Table 1.

Connections Between Themes, Interview Data, Clinic Procedures, and Recommendations for Optimal Health Care Services for Transgender Women

Theme	Interview Data	Clinic Procedures	Recommendations
Identity issues and tensions with gay male communities	“I identify myself as a woman. See myself as a woman.”	Clinic personnel used preferred gender identity with corresponding pronoun. TW are encouraged to identify their preferred gender category, including woman. Clinic personnel treat TW patients with respect, thus encouraging word-of-mouth recruitment of TW to clinic. Well-trained health care personnel ensure that the clinic is viewed as a safe place by TW patients. The clinic is open to all rather than specifying a focus on care for LGBT individuals.	Clinics should reach out specifically to transgender individuals and must be sensitive to various TW identities, including TW not identifying with any part of the LGBT umbrella term Word of mouth can be systematically used to increase use of community-based health clinics by TW. Staff and providers working in community-based clinics need to be continually trained and updated on issues relating to transgender health.
	“I don’t consider myself gay or transgender.”
Transgender-friendly services	“They’re interested in knowing what’s going on with you. They show concern, whereas in some places you go to it’s like—‘Okay, this is what you’re here for, let’s do it, let’s get it done, that’s that.”’	Clinic personnel were accepting of and compassionate with TW at the clinic.	Services should include HIV counseling and testing, HIV treatment, hormone therapy, and psychosocial services (e.g., violence prevention, assistance with employment, housing, and immigration).
Holistic approach to the provision of HIV prevention and primary care	“It was like, you would have to go to so many different places to get what you need to keep yourself up, but with a place like here—you’re one-stop-shop.”	Clinic personnel provide health and social services under one roof.	Community-based clinics should consider offering a range of health care and social services to TW.
	“They [other TW] feel that the HIV meds would mess with the hormones, and by them being transgender, they want the hormones to work okay.”	Clinic personnel made access to female hormones a priority, even for HIV-infected clients	Providers who serve HIV-infected TW need to take into account the psychosocial and safety needs of continuing with hormone therapy and attempt to combine hormone therapy with antiretroviral therapy when advisable.

NOTE: LGBT = lesbian, gay, bisexual, and transgender; TW = transgender women.