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In part 3 of our interview with Brian King of HES/Prism/NETA in Beverly, MA we learned about compartmentalizing behavior and how to help oneself be more integrated.  Here in part 4, our final post, we’re talking with Brian King about how the deep need for affirmation by transgender women can sometimes drive them to take risks they might not otherwise engage in.   We’ll also talk a bit about how transgender women can stay safe and conclude our interview with Brian.

Beck’s Café: Brian, we’ve talked about risk behaviors and some of what motivates those behaviors that harm people’s health. And we’ve also talked about peer groups and how those help people to make wise choices and to stay healthy.  Does affirmation (or lack of affirmation) of who we are also play a role in a trans-persons behavior and potentially be a cause of risky sexual behavior?

HES: Well, it’s important for your readers to know that sexual activity is not risky in and of itself. However, affirmation is indeed an important issue and particularly for those who have had some sort of history or abuse for whom they are.  Let’s take a look at something simple like using a condom.

Becki, on the surface of it, using a condom should be a no brainer. But for some, stopping the physical romantic moment is something they won’t do.  Not because they don’t understand the potential risk, but because it would ruin the chance for being affirmed for whom they are as a trans-woman.  The trans-woman doesn’t bring it up so that the opportunity for being accepted is not ruined.  When you are in the moment what is more important? The affirmation or taking care of one’s own health.  For many, the affirmation comes first, not the health.  Sex addiction may also play a part in this, but that addiction is really a symptom of something deeper driving that person.  If you are having multiple partners it’s helpful to examine your behavior in your context: Are you someone who is single, having fun exploring sex; protecting yourself in the midst of that, having conversations with your partners; having fun?  Or is your context more about: sleeping with multiple partners; not using a condom; the physical interactions are emotionless; sex feels meaningless and you keep wondering why are you doing this over and over again?

Beck’s Café: I can see how affirmation is pretty important now.  Brian, what steps should a transgender person take to protect themselves should they decide to be sexually active?

HES: I try not to use the word “should” because contexts are always different and that’s your best determiner of behavior.  So, is a trans-person in a long term relationship and they have trust over 6 months that you are monogamous?  A barrier like a condom might not make sense, if you truly don’t have a risk.  You are both in a safe monogamous relationship then.

Another example; someone is in a relationship that they thought was going to be forever but, did it last a week or a month?  Did the other person betray or hurt you?  How long should you wait till you build trust with the new person your are with?  You need communicate together about yourselves and about your sexual health.  One out of two people who have HIV don’t know their status.

Some people choose to use oral condoms for oral sex.  Oral sex is very low risk for HIV it’s more likely for STD’s and they are alot easier to get than HIV. Gonorrhea of the throat and syphilis of in the mouth are risks with unprotected oral sex.  Many times you don’t have symptoms but you can still pass along these other STD’s!

HES recommends getting your STD screenings once or twice a year.  Just make it a normal activity, around your birthday.  When you don’t know that you have an STD and you are not displaying any symptoms, that’s when very serious damage to your personal health and to others can happen.  But many STD’s can be cured with simple anti-biotics if is caught early.

Normalize this, it doesn’t make you dirty because it is not, you are just taking care of your own health.  80% of women over 35 have HPV, human papillomavirus, for example!!! It’s that common.  I get my STD tests on a normal basis; don’t fear being stigmatized.   At least get tested for the most common STDs: gonorrhea, chlamydia, syphilis, and HIV. A general STD test should include testing every place on your body where your sex happens.  If you give oral sex make sure your throat is swabbed.  If you have anal sex, make sure your behind is swabbed.   A urine test for genitals.   A blood test for syphilis.  And we offer a simple rapid HIV test with a finer prick that gives you your result 10 minutes.

Beck’s Café: And it’s really easy; even I got tested when the HES Van came to a Friends of Randolph Country Club Party (FoRCC) at RCC in Randolph one night and I was completely healthy!

HES: Terrific Becki!

Beck’s Café: Brian, any last thoughts here as we finish up this wonderful conversation and pot of coffee here at Beck’s Care?

HES: Yes, NETA and HES would love to hear from the transgender community!  We want to offer our services and be a resource.  It’s important for the transgender community to tell us how to help them, what their needs are, and how they are being met or not being met.  What is working and what is not working? We really want to fill in the gap on health care for transgender people, and complement and collaborate with the services that already exist.

Beck’s Café: Thanks so much Brian for visiting with us.

HES: My pleasure Becki and thanks for the coffee!

In part 2 of our interview series with Brian King of HES/PRISM/NETA in Beverly, MA.  We learned how HES became interested in transwomen’s health and the importance of peer support. Today we’ll be talking with Brian about how people in the LGBT community can sometimes compartmentalize their behavior, what that means, and how  to help yourself.

Beck’s Café: Brian, we’ve covered a lot of ground in our conversation, and one area I wanted to ask is about how transgender people compartmentalize their behaviors, particularly risky sexual behaviors.  You’ve said that you’ve seen this with other populations that HES has worked with.  Can you help our readers understand this phenomenon better? Is it healthy?

HES:  What we’ve observed in working with gay and bi-men  is exactly that, compartmentalization.  They say they have sex with men and yet do not identify as gay or bisexual.  They may also been in relationships with women.  I can understand not wanting to be labeled.   Many times they see being identified as gay as taking on gay flamboyant stereotypes or what gets sensationalized in the popular press.  But when a person completely splits into two separate identities, they often don’t want to acknowledge that the other side exists.   And sometimes, it’s like what they say about Vegas.   If I don’t talk about it, it didn’t happen, and therefore I don’t have to think about the risks I took last night.  That was someone else.

Our experience working with transgender people is the same: Compartmentalizing risky behaviors, splitting your personality in a sense. The general rule of thumb however is that integration of a person is the healthiest way to live.  Compartmentalization brings about a certain lack of internal authenticity regardless of the outward presentation to the world.  That lack of internal authenticity can catch up with a person and affect them or affect their behavior. Organizations like NETA and TCNE can be a big help allowing trans-people to be who they are.   Many times though, people feel they can’t integrate who they are now as the pain of staying in the closet is less than the perceived risk of coming out and integrating ones self within a helpful peer community.   Those risks can be very real.

Someone might have a lot to lose by “coming out.”    So providing a safe space where transgender people can be validated and respected for who they are, and find community, is a top priority

(tomorrow, In part 4, we’ll be talk with Brian about the connection between the need for affirmation and risky actions)

In part 1 of our interview series with Brian King of HES/PRISM/NETA in Beverly, MA.  We introduced Brian King and the organizations he works with HES, PRISM and NETA.   We also talked a bit with Brian about Hepatitis and transwomen.  Today we’ll touch on how HES became interested in transwomen’s health and the importance of peer support.

Beck’s Café: Brian, how did HES get connected to the Transgender part of the LGBTIQA community?  There doesn’t seem to be an obvious link since our population is relatively small.

HES: Great question Becki, but the simple answer is we were moved by compassion to reach out and offer our services more widely to the community.  HES’s Gay and Bi Men’s program geographically targets the areas of Essex County, Massachusetts North Shore and Merrimack Valley.  We’ve done a great deal of outreach and community building over the past 15 years by educating the people who are the leaders and influencers in various communities.  We found that educating the leaders in a given community in turn influences so many others in that community.  As it turned out, the more leaders and influencers we touched the more we came into touch with the transgender community.  We found a lot of these communities overlapped; so much so we’ve actually formed a new umbrella group called PRISM that takes into account the various needs of the groups.  We have representatives from the entire LGBTIQA community actually which creates a strong network of support and service provision.

Becki, another interesting point is how this information travels back upstream to our funders.  HES is a non-profit and our data helps the various public and private funding agencies to see what the real needs are in the greater community and all the positive effects their funding has.  Interestingly, the state of Massachusetts itself has red flagged the transgender community for HIV study and health support.  The state of Massachusetts sees there is potential risk in the community largely due to the social stigma transgender people face, and the lack of access to accurate information about HIV, STD and important health prevention and treatment services.

Beck’s Café: So Brian, did HES and the state flag the transgender community because they felt the health risks were similar to those in the gay or lesbian community?

HES: There is some overlap for sure and some distinctly different health issues too. One of the key similar issues is that of the “minority stress” concept and its effect on risk behavior.  Basically, minority stress is the concept that societal norms like prejudice against LGBT people create an atmosphere where stress happens.  Any person who is part of a stigmatized minority is going to have increased levels of stress and that can result in symptoms similar to PTSD.  If you’ve heard regular negative comments directed at you, been stigmatized in your peer group, job or community, or have experienced religious oppression, these can all lead to this minority stress concept.

Becki, the risk results of this minority stress concept is reflected in how people behave.   Symptoms such as avoidance, homeless, depression, anxiety, low self-esteem, sexually risky behavior, and drug and alcohol use can make it more difficult for people to make healthy decisions around maintaining appropriate boundaries, such as dealing with confrontation and stress vs. one’s own needs.  Many times, the minority are afraid of being stigmatized again so they might agree to another person’s harmful influence out of a false hope of safety or escape.  People tend to make decisions based on what their historical experience has been.  If you are afraid of being attacked again, having experienced it once, you behave differently in similar future situations in order to avoid being attacked again.

One thing we’ve learned about those who are risk and experiencing minority stress is that social support is a BIG HELP.  When someone is isolated and being stigmatized they are less able to resist engaging in potentially harmful behaviors.; having a relationship with friends brings you safety.   There is clear evidence to show that strong community support is the leading factor in the reduction of minority stress and the related PTSD symptoms that occur.  The opposite of the stigma we talked about is pride and a sense of community.  Greater Boston has a very strong community.

(tomorrow, In part 3, we’ll be chatting with Brian about compartmentalizing behavior and if that’s healthy or harmful)

We’re starting a series of conversations here this week at Beck’s Cafe with Brian King of Health and Education Services (HES) of Beverly, MA.  HES is the sponsor organization for the North East Transwomens Alliance (NETA) and for PRISM Health, a network of programs within Health & Education Services, Inc. committed to providing competent services for the LGBT community on the North Shore and Merrimack Valley.  Brian is the Director of HIV Prevention & Education at HES’s and the Executive Sponsor for the Gay & Bi Men’s Health Program, PRISM Health and NETA

If you were at First Event 2010 chances are you were accosted by some of the members of NETA/HES in their zeal to survey as many attendees as possible.  NETA and HES have a single mission with their organization: “dedicated to the health and well-being of transgender women living in New England.” Sounds like a pretty good mission to us here at Beck’s Café.  In fact HES has been in the business of helping people stay healthy for some time now and “provides a wide range of community based mental health and substance abuse, prevention and addiction services to Massachusetts’ Greater North Shore and Lower Merrimack Valley residents.”

Beck’s Café: Brian, thanks for taking the time to meet with us.  Let’s start with an easy question, what’s the traditional mission for HES?

HES: Well it’s great to finally have a chance to chat Becki!  HES tries to provide comprehensive services for people that are underserved such as: the homeless, those who are traumatized, people facing social stigma that isolates them, those caught in substance abuse, HIV prevention services, STD prevention and treatment services.  Our feeling was that by having one location and all the services under one umbrella, it made it possible for the people we are targeting to more easily access the services they need and this creates a more seamless continuity of support.

Beck’s Café: So it’s easier to receive medical help in one area then kind of drive across town to the next one.  It just makes life easier for people, is that the idea?

HES: Exactly. This helps to keep the door open for those needing services. It reduces the stress and barriers of health care for people by reducing barriers like travel or having to coordinate among multiple service providers.  Many people at risk face so much stress even a simple barrier like travel can derail them from getting important health care or other critical services.

For example, something like Hepatitis A or B is easily treatable and preventable, and yet, barriers stop people from either getting healthy or staying healthy.  Hepatitis A isn’t necessarily contracted from sex with a partner but instead from food such as eating poorly prepared sushi or contaminated food or drinking infected water; HES provides vaccines for Hepatitis A.  Not being treated for it can be a major health problem.  Hepatitis B can be contracted from anal, vaginal or oral sex and is the most common, serious liver infection in the world.  In fact, Hepatitis B is 100 times more contagious than HIV.  The good news is that it can be easily avoided  by way of safe vaccines which HES can provide. Also being vaccinated protects the liver and this is especially important if a trans-woman is going to start hormone replacement therapy (HRT).  A trans-woman’s liver has to be healthy for her to process the estrogen she’s taking.  IF you are on HRT hepatitis A & B vaccines could be very important!

(Tomorrow, we’ll be chatting with Brian about how HES got interested in transwomen’s health)