The term “transgender” has entered into the lexicon of mainstream America and people are finally taking notice. Transgender is an umbrella term which encompasses several distinct identities (gender; not sexuality). This notice is long overdue and in some cases, still terribly misguided. Last year has been a violent and tumultuous one with more than 22 killings of transgender women #SayHerName . This same violence, inequality, and discrimination become the determinants of health for many transgender and gender non-conforming people. Exclusion from a safe existence is not merely an anecdote but an actual barrier to health care. Health disparities continue to mount. And much like mainstream America, we in the health care field have been slow to address the concerns of the transgender community.

By now, hopefully, you’ve had a moment to sift through the 2015 STD Treatment Guidelines published by the CDC. The 2015 guidelines provide major updates on PrEP, gonorrhea, HCV, and expedited partner therapy, and include a new Special Populations section for Transgender Men and Women. For NCSD, this new section is a subtle but striking update. The 2015 CDC STD Treatment Guidelines are the first to be released with a specific focus on Transgender people, and we want to highlight this step forward in access to STD prevention and treatment services for everyone.

We salute our colleagues at CDC for recognizing the sexual health needs of transgender people in the section dedicated to highlighting key groups with the goal of health equity. Simultaneously, we have to wonder why it has taken so long to address transgender people and their unique sexual health needs. The transgender-inclusive guidelines provide us with an updated launch pad in addressing STD treatment options. The guidelines recommend clinicians assess STD-related risks based on current anatomy and sexual behaviors.

The National Transgender Center for Equality (NTCE) has diligently championed full human rights for transgender and non-conforming persons since its 2003 inception. NTCE’s Transgender Sexual and Reproductive: Unmet Needs and Barriers to Care document equips service providers with a blueprint for improved health results. If the 2015 STD Guidelines were paired with NTCE’s recommendations, this would be major.

RECOMMENDATIONS TO IMPROVE TRANSGENDER SEXUAL AND REPRODUCTIVE HEALTH CARE

• Follow accepted medical guidelines. Sexual and reproductive health providers should become familiar with clinical guidelines and recommendations for transgender people from the American Congress of Obstetricians and Gynecologists (ACOG) and the World Professional Association for Transgender Health (WPATH).¹
• Adopt policies of respect and nondiscrimination. Providers should also adopt a formal policy of nondiscrimination and respect for each patient’s gender identity. One approach is to develop a clinic guide for transgender-inclusive services, as some providers have done.²
• Train staff on cultural competence and nondiscrimination. Clinics should train providers and staff on transgender-appropriate care, nondiscrimination, and inclusivity. The Fenway Institute and the Joint Commission have created materials to support staff training on transgender and LGBT competence.³
• Incorporate transgender inclusion in grant guidelines. The U.S. Department of Health and Human Services should revise program guidelines for Title X family planning grants to prohibit discrimination on the basis of gender identity and sexual orientation and to address the cultural and clinical needs of transgender patients.
• Report discrimination. Federal law prohibits gender-based discrimination by health care providers that accept any form of federal funding. Patients and their advocates should assert their right to receive treatment free from discrimination by filing complaints of discrimination with appropriate authorities.
• Eliminate public policies that require sterilizing procedures for trans people. Policies requiring transgender people to undergo sex reassignment surgery before changing their gender marker on government documents violates their reproductive rights and frequently amounts to forced sterilization. Federal, state, and local agencies should update policies to permit gender marker changes without requiring proof of surgery or other invasive medical procedures.

We must look beyond our silos. Transgender folks face a barrage of concerns beyond STDs that impacts their sexual health. Housing and job discrimination are chief among them on that list of barriers to care. Providers without knowledge and cultural competency further add to the burden.

The grave health disparities of transgender persons have not dissipated just because the CDC included them in the Guidelines. The last Guidelines, released in 2010, gave a sliver of space to a large swath of people greatly affected by STDs, by including transgender women (male-to-female) to the MSM section in previous guidelines. This move to designate a section of the STD Treatment Guidelines to provide comprehensive sexual health care for transgender people is long-overdue, but a step forward in increased access to STD prevention and care for everyone.

1 ACOG Committee Op. No. 512: Health Care for Transgender Individuals, 118 OBSTETRICS & GYNECOLOGY 1454 (2011); World Professional Association for Transgender Health, Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (7th ed. 2011), http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1351&pk_association_webpage=3926.
2 Planned Parenthood of the Southern Finger Lakes, Inc., Providing Transgender Inclusive Healthcare Services (2006),http://www.plannedparenthood.org/ppsfl/files/Southern%20Finger%20Lakes/Providing_Transgender_Inclusive_Healthcare_Handbook.pdf
3 Fenway Health, http://www.fenwayhealth.org/site/PageServer?pagename=FCHC_abt_about_home; Joint Commission, Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community: A Field Guide (2011), http://www.lgbthealtheducation.org/wp-content/uploads/13-017_TransBestPracticesforFrontlineStaff_v6_02-19-13_FINAL.pdf.