How our Transgender Program has Innovated in the wake of COVID

The history of Pride is a complex and layered history, one with many starting points, but a famous origin point often cited is that of the Stonewall Uprising, which centered a Black transgender woman, Marsha P. Johnson. At Boston Health Care for the Homeless Program, we have been diligent about ensuring that our high-quality care is accessible to all people, including members of the LGBTQIA+ community who are overrepresented among the population experiencing homelessness.

In 2008, after conducting a community needs assessment which indicated strong support for this effort, we started our Transgender Program, under the tutelage of BHCHP nurse Pam Klein. The program serves transgender people who need primary care, urgent care, mental health care, crisis intervention, HIV counseling and testing, case management, a weekly support group (open to anyone who is transgender-identified even if they are not our primary care patient), and connection to legal services.

With the continued global health crisis induced by the spread of the COVID-19 pandemic, health care has looked a little different. We spoke to Pam Klein recently about the ways the support group has had to be nimble during this period of physical distancing and of the innovation in our program. For example, Chastity Bowick, one of Pam’s colleagues and a strong advocate for the transgender community, coordinated with About Fresh to donate 30 boxes of fresh fruit and vegetables biweekly, specifically for transgender people. “They prepare the boxes , and then we pick them up and distribute them to patients we know who can’t afford or access fresh food right now.”

As for the support group: “We went virtual” she says. Pam says that the support group, like most things in this new normal, has had its ups and downs - moments of success and moments of growth. “We’ve had some folks who haven’t been attending in person be able to attend, so that’s been good. The technical difficulties have been hard for some people, but I think it’s essential that we’ve been able to offer it.”

Pam says that forming the group has spurred the creation of a private online space for patients, where the support group facilitators will post post information that they used to only distribute in person. So information about online events, relevant media, and other things will be available to all of our Transgender Team patients and support group members. “People will have to be invited into the space, of course,” she says, “but I don’t think we would have ever thought of it if we hadn’t been innovating in other ways to get people together while we all have to be apart.”

The online space of the support group provides a different kind of intimacy. For housed patients, it provides a platform for them to share their living space with their peers. Pam says that, for patients, being in their own spaces has actually made some people more comfortable. “There’s something about being in your own environment that allows people to be more vulnerable,” she says. People are a little more relaxed and enjoy the feeling of being able to invite others into their space. For those who are not housed, it can be challenging to find a private spot to log in but some patients have figured out how to manage it.

Telehealth visits have also been a positive innovation during this time as has medication delivery from the pharmacy. “That’s been huge,” says Pam, “Transgender patients don’t always like taking public transit, where they can be abused or harassed or worse. They’re always steeling themselves for ridicule, so being able to get care via video and not have to come to the pharmacy for medications has actually been mood-lifting for some, and it’s something we want to continue to do, even after the worst of the pandemic ends.”

When asked about the need for the transgender support group, passion creeps into Pam’s voice, “People enjoy a space where they feel completely at ease and accepted and know that nobody is judging them or looking askance. They feel comfortable and safe and supported and they deserve to feel that way. Until society is completely void of all judgment and unkindness, until there’s no more stigma/discrimination, I think that space is going to be important. Even if all that discrimination went away tomorrow, for older folks who have a whole lifetime behind them of poor treatment and trauma, I think they would still need this kind of support. For the next generation, there may not be as much of a need for it, but we will continue to have this space for as long as there is discrimination.”

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