Transwomen’s Healthcare In-Focus: Interview with Brian King of Health & Education Services/PRISM LGBT Community Health (part 2)

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)

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