Table 2.
Key Themes and Supporting Quotes
| Credibility in the TGNC community |
| What I love about it is nobody's being forced to do this on staff. This is coming from the heart. It's coming from individuals and it's really building a culturally-competent and medically-competent program. So, it's a very organic process. |
| At the structural level, I think stigma affects health outcomes, as cis-centered and heteronormative policies and practices limit the resources that are available to trans individuals. But looking at how we provide care, and the policies and practices that we have at [the clinic], we try to eliminate those cis-centered, heteronormative policies and try to make it more diverse, inclusive for everybody, regardless of their gender identity. |
| Trust and enculturation |
| I think more than having training, education and concrete solutions about gender-affirming care, I think it's living it, practicing it on a daily basis, and enculturating those practices in our daily activities here at the clinic—in the clinic and outside the clinic. |
| We try to make sure that they have the proper training as well to ensure that they're knowledgeable of this terminology and pronouns and that kind of stuff. |
| Critical role of transgender navigator |
| And we don't just like tell them, “Oh, now you go over there.” We make sure that all of our staff, whether they need to meet with myself or, or I'm taking them to the Health Center to schedule with either or, we make sure we always do warm hand-offs. So, we're always with our clients. We're just trying to create warmth and that saves face and they're not alone. [CHW] |
| So that, I think makes a big difference for them. It's coming in, registering, making them feel comfortable right away, you know, being included in everything, and [navigator] coming to meet with them. I think that's made a huge difference for our patients. One of our key staff in the central registration department is trans, so that's a very welcoming and comforting first encounter with, and then being introduced to [navigator] who helps walk them through everything within the organization to get them connected where they need to be. |
| Sex-positive HIV risk assessment |
| As far as like HIV risk assessment, it would be [asking about] sexual practices. What are the things that they're doing to decrease their risk for HIV? Are they on PrEP? Have they ever been on PEP? If they are living with HIV, what medications are they on? Are they taking the medications on a regular basis? What are the barriers they are experiencing if they don't have really good compliance? So those are some of the things that we have in regards to discussion of HIV care. One of the things, the way that I approach my care for my patients is I always tell my patients that, you know, every part, every aspect of your health is very important and that equals sexual health. So looking at it in a positive manner and having a sex-positive way of asking the questions I think has been very helpful. |
| Impact of ELEVATE |
| When we did our Transgender 101, a lot of the surveys that we saw were our staff really wanted more continuous, reoccurring training because they were confused, or it was just brand new to them. So participating in ELEVATE, we were able to extend some more of that education, as well as I'm currently working on extending that to retail stores that are attached to [the clinic]. And I am working on doing kind of a Transgender 101 specific to them for, you know, like dressing room procedures and stuff like that. So… |
| I heard a lot of people didn't quite understand something before going in, and now have a much, much better understanding. I personally have been to many trans-related trainings over the years, and I found that this was the best training I've been to, and I learned something new. S-O-G-I, and now I know it's S-O-G-I-E with “expression.” And I heard from people in our retail stores that they hadn't quite understood exactly the issue of pronouns. And the Director of that said, “I get it now. I understand the importance of appropriate pronouns,” whereas they hadn't quite grasped that before. |
COO, chief operating officer; LDM, learning development manager; SOGI, sexual orientation/gender identity; TGNC, transgender and gender nonconforming.