Question

Cristina is a 28 year old woman who identifies herself as Latina, of Puerto Rican descent, raised on the West Side and currently lives with her grandmother at Elliot House in Chelsea. At intake she reveals that she is transgender and has been living as female since she graduated from high school but her parents could not accept her gender transition so she left home and has been living with her grandmother ever since. She works full time as a clerk at a local dollar store but the pay is very minimal and she tells you she needs money to complete her transition so she started doing sex work. She came in today because when she went to a free mobile clinic in the Bronx , where she often sees her clients, to get condoms and a rapid HIV test, she did a screening for blood pressure and diabetes and her blood pressure was 160/90 and she was told she was pre-diabetic. She is very anxious about her health but has never had a regular PCP because she was afraid of insensitivity to her gender status. She is also anxious taking medications that might interfere with her transition or impact upon her appearance. She reveals that she is often depressed, when she worries about her future and now even more so now that she might have diabetes and because of her past experiences, she sometimes has nightmares. She came to your health center because some friends told her it was a good place for the LGBT community.

How do you handle her concerns about treatment?

What potential referrals might you make and where?

Answer 1

Q1 Counselling for the patient

Being L,G,B or T is not a ‘problem’, nor is it a ‘choice’ as such. LGBT individuals are merely individuals who have sexual preferences that differ from what would appear to be the ‘norm’, due to differing learned behaviours and, you know, having a personal perspective and mindset that differs from everyone else’s. Saying that it’s objectively wrong for people to have sexual preferences that differ from the norm is objectively wrong itself.
So it's fine to discuss your concern with a health care professional. No one is going to judge you.I do understand that there remains a tremendous amount of stigma and outright hatred directed toward the LGBTQIA community, making it very difficult for you.But it very important to have a primary care physician (PCP). It has to be someone accessible and with whom you are comfortable.

You are too young to have prediabetes and high blood pressure. Its good that she had done the tests and sought medical help.you need a physicians consultation and a psychiatrist help.Also a psychologist/counsellor session for further guidance.

2. Referrals required

• physician's opinion for the high bp and borderline sugar levels
• gynaecology or transgender clinic referral to rule out any sexually transmitted diseases
• Psychiatrist opinion for depression and nightmares
• Counselling for better guidance and rehabilitation via external agency or hospital counsellors