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About Us

Our Purpose 

The purpose of the Transgender Response Team (TRT) is to launch and sustain a linked framework of culturally competent, evidence-based HIV prevention services for transgender communities and individuals in the state of Maryland.
 
 
 
 
The TRT will accomplish this work by focusing on efforts that:
  • reduce the stigma and oppression that fuel risk and risk-taking behavior;
  • facilitate power-sharing between consumers and providers, and;
  • promote solution-based dialogues and actions.
The TRT was convened by the Infectious Disease and Environmental Health Administration (IDEHA -previously called the Maryland AIDS Administration) in response to input received at the Transgender Health Forums held during the summer of 2007. The forums revealed a common desire among transgender consumers, health and human services providers, and other stakeholders for the creation of a stable venue to engage in activities to tackle the many barriers transgender Marylanders face to full and equal inclusion in society, which collectively contribute to heightened risk for HIV for transgender people.
 
Membership in the Transgender Response Team is open to local members of transgender communities, their allies, service providers, and others interested in improving the health of transgender Marylanders.
 
The Transgender Response Team is asked to:
  • identify and engage in opportunities to create structural/environmental change that contribute to reducing and/or eliminating HIV/STD and other health risks for transgender consumers.
  • consider analyses of available data and how to apply it to the design and improvement of programs serving transgender consumers.
  • assist in identifying and engaging partners outside of the traditional circle of HIV/AIDS prevention and care services, who can help move efforts forward to attain equal access and cultural competency in services for transgender consumers.
  • advise Infectious Disease and Environmental Health Administration (IDEHA) Center for HIV Prevention staff, and other members of the TRT, by identifying gaps in transgender health and human services and suggesting solutions.
  • provide information about local projects such that other participants can make informed service referrals of transgender consumers into these projects.
  • assist in raising the visibility of transgender communities, their needs and assets, to stakeholders in positions to contribute to positive change for transgender consumers.
  • assist in raising the visibility of local projects represented on the TRT.
  • identify and engage in advocacy efforts intended to support civil rights protections for transgender consumers.
  • offer feedback on new programmatic initiatives designed to improve the health of transgender consumers.
  • identify and overcome barriers to the realization of a linked framework of local health and human services for transgender Marylanders.

About Structural Interventions

Why do structural interventions belong in the HIV prevention toolkit?

HIV risk behavior—including injection drug and other substance use, and sex—occurs in a context of multiple, sometimes competing, influences. One major genre of tools in the HIV prevention toolkit is behavioral interventions. Behavioral HIV prevention interventions focus on individuals’ behavioral factors such as knowledge, risk perception, and skills (such as communication skills and mechanical skills.) Members of communities at risk of acquiring HIV need a solid foundation of knowledge, risk perception, and skills to avoid infection. However, HIV risk does not occur in isolation. Rather, HIV risk behavior occurs in a larger social and environmental context that wields a significant role in decision making, sometimes trumping the individuals’ own intentions and better judgment. Therefore, HIV prevention efforts must also consider the context in which HIV risk behavior occurs.
 
Environmental influences on behavior include socioeconomic status—which impacts the quality and stability of one’s housing/shelter, access to medical care, food, education, and employment—and the overall structure of privilege and oppression in our society. Environmental influences can raise HIV transmission risks in external and obvious ways, such as when a commercial sex worker can earn a higher wage for offering barrier-free sex than for protected sex, or when oppression prevents a member of an oppressed group from completing their education and becoming competitive in a credentialed workforce.
 
Environmental influences such as oppression may raise HIV transmission risks in more subtle ways, such as when a member of an oppressed group believes the negative message given to them from the dominant culture that they are worth less than members of the privileged group. Prevailing norms of ignorance and hostility to oppressed groups can produce significant trauma, isolation, and poor mental health outcomes among members of oppressed communities. They may lack the resources to acquire mental health services that—if culturally competent and not further stigmatizing—might assist them in overcoming trauma. In the absence of these resources, members of oppressed groups may use substances to “cope” with anxiety and depression. For those predisposed to addiction, this coping response may produce a disastrous new set of problems. Like mental health services, substance abuse treatment may be cost prohibitive and/or culturally incompetent. Under the influence, people are less likely to follow through with HIV risk reduction commitments they may have for themselves. By recruiting members of oppressed groups to the belief that they have less value, environmental oppression leads to HIV risk behavior.
 
Structural interventions seek to reduce HIV risk behavior by changing the environment in which it occurs. If individuals are stably housed, they are less vulnerable and less likely to need to engage in illegal activity to meet their basic needs. In this way, working to expand the availability of low-income housing is an HIV prevention intervention. If communities are given access to education, they gain opportunity to access employment. Therefore, efforts to ensure safe schools legislation is passed, operationalized, and enforced, can be described as an HIV prevention intervention.

(See the document posted below: HIV Prevention at the Structural Level: Defining Structural Change, from the Children's Hospital of Los Angeles, Center for Strengthening Youth Prevention Paradigms, 2013.)
 

An example of a structural intervention

In 1994, the Maryland General Assembly exempted Baltimore City from components of the statewide paraphernalia law which prohibits the possession of drug injection equipment. The AIDS Administration funds the Baltimore City Health Department’s syringe exchange project, which changed the environment for injection drug users. The project makes clean needles accessible to IDU as well as removes the legal risk to them of carrying them. The number of new cases of HIV in Baltimore City attributed to the sharing of dirty injection drug needles has fallen consistently since the needle exchange van project began.
 
Source: The Maryland 2005 HIV/AIDS Annual Report,  pg. 44.

TRT Major Accomplishments, 2007 - 2010

  • Developed and submitted recommendations to the Greater Baltimore HIV Health Services Planning Council that are medically-relevant and intended to improve cultural competency in services to transgender consumers.
  • Approved and disseminated the first transgender-specific HIV prevention brochure used in Maryland.
  • Influenced decision to fund and implement first transgender youth-specific HIV prevention program in Maryland.
  • Provided support crucial to the successful transition of the adult transgender HIV prevention program after the closure of HERO; ongoing support in maintaining and expanding these services.
  • Developed a sustainable collaboration between government and community stakeholders from a wide variety of sectors to inform, enrich, and promote culturally competent HIV prevention services for transgender communities in Maryland.
  • Served as a key influencer in obtaining from DHMH a Letter of Support for the transgender anti-discrimination bill introduced in the 2010 session of the Maryland General Assembly.
  • Worked effectively with Baltimore City Health department to support expansion of Needle Exchange services to transgender consumers, including provision of IM syringes for hormone injections.
  • Conducted community-building through planning and delivery of three consecutive Transgender Day of Remembrance events (2008 – 2010) in Maryland; expanded the 2010 event to provide more educational and support activities to transgender and allied participants, and to provide greater visibility and understanding of the community.
  • Created an educational tool for HIV Counselors on the importance of asking the 2-part sex and gender questions, to ensure that transgender persons are reflected accurately in data collection.
  • Created and maintained a safe networking space for transgender consumers to participate in effectively addressing community-wide needs; a venue that is directly connected with decision makers and is separate from spaces used for personal or community support.
  • Provided technical assistance and networking support of emerging transgender leaders in building new service-based networks and Community Based Organizations.
  • Ongoing commitment to serving as experts who provide access to community experience, needs, culture, and research opportunities to new HIV prevention efforts directed at transgender communities. 
 
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Jean-Michel Brevelle,
Apr 7, 2013, 9:39 AM