Gender-Affirming Care in Puerto Rico

Improving Care for LGBTQ+ Communities

Advances in HIV diagnosis, treatment, and prevention promise to dramatically alter the course of HIV for individuals and communities and make ending the epidemic of HIV in the U.S. a reality. PCDC is committed to creating a future where every person has the opportunity to be as healthy as they can be, and no one’s access to health care is limited due to their social circumstances or gender identity. To advance health equity, PCDC builds the capacity of governmental health agencies, federally-qualified health centers, behavioral health providers and others to provide culturally-affirming care in diverse communities.

Since 2019, PCDC has received funding from the Centers for Disease Control and Prevention (CDC) to improve HIV care through the High Impact Prevention (HIP) in Health Care program, reaching over 1,000 clinical providers and agencies with best practices to increase engagement in care among LGBTQ+ patients. Building on its experience as a CDC grantee, PCDC has worked with diverse providers to improve care for LGBTQ+ patients.

Recently, PCDC led a community of practice focusing on gender-affirming care in Puerto Rico, working in partnership with local health care providers and the territorial health department. A community of practice is a group of people who share a concern or a passion for something, and who want to work together to learn how to do it better. As part of this work in Puerto Rico, PCDC partnered with the trailblazing Latina transgender activist Queen Victoria Ortega to convene an in-person learning discussion with members of the local San Juan transgender community, health care providers and health agency leaders. Facilitated entirely in Spanish, the conversation focused on building trust, creating affirming and safe spaces for transgender patients, and increasing awareness and education about PrEP and other HIV prevention strategies. Opening up this local dialogue for the first time strengthened providers’ commitment to sustaining this work. After the event, several agencies requested continued support from PCDC to facilitate conversations with their clinical and administrative teams about gender-affirming care.

PCDC provides training and technical assistance to help all primary care providers offer gender-affirming care to transgender, gender nonconforming, and non-binary populations. Gender-affirming care includes a range of social, psychological, behavioral, and medical interventions to support and affirm a person’s gender identity. People who identify as transgender are more likely to forego medical care than people who identify as straight. Nearly one in three transgender patients report having a negative encounter with a health care provider in the prior year.3 Gender-affirming care can help keep people engaged in care. It also empowers people who are most at risk of HIV to get tested and access prevention services, like PrEP (pre-exposure prophylaxis).

Clinical providers interested in offering gender-affirming care can begin by assessing their team for acceptance, knowledge, and educational needs, then provide training and staff development on topics such as inclusive language, gender expression, hormonal therapy, sexual health, and gender-affirming surgery. PCDC goes beyond foundational information about gender terminology to include training and coaching on clinical interventions, community partnerships and local resources. By encouraging providers to look beyond the walls of their clinic, PCDC emphasizes the whole health of each unique individual and helps break down anti-LGBTQ+ stigma.

“PCDC works to understand the local context before providing any type of technical assistance. We interview people working and living in the community. What are the local policies? How do people interact with each other? Who are the key players? To be successful, we need to know who are the trusted voices in the community so we can facilitate conversations as part of our work,” says HIP Project Director Oscar Marquez.

PCDC helps providers adopt and operationalize more inclusive policies. Providers often have questions, such as:

  • How do you ask LGBTQ+ patients about their sexual history – and when is it appropriate to do so?
  • How can intake forms include more gender-inclusive language?
  • What can providers do to promote health services specific to transgender individuals?

Fostering dialogue and working to build trust among providers and community members is an important part of PCDC’s approach to learning and quality improvement. This is especially true as providers work to make their own clinics more gender-affirming and inclusive.