"Tal Cual" - "as I am" - provide friendly health services for trans population in Dominican Republic
Y. Peña Cabral1, F.B. Santana Taylor2, R. Castillo3, D.E. Benitez Polanco4, L.E. Rivas5
1Centro de Orientacion e Investigacion Integral-COIN, Social Marketing/Youth, Santo Domingo Este, Dominican Republic, 2Centro de Orientacion e Investigación Integral-COIN, Projects, Santo Domingo, Dominican Republic, 3Comite de Trans Trabajadoras Sexuales Dominicanas - COTRAVETD, Coordination, Santo Domingo, Dominican Republic, 4YurWorld - Youth in the Real World, Education, Santo Domingo, Dominican Republic, 5YurWorld - Youth in the Real World, Coordination, Santo Domingo, Dominican Republic
Issues: Transgender persons face multiple social and institutional barriers to competent mental and physical healthcare. High rates of STI's and HIV, an array of special healthcare needs and a set of life challenges that often contribute to substance abuse and detrimental mental health, makes this population central to any discussion on rights-based access to healthcare. With an HIV seroprevalence rate of over 30% (Encuesta Delta 2004) in the Dominican Republic this subpopulation represents a major underserved high risk group.
Description: The “Tal Cual” project has collected basic situational data and offered a healthcare response designed to increase the number of transgender persons accessing services and receiving quality sexual and reproductive healthcare in a safe and supportive environment. It provides training and sensitization for providers through an internship programme where public sector healthcare givers learn culturally appropriate and competent care to transgender individuals.
Next steps: Government authorities are obligated to provide health services to all people including marginalized groups as part of the national commitments made to basic human rights for all citizens. The community based “Tal Cual” programme does not take this responsibility away; it is merely recognizes that the state often does not posses the “know how” to work effectively with these groups.
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- A focus on primary care is less stigmatizing than an approach stressing STI's and HIV.
- Medical management of hormonal therapy is safer, builds self-esteem and improves ARV adherence.
- A youth clinic setting provides a tolerant environment with ample opportunities for diverse youth to learn about each other.
- A mobile clinic with peer health promoters is an excellent outreach strategy for reaching this group.
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