Op-Ed: We Can’t End HIV Epidemic Without Gender-Affirming Care

LGBTQ Health Leader Warns Expanded HIV Care Needed Now
Amida Care president and CEO Doug Wirth
Donna Aceto

Across the country, people of transgender experience are facing alarming attacks that undermine their right to live full, authentic lives. Arkansas recently became the first state in the nation to ban gender-affirming 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 finding shows that transgender women are 49 times more likely to be living with HIV compared with the general population, and a CDC analysis confirmed 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.

Zil Goldstein is associate medical director for TGNB Care at Callen-Lorde Community Health Center.

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 office. 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-affirming care. Not only does gender-affirming 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-affirming 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-affirming 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 1,100 transgender members access gender-affirming 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 pre-exposure 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-affirming 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 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 floor — adequate funding is needed to fully support plans like Amida Care and community-based organizations like Callen-Lorde, which are doing the on-the-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-affirming 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