Question

Cristina is a 28 year old woman who identifies herself as Latina, of Puerto Rican descent, raised on the West Side and currently lives with her grandmother at Elliot House in Chelsea. At intake she reveals that she is transgender and has been living as female since she graduated from high school but her parents could not accept her gender transition so she left home and has been living with her grandmother ever since. She works full time as a clerk at a local dollar store but the pay is very minimal and she tells you she needs money to complete her transition so she started doing sex work.

She came in today because when she went to a free mobile clinic in the Bronx , where she often sees her clients, to get condoms and a rapid HIV test, she did a screening for blood pressure and diabetes and her blood pressure was 160/90 and she was told she was pre-diabetic. She is very anxious about her health but has never had a regular PCP because she was afraid of insensitivity to her gender status. She is also anxious taking medications that might interfere with her transition or impact upon her appearance.   She reveals that she is often depressed, when she worries about her future and now even more so now that she might have diabetes and because of her past experiences, she sometimes has nightmares. She came to your health center because some friends told her it was a good place for the LGBT community.

1. What are the challenges and potential barriers to engaging and maintaining this patient in care?

2. What kind of screenings and assessment should be done and what is the best way to engage her in that process?

3. How do you handle her concerns about treatment?

4. What would be the most effective preventive and treatment plan/approach for her care?

Answer 1

What are the challenges and potential barriers to engaging and maintaining this patient in care?

The transgender community is one of the most marginalized segments of the society. From childhood onwards, they are facing discrimination. So as a medical professional, I might face the following potential challenges and potential barriers to engaging and maintaining this patient in care

1. It is very difficult to get their trust as they might be skeptic in all interventions

2. Other patients or staffs can discriminate her and it will make her more unsecured

3. She might not be cooperative in treatment plans

What kind of screenings and assessment should be done and what is the best way to engage her in that process?

We have to respect her personality before doing any procedures and ask get her consent before doing any interventions. A psychosocial assessment by a qualified mental health professional should be done. Proper health education should be given. Screen her for any sort of sexually transmitted diseases and NCD’s. Proper nutritional plan will be made. Always monitor for suicide ideations or thoughts

How do you handle her concerns about treatment?

I always gives priority to her opinions. Will give her proper health education and counselling and always listens her and will identify her problem. I will never consider her as a patient. I will consider her as a human being. Will motivate her to think about a good future. I will always provide psychological support. Will help her in all legal procedures for the surgery if she needs

What would be the most effective preventive and treatment plan/approach for her care?

Awareness of the general public and medical professionals are the first step in the treatment plan. It is important that providers must be aware of this population and the challenges and discrimination faced by them. Always consider her as a human being.

Treatment plan includes

1. Awareness on sexually transmitted diseases and preventive methods

2. Counselling

3. Mental health assessment and care

4. Diet plan

5. Relaxation techniques

6. Behavioral therapy

7. Hormonal therapy & Surgery as per her wish ( will arrange)