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Acceptance and Engagement
Acceptance of Me Is Everything

Released: November 27, 2023

Stephanie Gray
Stephanie Gray,
Activity Information

Activity

Progress
1
Course Completed
Key Takeaways
  • To keep me engaged in my healthcare, my healthcare professional must accept me for who I am and how I present.
  • Gender-affirming hormone therapy and HIV medications can be safely and effectively used together.

I am a transgender woman living with HIV who was diagnosed in my 40s. I was so confused by my HIV diagnosis and where I acquired HIV; it could have been from a needle-stick incident or from unprotected sex. I’m from the Midwest, and it was rough for me being Black, being poor, and being trans—discovering that I was also HIV positive added to that burden because I feared for my life.

The Trauma of Being Misgendered
When I was first receiving medical care for my HIV, there was not a lot of care coordination for people who are trans or nonbinary. A lot of people like myself were constantly misgendered, often in front of others. I was called by my correct name, but it was traumatic when I saw medical documentation that listed me as a male when that is not how I identify. Being misgendered changes your psyche; it changes how you deal with and interact with other people. Being misgendered caused a lot of barriers for me in seeking care for myself.

I had started my transition prior to being diagnosed with HIV and had already legally changed my name on documents like my driver’s license and Social Security information. But there were some issues with my insurance related to my sex. My insurance had me listed as male, but other documents listed me as female. It was problematic when my healthcare professional (HCP) would document my care as “Stephanie Gray, male.”

Because of these issues, I had to assert myself and be proactive in correcting verbal statements and documentation when I was misgendered, which is incredibly difficult to do when you are being ostracized for who you are.

What I Want HCPs To Know
As much as it is important to use people’s pronouns correctly, a bigger issue is to acknowledge and recognize how someone presents. And not just verbally—make sure that all documentation matches. Even if my HCP uses my pronouns and calls me correctly by name, if they misgender me on paperwork, that creates a huge setback for me because it diminishes me as a person. We are all human beings and deserve to be treated with care and respect.

Transitions and Treatment
I take gender-affirming hormone therapy (GAHT) and, fortunately, this has not been affected by my HIV treatment. Likewise, my HIV treatment has not needed to be adjusted for my GAHT. Receiving HIV treatment alongside my GAHT is safe and effective.

Even though I have not been affected by drug‒drug interactions, I think it is important for HCPs to check on which medications work cohesively with GAHT before prescribing either. I have more recently developed stage 3 chronic kidney disease and have had to decrease the doses of my feminizing hormone medication and my antiandrogen medication (spironolactone) so that they are appropriately dosed for my kidney function.

Coping Mechanism
Having HIV and being trans makes it difficult to get employment and, really, to survive. Although the difficulty of it is not an excuse to check out, I was turning to drugs as an escape. In pursuing that escape, I lost control of my life. My drug use was yet another barrier to getting medical care for me because I developed low self-esteem from using drugs. It made me nervous to seek medical care because I didn’t want to be judged.

The Power of Acceptance
I am fortunate that my family is accepting of who I am. I’m close with my nieces and nephews—in fact, I raised them—and they call me “Auntie Steph.” I’m really one of the lucky ones with regard to my family because a lot of people get kicked out or disowned when they identify as trans.

This is contrasted with an HCP I once had who dismissed my waxing and waning testicular pain as an attempt to “get a free sex change.” This comment made me feel lower than low. I was not gaming the system in an attempt to get free sexual reassignment surgery—I had legitimate pain that I wanted to have addressed.

This made me very apprehensive about seeking further medical care, but fortunately I found a new HCP who accepted me for exactly who I was. She even made sure that my medical records represented how I presented. I will never forget her because of the positive impact this had on me. She was an advocate for me as a person and got me started on medication to treat my HIV. She saved my life.

Your Thoughts?
How do you ensure that your transgender patients are correctly gendered and named, both verbally and in your medical documentation? How do you approach and address potential drug‒drug interactions between GAHT and HIV therapies? Join the conversation by posting a comment.