Honoring Our Native Transgender Communities

1. Honoring Our Native Transgender Communities

2. Native Americans/Alaska NativesUnited States • In 2000, US Census – NA/AN make up 1.5 % of total US population – over 3 million people • In CA, over 100 tribes – Federal & State Recognized • 40% living in rural/reservation areas; 60% living in urban areas (Los Angeles County)

3. Two Spirit term refers to Native American/Alaska Native Lesbian, Gay, Bisexual, Transgender (LGBT) individuals Came from the Anishinabe language. Has a different meaning in different communities. Encompassing term used is “Two Spirit” adopted in 1990 at the 3rd International Native Gay & Lesbian Gathering in Winnipeg, Canada. It means having both feminine and masculine spirits within one person. The term is used in rural and urban communities to describe the re-claiming of their traditional identity and roles. The term refers to culturally prescribed spiritual and social roles; however, the term is not applicable to all tribes and some transgender individuals We’wha Two Spirit – Native LBGT

4. Tribal Language &Two Spirit Terminology

5. LGBT/Two Spirit Umbrella Transgender Lesbian Gay Bisexual TwoSpirit A woman whose enduring physical, romantic, emotional and/or spiritual attraction is to other women. A term for people whose gender identity and/or gender expression differs from the sex they were assigned at birth. An individual who is physically, romantically, emotionally and/or spiritually attracted to men and women A man whose enduring physical, romantic, emotional and/or spiritual attraction is to other men A contemporary term used to identify Native American Lesbian, Gay, Bisexual, Transgender individuals with traditional and cultural understandings of gender roles and identity.

6. Spirituality and Culture • “Alternative gender roles were respected and honored and believed to part of the sacred web of life and society.” • Lakota view: Winktes are sacred people whose androgynous nature is an inborn character trait or the result of a vision. • Example: Lakota Naming Ceremony • For many tribes, myths revealed that two-spirit individuals were decreed to exist by deities or were among the pantheon of gods.” • Example: Navajo Creation Story – The Separation of Sexes

7. Prominent figures • We’wha (Zuni) circa 1849-1896 • Hastiin Klah (Diné) 1867-1937 • Osh Tisch (Crow) 1854-1929 • Woman Chief (Crow) circa early 19th century -1854 • Lozen (Chiricahua Apache) 1840 – 1890

8. We’wha (Zuni) circa 1849-1896 Zuni spiritual leader Performed sacred roles in ceremonial dances

9. Hastiin Klah (Diné) 1867 - 1937 celebrated weaver and a sand painter

10. Osh-Tisch (Crow) 1854 - 1929 “Finds Them and Kills Them”

11. Woman Chief (Crow) 1854 - ? Gros Ventre Indian “Married” a woman

12. Lozen (Apache) 1840 - 1890 Skilled warrior Fought beside Geronimo

13. European Colonization Spanish invader Vasco Nuñez de Balboa (1475-1519) presiding over the massacre of "sodomites" in Central America, Engraving by Theodore De Bry.

14. Boarding Schools – 1870s

15. Boarding Schools • Army officer, Richard Pratt, founded the first of these schools. He based it on an education program he had developed in an Indian prison. • "A great general has said that the only good Indian is a dead one, in a sense, I agree with the sentiment, but only in this: that all the Indian there is in the race should be dead. Kill the Indian in him, and save the man." • Students at federal boarding schools were forbidden to express their culture — everything from wearing long hair to speaking even a single Indian word.

16. "I remember coming home and my grandma asked me to talk Indian to her and I said, ‘Grandma, I don't understand you’. She said, 'Then who are you?' “1945 - Bill Wright, a Pattwin Indian

17. Relocation Program – 1950s • 1952, the federal government initiated the Urban Indian Relocation Program • Jobs, education, housing, vocational training

18. Historical Trauma • Cumulative emotional and psychological wounding over the lifespan and across generations • Confront the historical trauma • Understanding the trauma • Release the pain of historical trauma • Transcend the trauma

19. Complete Wellness forNative Americans/Alaskan Natives • Spirituality is important aspect of Native way of life – everything is connected – body, mind and spirit. • Living in balance is essential – harmony and balance through traditional prayer, songs, ceremonies. • Traditional medicine is used to cure illness and disease – with herbs in ceremonial settings – often on the reservation or rural communities. • Traditional medicine can be used with Western medicine to develop a holistic wellness of their body, mind, and spirit.

20. Transgender Data • There are no concrete statistics on the number of transgender people in the United States. • Estimates on the number of transsexual people, which ignore the broader transgender population, range anywhere from 0.25 to 1 percent of the U.S. population. • Additional research on Native Transgender population is needed with accurate and inclusive HIV/AIDS statistics. • Inclusion of Native Transgender in research and data is imperative! (even if the population is considered small).

21. Epidemiology of HIV among Transgender Individuals • An Epidemiological Profile of HIV & AIDS 2009 Los Angeles County: Transgender individuals are estimated to have the highest HIV seroprevalence rate with 21% of the priority populations in LA County in 2005. Specifically, Native Transgenders represent 2.9% of the cases which is higher within the populations. • San Francisco Department of Public Health Study – A Snapshot of Discrimination: In 1997, the San Francisco Department of Public Health surveyed 392 MTF and 123 FTM transgender people that included specifically Native Americans with 6% being Native MTF and 3% being Native FTM.

22. AIDS Project Los Angeles (APLA) Funded by Office of AIDS Programs and Policy, Los Angeles County Funded by the Department of Disability, City of Los Angeles, AIDS Coordinator’s Office

23. An Overview • Red Circle Project (RCP) was created in August 2003 at APLA by an initial a grant from the U.S. Conference of Mayors. • RCP is the only HIV Prevention Program in Los Angeles County that specifically targets Native American /Alaska Native Community. • Goal of the project is to increase positive social norms around safer sex and emphasize its benefits as well as the importance of early screening for HIV – referrals for testing. • Project provides education and prevention information to Native community at outreach events such as Powwows, etc.

24. Developing and Implementing Support Group Workshops • Currently, adapting Community PROMISE intervention for urban Native Two Spirit/Gay Men and Native Transgenders. • The “Strengthening the Circle” Curriculum has four (4) workshops that address behavioral and cultural issues. The workshops are designed with the concept of Native American/Alaska Native’s understanding of the “Medicine Wheel.” The Medicine Wheel is a symbol of knowledge that enables individuals to live in balance with all aspects of life – physical, mental, emotion, and spiritual. • The workshops will also encourage participants to make informed decisions that will guide their subsequent behavior.

25. www.redcircleproject.org • The RCP website provides pertinent information about HIV/AIDS for individuals and service providers in Los Angeles. • It also lists local organizations and agencies that provide services for Native organizations locally and nationally.

26. Challenges of Programs • Stigma about HIV in the community still exists, however more education and outreach efforts are providing valuable information. • Continued collaboration is needed between agencies – Native and non-Native. • No specific geographical areas of Urban NA/AN exists (ie. neighborhoods, bars, etc.) and providing services is a challenge. • Misclassification of clients is an issue among providers. • Additional research and accurate information on HIV/AIDS statistics is needed. • Additional funding is still needed for additional services and resources.

27. Questions & Answers Please feel free to ask questions and/or comments . . .

28. May the Creator Always Guide and Protect You as You Walk In Beauty . . . Ahe’hee (Thank you) The Red Circle Project AIDS Project Los Angeles (APLA) 3550 Wilshire Blvd. Ste. # 300 Los Angeles, CA 90010 Elton Naswood, Program Coordinator P: 323.329.9905 E: enaswood@apla.org Michelle Enfield, Prevention Specialist P: 323.329.9906 E: menfield@apla.org

29. Data among the Transgender Community: Working with Native Transgender Individuals Global Village July 23, 2012 Washington, DC

30. Injustice at Every turn • National Gay and Lesbian Task Force and National Center for Transgender Equality • Almost 6500 participants in the Survey • Guam, District of Columbia, US virgin Islands, and Puerto Rico

31. Injustice at Every turn • Dramatic Findings • Discrimination • Poverty – 10,000 or less than the general population • Suicide – 41% have thought of attempted suicide, • This not including individuals who followed through. • Compared to 1.6% of the general population

32. Injustice at Every turn • Experienced Bullying in School • 51% have experienced • 15% left school K-12 • This also including teachers Boarding Schools?/Public Schools/Rural/Urban • Lost a job due to bias • 55% of participants • Tribal employment? • Victim of physical Assault • 61% of participants • Victim of Sexual Assault • 64% of participants

33. Injustice at Every turn • Housing Discrimination • Native Americans were the highest statistics • 47% of participants • Respondents who have experienced homelessness were highly vulnerable to mistreatment in public settings, police • abuse and negative health outcomes.

34. Injustice at Every turn • Public Accomodations • 53% of participants • denied equal treatment by government agencies or officials PoliceInteraction 22% of participants Tribal Police? Family 43% still had some sort of connection 57% have experienced Rejection

35. Injustice at every turn Health Care Denied HealthCare – 19% Indian Health Services Reservation Rural Urban • High HIV rates: Respondents reported over four times the national average of HIV infection. • 50 % had to educate their healthcare provider

36. Honoring our Native TG Woman • Native American Transgender Population • General Historical Trauma • Reservation settings/Urban settings • Migration of Native Transgender Population • Alaska? Hawaii? Global?

37. Resiliency • We are still here • Working • School • Family • Acceptance

38. Basic Concepts: • Sex (assigned at birth) • Sexual Orientation • Gender Identity • Gender Expression

39. Data Collection - EMR • Electronic Medical Records – how data is being collected • Committee formed to address companies that provide EMR

40. How to be an awesome Ally & Provider! • What is your sex or current gender? (Check all that apply)⃤ Male⃤ Female⃤ TransMale/Transman⃤ TransFemale/Transwoman⃤ Genderqueer⃤ Additional Category (Please Specify): ______________⃤ Decline to State • What sex were you assigned at birth?⃤ Male⃤ Female⃤ Decline to State Center of Excellence for Transgender Health

41. Things to remember: • Paperwork/documents • Policies/procedures • Laws • Data • Safety – physical, mental, emotional, spiritual • Client centered

42. Services and Referrals • Center of Excellence for Transgender Health, UCSF, www.transhealth.edu • National Center for Transgender Equality, www.transequality.org • Injustice at Every turn • Statewide Transgender Organizations • TGRCNM, New Mexico • Local Transgender Organizations • Los Angeles, San Francisco, Chicago, New York, Phoenix, Atlanta, etc.

43. Thank you • Mattee Jim • Supervisor HIV Prevention Programs, First Nations Community HealthSource, 5608 Zuni Rd., Albuquerque, NM 87108 – (505)262-6554 mattee.jim@fnch.org • National Advisory Board Member, Center of Excellence for Transgender Health, UCSF • Board Member, Transgender Resource Center of New Mexico • Co-Chair, New Mexico Community Planning and Action Group Transgender Task Force • Community Advisory Board Member, Share Action, AIDS Project Los Angeles

44. BASIC PRINCIPLES Transgender HIV Health Services Best Practices Guidelines

45. Developing a Transgender Culturally Competent Environment • Creating a welcoming, culturally competent, and responsive place where patients/clients feel comfortable and safe is an important aspect of keeping clients/patients in care. Clients/patients are more likely to continue going to an agency where they not only feel their needs are being met, but also where they feel respected. A transgender culturally competent environment applies both to physical space and overall agency culture. The following standards provide strategies for ensuring that agencies establish and promote an inclusive, non-discriminatory place for both staff and clients/patients. Transgender HIV Health Services Best Practices Guidelines

46. Creating a safe and comfortable agency space • Provide gender neutral or unisex restrooms. • Display posters and literature supportive of transgender people. • Ensure that the receptionist (or the first person with whom a client would interact) is comfortable working with transgender people and is appropriately trained. • Attempt to locate agency in close proximity to where clients live. • Monitor waiting room areas to ensure that spaces are free from violence and harassment, and ensuring there is a plan of action should these occur. • Offer transgender sensitivity training to clients/patients. Transgender HIV Health Services Best Practices Guidelines

47. Using AppropriateCommunication and Language • Communication is a key component to achieving and improving health literacy. Communication and language barriers affect consumers’ abilities to communicate with providers and their understanding of health concepts and procedures. Barriers to effective communication can also limit consumers’ ability to adequately advocate for their health. The following standards specifically address communication and language barriers that transgender clients/patients encounter. These standards ensure that providers utilize gender neutral language and that agencies as a whole are inclusive of transgender clients/patients. Transgender HIV Health Services Best Practices Guidelines

48. Using Gender Neutral Language • Address clients/patients with respect and courtesy. • Address clients according to their presenting gender and when in doubt, politely ask. • Ask clients what name they prefer to be called and address clients accordingly. • Do not make assumptions about a patient’s/client’s anatomy or about names for the patient’s anatomy. • Use pronouns that are appropriate to the client’s gender identity. • As part of being respectful of patients, do not ask questions that are not related to the patient’s health. Do not ask personal questions for the sake of curiosity. • Acknowledge that some questions may touch on sensitive or personal subjects. • Ask questions in a non-judgmental manner. Transgender HIV Health Services Best Practices Guidelines

49. Using Gender Neutral Language • Use pronouns that are appropriate to the client’s gender identity. • As part of being respectful of patients, do not ask questions that are not related to the patient’s health. Do not ask personal questions for the sake of curiosity. • Acknowledge that some questions may touch on sensitive or personal subjects. • Ask questions in a non-judgmental manner. Transgender HIV Health Services Best Practices Guidelines

50. Using Gender Neutral Language • Attempt to use words that the patient/client uses, prefers, and understands, particularly for anatomy, sexual activities or other sensitive matters. • If you don’t understand a word or reference, politely ask him or her to explain. Transgender HIV Health Services Best Practices Guidelines