accessible health care services for the transgender community. Here Keatley tells POZ.com what drives and inspires her, and what she hopes for in the future.
Why did you start working in the field of transgender studies?
I am a transgender person. I was aware of the stigma and the lack of culturally competent quality services available for trans people. In fact, I was acutely aware of the bias that comes with providing care for the transgender community. I really felt that I could make a difference if I prepared myself academically to first of all look at what the issues were and secondly, come up with strategies for how to address them, [including] trans health care and psychosocial service needs. In addition, I wanted to raise awareness about the way HIV was impacting transgender populations and how the health care system was not responding to this community of people who needed services designed specifically for them. It was a combination of my being in graduate school, being involved in HIV work and seeing firsthand how trans people were not being integrated into service settings.
You’re currently the director of the Center of Excellence (CoE) for Transgender Health at the University of California at San Francisco. How was the center founded?
In 2007, the State of California could no longer ignore the public health crisis that was occurring with transgender populations. It was clear from the epidemiological reports that transgender people were being disproportionately impacted by HIV and there was a pent-up demand to address these issues. The State of California convened a community interest group, and a number of ideas were tossed around. In this process, we kept hearing over and over again that there was no central repository of information on how to reach and engage and provide services for transgender people. After a thorough research, we laid out to the state where the service systems were, where the gaps were, and how to close them. I recommended to the state that they make funding available for a center of excellence for transgender HIV prevention.
What is the mission of the CoE?
In 2007, when the center was founded, there was a strong focus on HIV prevention and care. But in 2009 the State of California went into the red and there was no money for HIV prevention programs. Shortly thereafter, we were awarded a grant from the Centers for Disease Control (CDC). Our focus is on providing technical assistance, tools and best practices for physicians and other health care service providers so they can best treat transgender people—and that’s not limited to HIV care.
What are some CoE programs?
The CDC funds two CoE programs. The first is CATCH: Coalitions in Action for Transgender Community Health. This is a community mobilization program that focuses on coalition building to expand community networks and increase the use of prevention services.
The second program is called Transitions. [This] program adapts and tailors evidence-based interventions for agencies that are interested in reaching transgender people. The CoE is focused on increasing the number of knowledgeable and sensitive HIV prevention programs for transgender people.
We’ve also spent a lot of time working with a medical advisory board on developing primary care protocols for doctors. When those practices are finalized, physicians will be able to complete coursework and receive CME [Continuing Medical Education] certification.
What would you say is the major issue facing the transgender community today?
One of the primary issues is a lack of inclusion [of transgender information] in the medical school curriculum, so physicians are not initially provided with the appropriate information on how to treat transgender people. Physicians interested in working with the community really struggle to find information on how to care for people who need it and [how to] provide that care without unintentionally causing harm—by not knowing what to prescribe [or not understanding] hormones and other drug interactions. There currently isn’t one central place where [health care providers] can go to access unbiased analysis of practices for delivering transgender health care services. A lot of the information that is shared is anecdotal, not university based, and physicians are reluctant to accept anecdotal information. There are a lot of ethical considerations [such as providing] off-label use of hormones, getting “creative” with insurance documents to avoid denial of reimbursement, [and being] creative with diagnosis. We’re trying to address this.
What particular problems do transgender people of color face?
As a Latina, I feel that trans people of color, in addition to being medically underserved, are also disproportionately affected by the lack of resources such as access to employment, insurance, housing, drug treatment and education. We need to address these kinds of ethnic and cultural needs. It’s so sad that so many trans people of color struggle on a daily basis to find any kind of services, much less primary care.
What do you hope to see for the transgender community in the future?
I’d like to see the elimination of the exclusion of transgender medical care from health insurance policies. I’d love for those exclusions to be gone. I’d like for transgender care to become a routine part of primary care. I’d love for there to be knowledge made available for physicians, and for their services to be adequately reimbursed. Routine care can often be denied for trans persons. Gender markers, especially in these days of managed care, limit access to certain “gender based” care, such as pelvic exams for trans men. I’d like to see a medical diagnosis created that would address transgender care in lieu of the gender identity disorder (GID) diagnosis, which I think does a disservice to the community. I do dream of a day where there is no trans bias.
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