We Can’t End HIV Epidemic
Without Gender-Affirming Care
BY DOUG WIRTH & ZIL GOLDSTEIN
Across the country, people of transgender experience
are facing alarming attacks that undermine
their right to live full, authentic lives.
Arkansas recently became the fi rst state in the
nation to ban gender-affi rming health care for
young people. Such laws that codify discrimination
have a devastating impact on the health
of the transgender community and on efforts
to end HIV.
A recent fi nding shows that transgender
women are 49 times more likely to be living
with HIV compared with the general population,
and a CDC analysis confi rmed that both
transgender women and men are disproportionately
affected by HIV. When compared with
non-transgender people, New Yorkers of trans
experience living with HIV are more likely to
delay care and HIV treatment.
These disparities are in large part due to the
barriers transgender people face at every turn,
including in employment, housing, education,
and health care. Many transgender patients
report having to educate their medical providers
about transgender health issues, including
awareness about post-operative care. They are
routinely denied coverage for procedures by insurance
and are often refused treatment due
to their gender identity. And nearly one-third
report having been harassed in a doctor’s offi ce.
As a result, transgender people are more likely
to avoid health care altogether.
As we celebrate Pride Month, we must recognize
the importance of access to life-changing,
gender-affi rming care. Not only does
gender-affi rming care improve mental health,
it also engages people in the full continuum
of care, including primary care and sexual
health services that help prevent new HIV infections.
Studies have shown that gender-affi rming
surgery among transgender people living with
HIV is associated with achieving viral suppression
— meaning the amount of HIV in a person’s
blood is so low that it is virtually impossible
to transmit the virus to others. Conversely,
a recent study found that unmet surgical needs
and being unable to access hormone therapy
are associated with HIV treatment interruptions
among transgender people.
Thanks to Governor Cuomo and the New
York State Department of Health, New York is
leading the nation in the dual efforts to End
the HIV/AIDS Epidemic and advance access to
gender-affi rming care. Amida Care is New York
State’s largest Medicaid Special Needs Health
Plan designed for individuals affected by HIV.
To date, the health plan has helped more than
Doug Wirth is the president and CEO of Amida Care.
1,100 transgender members access gender-affi
rming surgery. Of Amida Care’s transgender
members living with HIV, 93% are virally suppressed.
Amida Care also assists transgender
members who are HIV negative with accessing
highly effective HIV prevention tools like preexposure
prophylaxis (PrEP). Every trans member
is surrounded by an integrated care team
of providers, social workers, health navigators,
behavioral health specialists, and a designated
health home, which work together to address
the needs of the whole person.
In health care settings, ensuring that people
of transgender experience feel supported
means being ready to answer the questions
they have about how to get the best health
care. It means always being ready to help
someone get hormones or surgery safely and
without throwing up roadblocks. Callen-Lorde
Community Health Center provides sensitive,
quality health care and services targeted to
New York’s LGBTQ communities regardless
of ability to pay. Accessing gender-affi rming
care is the best way to help a transgender
person be healthy. It’s not a question of incentivizing
HIV treatment and prevention,
but making sure people live in bodies that
they want to care for. Callen-Lorde ensures
all their medical providers are ready to have
informed conversations with their transgender
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patients, and offers extra supports to help
people overcome the constant transphobia
they experience.
This is the type of creativity that’s needed if
we’re going to ultimately end the HIV epidemic
in New York. We’re fortunate to be among the
minority of states in the nation that mandates
Medicaid to cover transition-related care. But
mandating coverage is the fl oor — adequate
funding is needed to fully support plans like
Amida Care and community-based organizations
like Callen-Lorde, which are doing the onthe
ground work to help New Yorkers as they
transition.
Amida Care and Callen-Lorde are ahead
of the curve, but we can’t do this alone. We’re
calling on the New York State Department of
Health to create a comprehensive plan within
Medicaid to address and adequately fund gender
affi rming care, which will help support the
transgender community so that they may live
their best lives and we can realize a healthier
New York together.
Doug Wirth is the president and CEO of Amida
Care, New York’s largest Medicaid Special
Needs Health Plan designed for people affected
by HIV.
Zil Goldstein, FNP-BC, AAHIVS is the associate
medical director for TGNB Care at Callen-
Lorde Community Health Center
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