As well as being a health and human rights activist, a fantastic speaker, and the program manager for the Thai Red Cross AIDS research centre, Rena also established a successful and unique regional transgender led sexual health centre called the Tangerine Clinic. Rena clearly has a passion equally for HIV care and presented an initiative through her clinic to provide PrEP to TGW unable to access limited free PrEP in Bangkok and its regional areas. As the incidence of HIV amongst TGW remains significantly higher at an estimated 12% (compared with a background incidence of 1% in Thailand) the ability to cater for this at risk group remains an important public health HIV challenge. Furthermore, additional barriers exist impairing this group readily accessing PrEP in the forms of discrimination and previous negative experiences of health care interactions, co-existent amphetamine like substance use and concerns about the interactions of PrEP and feminising hormone treatment (FHT). The use of a specific transgender clinic such as Tangerine Clinic in Bangkok allowed this service to have a wider reach as did lower cost subsidized therapy; despite their being virtually no difference in uptake of PrEP based on free versus low cost fee-based basis, there were disappointing levels of decay in the return of users with only around a third of users returning at 6 months.
I took away quite a few things from this session. It was clear that TGW (and by extension other sub populations of people living with HIV) need tailored or at the very least non-threatening and inclusive clinical services in order to maximise engagement and empowerment for tackling their health needs, including but not limited to HIV. Providing a “one-stop-shop” including FHT as part of routine sexual health screening / PrEP provision significantly improved retention of PrEP users in another study presented at the conference. In Australia this is within the realms of the experienced transgender-sensitive (although I feel as a progressive democracy we should all carry this label) general practitioner to provide, usually with support from TG sensitive endocrinologists or other specialists. I am lucky to be part of a vibrant transgender clinical network who have regular meetings and online clinical support. I was also pleased to find supportive studies presented at the conference showing that there was no significant interaction in gender affirming hormone therapy and PrEP, information I will be keen to reassure my trans-patients with.
Author bio: I am a small clinic owner in private GP practice and am passionate about providing the best care for all our patients; to this end we have developed a focus on immunology and infectious diseases and I am an S100 prescriber. We eradicated all known cases of HCV in our practice last year and proactively advertise testing for this. I am a member of the Perth S100 HIV and viral hepatitis networks as our clinic are regular attendees at the Perth Transgender network meetings. I remain invested in our future colleagues as a clinical lecturer at two Perth-based medical schools, having taught or hosted in clinic 10-20 students per year, and also as a part time employee with WAGPET where I am a regional medical educator for Perth Inner Metro and Fremantle. I was also fortunate enough to be honored to be awarded the 2019 WA GP of the year.
