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HIV Social Work: As Real as It Gets in San Francisco

Lisa is a HIV social worker at Ward 86 in San Francisco General Hospital, pill the oldest outpatient HIV/AIDS clinic in the world. She manages the Women’s Clinic which specializes in transgender women’s health. Transgender women have the highest HIV prevalence group in the city require some of the most complex medical treatment.

“Do you want to see my vagina?”Usually, treat I am only asked those kind of questions in the dark. Today I am under the fluorescent hospital lights in my office during a counseling session with a transgender woman, Vanessa. She is giddy with excitement after arriving home from Thailand where she had her sexual reassignment surgery. “I am sure it is lovely, but no thank you,” I reply.

Vanessa is a 6’3 woman living with bipolar disorder who commands attention. She came this morning to our Women’s Clinic, a supportive community where HIV-positive ladies can let their hair down while taking care of their health. She announces to all in the waiting room that she just had her long-awaited surgery. The other ladies applaud. Fed up with being denied by insurance to cover her surgery costs, she had traveled to Thailand where the surgery procedures are less regulated and less expensive.

I ask her to tell me about what is it like for her to have a vagina. Sometimes I can’t believe the words that come out of my mouth at work! But, the therapy begins here. Vanessa discusses her new self confidence in her transformed body. At age 45, she struggled her whole life to be a complete woman. Finally her body matches her mind. She talks about how she has hated her penis since early childhood. She feels relieved to have that weight off her body. She describes the joy of no longer feeling embarrassed in that moment when she disrobes in front of her male partners. She asks me to help her with the paperwork to change the gender on her passport, state ID, and insurance card to legally reflect her new identity.

Our gynecologist works with her on how to dilate her vagina properly for post-treatment care. My counseling over the following weeks with Vanessa centers around delaying sexual intercourse for the first two months during her post-treatment care so that her body can heal properly. She bursts at the exciting thought of “losing my virginity.” She has had so many offers in her sex work from men that she has a hard time putting her health first. Her new vagina raises her current market value. She brags telling me she’ll likely earn more money than me this year.

We are a funny working team. Dressed in all men’s clothing, I nod in agreement as I listen to her discuss bending gender lines to feel comfortable. My Catholic upbringing makes me somewhat hesitant when we talk about her sexual history. But Vanessa usually blurts it all out loud before I even ask. She teaches me to keep it real and loosen my language. We both feel at ease with one another. After all, Women’s Clinic is about just being yourself.

To protect the privacy of patients’s confidentiality, Vanessa’s name and some descriptors were changed to protect her identity. The photo is of a young transgender women from Life As a Transgender.

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8 Responses

      1. I used to work with a woman who hated our mutual boss (who I dksiiled also). And one day she was really indignant. I talked to Bill, she said, and he said he thought I didn’t like him! He told you that? Yeah! Why would he say that? Well, you don’t like him, I said. But he doesn’t know that! I thought it was funny how upset she was to be accused or something that was true. She seemed to actually think he was doing something wrong by believing (correctly) that she didn’t like him.I don’t think people either like me or don’t. Most of my peers didn’t like me when I was a kid, but I think most of my coworkers think I’m all right. I’m sure they gripe about me behind my back, like I do about them, but that’s normal. I haven’t known many adults (maybe one or two) who have made their dislike of me obvious enough for me to notice, which is just as well.

    1. Open mouth kissing can be a sign of a child be esopxed to “adult” situtations before they know how to process, but that could be even movies or seeing dad kiss his girlfriend (if he has one) doesn’t have to mean anything else, even if it is unnerving, kids can see a couple on the street and think it’s the way girls and boys kiss since everyone else kisses differntly. Also Nekkie clothing issues are part of just growing up. If she displayed radical poseing, then I’d worry. But kids get into showing of nekkie! DD hauls her shirt up to show every person she meets her adorable belly button, because her nose, belly button, ears and eyes she can name! she then pokes her belly button at people and laughs hysterically because I tickle her belly button and she thinks it’s sooo cool to tell the world she has one. So running around nekkie might just be a phase. Ask a doctor about what is approriate and what isn’t and for a few books to explain some age approriate behaviors and what to look for if there is an issue or worry.You’re doing great not spanking her, it’s normal for kids to wonder about thier bodies. Spanking her is totally silly, kids with “tough love” end up being confused about anything normal.

  1. I think you need to take her the doctor and have her ceehkcd out because this sounds suspiciously like some sexual abuse cases that I have heard about soo many times. Take her better safe than sorry.However one other thing just occured to me and that is that if the people who live at Dad’s house run around naked she may be imitating them. Check that out first -ask him what he thinks you should do about the child undressing like that ask if they run around the house naked because something is not right and your instinct about it is right on -keep looking for answers. Just keep telling the child she has to wear her clothes -get clothes that button up the back or are one piece and not easily removed.

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