← A Shot in the Arm Podcast
A Shot in the Arm Podcast
Trans Life: How to Survive Trump’s 2nd Administration | Dr. Tatyana Moaton
01:09:27
In this powerful episode of A Shot in the Arm podcast, host Ben Plumley discusses the state of the HIV/AIDS epidemic in the United States under a hostile federal government with Dr. Tatyana Moaton, the Director of Strategic Innovation and Partnership at the San Francisco Community Health Center.
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- [00:01]
A
Welcome to A Shot in the Arm podcast. I'm your host, Ben Plumley, and this is a podcast about innovation and equity in global health. Now, today's podcast actually is the second of two podcasts we've done centered on the state of the HIV AIDS response and state of the epidemic. To my mind, it's one of the most challenging and pernicious pandemics of the 21st century, even though it began at the end of the 20th century. Our first episode was on the international state of the response with friend of the Pod, Emily Bass. And our second today is going to focus on the state of AIDS in the United States in the light of a hostile federal government and focusing in really on a particularly small, brave community that this administration has a particular disdain for.
- [01:03]
Now, our guest today is someone who knows the policy challenges at the 38,000 foot level, but also right on the front line as well. She is the Director of Strategic Innovation and Partnership at the San Francisco Community Health Center. But before introducing her, a couple of health warnings from my side. The first is a declaration of interest. Some of you may know that I am the chair or president of the San Francisco Community Health center, so just want that out in the open. The other is that as many of you also know, I've been having some health challenges this year with stage four colon cancer, and I'm still taking chemotherapy. One of the things it does is put a sort of a chemo fog in your brain. So there may be moments where I forget words or right in the midst of things, I forget sentences. A real challenge for someone who wants to be a podcaster. Hey, so if that happens, please bear with me.
- [02:10]
So let's get back to our guest, and it is a huge honor for me to welcome to A Shot in the Arm and to become a friend of the pod. It's Dr. Tatiana Moeton, who is the Director of Strategic Innovation and Partnership at the San Francisco community health center. Dr. Moeton, welcome to the show.
- [02:32]
B
Thank you so much, Ben. I'm so excited and grateful to be here with you. And thank you for sharing that as well, my friend. And my heart goes to you and your partner as well as you're going along that journey. But thank you, thank you for having me today.
- [02:47]
A
Well, thank you. Thank you for those words. Now, Dr. Merton, may I call you Tati? Which is when we're talking outside the formalities of a podcast, is what I tend to call you. But your PhD, what is it in?
- [03:03]
B
So it's a management science, and so it's an interesting Journey for me to both the health center and I know we're going to kind of get into that, both this field in and of itself. I'm a business person, hr, long HR history. And that has been. Most of the work has been in diversity, equity and inclusion and belonging for creating those pathways for individuals into the workplace. And yeah, so excited to talk about some of that journey as well. But, yeah, mostly in management science and just understanding the systems that are at place. And so one of the reasons that I was passionate about going back was just being in the work and seeing how systems were impacting communities. And one of the things I wanted to do and kind of analyze and look at was what were some of those pathways that were being blocked for folks that were actively involved in this work, and what are some of those frameworks that have been created historically, particularly within the HR space, that have sought to keep those very same people that are impacted by these epidemics and pandemics from being those persons who are delivering the care? And so. Yeah, yeah. But excited, as I said, I don't want to jump in here because I know that we have some of those questions, but.
- [04:18]
A
Yeah, well, as you'll get to know, a shot in the arm just goes where the conversation takes us. But it is interesting, the point you make about making sure that communities are able to work in organizations that purport to serve those communities. That's something that has been a central tenet of the philosophy of the San Francisco Community Health center, hasn't it? Do you want to talk a bit about the center and what it does?
- [04:46]
B
Absolutely, absolutely. San Francisco Community Health center is a safety net organization that serves the community, the richness of the communities. I always say, and I know, particularly in this both social and political climate, that folks are weaponizing words like diversity and equity and inclusion have been. Those are the trigger words of the season. But it's interesting to me, as I say and utilize the term richness, because that's what makes up who we are. We're living in an interconnected society. And so San Francisco Community Health center sits at the intersections of that. And so we primarily serve individuals that are located within the tenderloin. And so we have been that organization that morphed out of a response to the HIV and AIDS epidemic that was impacting the API community to become a federally qualified health center, which means that a designation that specifies that we see everyone. And so that was something that they were already doing. And so it was just formalizing that, but just being responsive to the call and the needs of our communities. And I continue to say that is what is most critically important. Most folks focus on cultural humility and cultural awareness and those types of things. But being truly culturally responsive and like you talked about, putting folks in front of the people to serve those communities that look and talk like themselves. And so that is another barrier that we're minimizing for our folks. And that's who we are. It's a part of the DNA of San Francisco Community Health center. And that's something that I'm really, really proud of, to be a part of that organization as well.
- [06:24]
A
And you know, being a safety net for people who fall through the other safety nets is crucial, but it's the, the richness of the communities that we serve. There are big challenges that they faced, whether they are homeless, people with mental health issues, obviously HIV affected, and particularly in recent years, the trans community. And that's one of the things that I have found so interesting, and actually I'm sort of quite proud of that. The center has really built, you know, what you might say, a center of expertise as it relates to services for trans people. Could you tell us a little bit about what those services are and how people can access them?
- [07:13]
B
Absolutely. And so for San Francisco Community Health center, we have a specified center that is called Trends Thrive. And so it's a program of San Francisco Community Health center that we came by acquisition from another community partner. And so that in and of itself was a program that started at the organization to serve trans individuals and gender, non binary and gender diverse individuals. And so through TransThrive, we provide some of those wraparound services. And so folks would not think that being in a healthcare setting, that these are the things that matter. And so when we're talking about social determinants of health, what are some of those barriers for folks getting into care and again, getting into this work? That was something that was really relevant both to my lived experience as a person navigating these essence of care, but also being cognizant of those people who have to come behind me. And so, like I said, being in a healthcare setting, folks would not think that food, transportation, gender affirming clothing and those types of things are critical to a person's entire being. I have met folks along this journey who have literally said, I don't care about anything else unless I am affirmed in who I am. We can't even have a conversation. San Francisco Community Health center has taken that to task. Through Transthrive, we provide support services, support groups, we provide gender affirming closets, such as she Boutique, which is a program that was created for and by trans women of color that has become now recognized as a nationally known program and framework for folks to re engage and engage into care for, you know, some of their first entry points by just getting a wig for themselves. And so we make that pathway. We know it won't all be easy, but just that much more easier for folks to get into care and have a conversation with the care provider. And I can remember very poignantly, during the height of the COVID response, it was our folks that were in the Tenderloin who were recognizing that these folks who are experiencing housing instability still needed health care. And so we were taking that health care right to where they were. And so that was the tent that was in the alley. And that was another moment of awakening for us that were actively involved in this work. Because in the social context, we would think that folks have the ability just to come into a health center. That's not always a reality for folks when they're dealing with a multiplicity of mental and behavioral health issues coming into your health center. And then for trans folks, that's another part of it and another layer that's added to it. And even, particularly as you talked about, that's heightened within this current climate. Emily talked about how some of the countries globally are looking at and creating plans around hiv. When we're looking at trans folks here domestically, what we are experiencing is erasure.
- [10:19]
A
Yeah.
- [10:19]
B
So to the levels that I talked, I gave a talk maybe two years ago at Stanford Law to some of the students, and I talked about how this, during Trump 1.0, that administration and this administration were attempting at the time to criminalize every part of our identity. It has always been a plan to erase trans folks. And so even just being, like I said, involved in public health and working with CDC and other public health partners to create interventions specifically for the trans community, I was really alarmed that immediately when this administration came in to see most of that research and information completely wiped away. And so that is a part of a plan that if the data does not exist, then we don't have something to correlate that to. And so that means that whole communities of people, myself included, living as a black transgender woman. And so, you know, there's another intersection that's added to that because I'm also a veteran of the military. And so you're saying that, one, I'm not qualified to serve, which I've already done honorably, but then also, I don't exist. My health disparities are not an issue because they're not recorded, they're not publicly available. And so there's this systematic erasure. And so when we're talking in the context of providing health care for us at San Francisco Community Health center, that has become a constant waking challenge, but also something that we are ready and prepared to face, you know, increasing our advocacy efforts. And, you know, you can speak also from experience as a part of our board, who says, no, we're not going to change the way that we provide services. No, we won't change those things. And I'm sorry.
- [12:15]
A
No, that's quite all right. I'd much rather listen to you than having to hear myself speak. You know, we'll come on to the reality that we live in at the moment. But.
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What was life like before Trump? Because.
- [12:36]
You know, from. From my perspective, having worked in HIV pretty much all my adult life.
- [12:45]
B
I.
- [12:46]
A
Really became aware of trans people in the late 90s. And it wasn't a concept, honestly, that I understood or could make sense of. I mean, I was having a hard enough time making sense of my own gay identity. But the one thing that really, really struck me was we're all in this together. You know, the ideas that we've heard from the far right and sometimes the far left, that, you know, trans women are really only men who want to get into ladies lavatories and, I don't know, look at young girls or whatever it is that they think might happen, which perhaps says more about them themselves than anything else. But the reality was very different people. Desperate, utterly, utterly driven. The most important thing, to live an authentic life as the person inside that they. That they were. But over the course of the last couple of decades, we. We have, I. I suppose we've. We've believed the story that we've seen improvements in trans rights, in trans recognition and identity.
- [14:03]
And that.
- [14:06]
You know, on the HIV side, we were getting close to zero infections. And it's only now, in the second Trump administration, that things have gone. Started to go terribly wrong. But that's not the reality, is it? The challenges over the last decades for trans people have been.
- [14:25]
Really significant right from the start. Do you want to speak to that? And again, I don't want to press you, but from a personal side, given the extraordinary career and life experience, lived experiences that you've had, how you navigated that journey.
- [14:44]
B
Oh, God, Ben. I want to contextualize this, because.
- [14:50]
Growing up as a youth, I'll say that because there's much debate around.
- [14:58]
Trans individuals and just who we are fundamentally. And so that's why when you get into these discussions, and that's a whole nother discussion for another day around the DSM and other classifications. But that's why I don't use terms like gender identity disorder and those types of things. And I'm more likened it to gender congruence because for myself, cognitively, I've known who I was since the age of four. And I can go back to specific moments of that recognition that something was not into, you know, was not aligned. And for myself, you know, presenting externally both for safety and we're dealing with the multiplicity of religious stigmas and, you know, all of these other things that are not, and even not having a term until, you know, the term transgender just became into this kind of en vogue where there were other things that, you know, we refer to ourselves as. But for myself, it was like, I, and I say this also to folks when I'm talking to them. I knew who I, I knew that I was a woman before the world taught me that I was trans. And so in that. But I also understand the uniqueness of my gender identity. And so it's not to say that I am dismissing the trans part of myself. What I'm saying is that trans is a part of who I am. It is not the entirety. But with that, because also what I've seen from, as you appropriately said, both from the left and the right, who's going to utilize this to their political advantage? What I've seen happen is that these same tactics, and that's why I say it's not new, they use these same things to dehumanize individuals. And so when you are literally saying folks who are, you know, it breaks my heart. One, I say when I am looking at trans youth and, you know, youth in general who are having to fight the fights that were fought back in the 70s and 50s and 60s during those times, and here we are again. But when I'm looking at that, and just from a holistic perspective, and I want to be clear about this, we were not on a smooth path to getting to zero infections pre trial. You know, yes, we had biomedical interventions, but what we're also seeing at the time before, as I said, all of this data goes away. 44% black and brown transgender women are one either living with or at risk of contracting HIV. And so that is literally going. And for myself, I, I, I put it in this way when I transitioned at the time back in the 90s, and I age myself, but when I Transitioned. At the time, the statistics for black men was one in three.
- [18:00]
And so you tell me, the moment that I step into my truth, the amount of disparities that exist, I go from 1 in 3 to 1 in 2, 44%. And so it was not this kind of beautiful place. But I will say that we were making progress. San Francisco Community health center served 16,000 San Franciscans. But of that, roughly, I want to say, I think the numbers were about 1800 of those were transgender individuals. That is about 11% of all of the transgender individuals that exist within the entire city of San Francisco. And so with all of the funding challenges and regulatory challenges that we are now experiencing with proposed rules that are coming into play with cms, around gender affirming care, the constant attacks, and even when we talk about funding from San Francisco and just how the shifts have happened and the attacks to HIV funding, in and of itself, 73% of our funding is still federal funding.
- [19:07]
A
Tell me about it. I have nightmares about this.
- [19:12]
B
And so when, as I said, with all of the progress, we were serving communities that mainstream healthcare failed. And so when we're looking at cities, safety net organizations, as I said, we don't close our doors to anyone. And we're dealing with folks who are coming in, who themselves are being, who are saying, I went to a provider and the provider will not even see me as a person. And so when you add that layer for a trans person, I've heard the horror stories over, you know, the decades of work that I've been in, folks who go in and presenting for just a chess call, and. And now that turns into this Looky Lou and four and five doctors, and now the student doctors are coming in, and you're being asked to disrobe below the waist for a chess code. Like, what world are we living in where we don't see the human factor in people? And so, as I said, you know, the hate, the stigma, all the discrimination, and all of those things that are being lobbed at the community are not new, but the uniqueness of it is that it has been increased and it's been weaponized. And it's like this kind of script that, you know from either end that they decide to replay in a quest for points when we are dealing with lies. I'm sorry, go ahead.
- [20:29]
A
Yeah. No, no, I mean. And again, I apologize for interrupting, but there are two features.
- [20:37]
And you've touched on one of them, about the uniqueness of the challenges faced by trans communities. And the first is the higher HIV rate. And I wonder if you could comment on that, I mean, from both the data and from the experience.
- [20:55]
Of our of clients at the San Francisco Community Health center and elsewhere that you know very well, how is it that the trans community is so much more at risk?
- [21:09]
B
I look at this and just from an analytical perspective, systems have failed trans people where we're looking at historical data, where trans people for many decades were lumped in with MSM data.
- [21:22]
A
Right.
- [21:22]
B
So when you're talking about being affirmed in who you are, and then again, for trans people of color, we are dealing with, as I said, this is where intersectionality comes into play. Play violence against who we are, violence against women, underemployment and unemployment rates, all of these other things. And then for folks that are situated in the south, religious trauma. I've had folks who have had the. Had to endure conversion therapy and all of these other things where they are being brought into the church and water and holy oil being thrown on them for hours. And so when we're looking at prevention methods and messaging, we don't see ourselves reflected even with programming around these things. And although pharmaceutical companies have gotten better with it, and that has come from community engagement and conversations. But again, that goes back to being willing to have the conversations both around accountability and education. But getting back to that, like what is happening and what is the contributors to these numbers, as I said, it is all of those things. Housing instability, health care. And again, even as we're looking at these kind of battles that are happening within Congress around health care subsidies, Obamacare, and I apologize for even calling it that, because I've seen also that as a tactic, because the Affordable Care act was never, never been titled as Obamacare and for us to continue to weaponize it in that way because it came through the passage under President Obama. But the Affordable Care act provided pathways for many individuals to have access to health care for trans individuals and those persons that are living with HIV and just some of the fundings to HRSA that are also a threat. And so when we're looking at those things, like I said, for trans individuals who cannot even have a conversation with their provider around being affirmed in who they are, are not going to engage in conversations around sexual health and prevention, you don't see me as a person. So how we have conversations around my sexual likes and dislikes and other things and risk factors, you know, that contribute to folks contracting hiv.
- [23:47]
A
There's the other feature that I wanted to ask you about. And.
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And I had one of those awful, horrific aha moments. A very good friend of mine across the bay in Oakland, used to run.
- [24:07]
An HIV organization originally for sex workers. Her name is Gloria Lockett. The organization is CalPEP. And on her wall, she had a list of photographs of all the people in Oakland who had been killed by gun violence in the course of the last year. And it's really shocking. I mean, it's a whole wall of these photographs. But there's one picture in particular which is about the trans women who have been killed, both in the region but also nationally. And it is shocking to see. And it speaks to this fear, this violence.
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And.
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How do you describe it? How do you articulate it? It's something that perhaps gay men in the 1950s had to experience, but even then, to a lesser degree, it was just isolation from community. It wasn't erasure through being killed. So how do you, and again, this is something that is clearly pre Trump.
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How do you think of this?
- [25:24]
B
And even in that, I, I, I get chills. One, because I've known folks personally that have been killed due to gun violence and specifically targeted violence against trans women disproportionately. The violence that has been perpetuated against the community have disproportionately affected and impacted trans women of color. And so I think it's like 70 to 80% of the deaths that have occurred in this country have been black and brown trans women. And again, this is a part of that systematic erasure. When we have both a president and an administration to say and come out very vocally. We've seen secretaries and Congress folks within this Congress refer to trans individuals with very derogatory terms. But when you are failing to recognize the human factor, again.
- [26:29]
Of trans individuals, folks will get in their mind from the extremes of society that it's okay to kill these people because they don't matter. And that's the reality. And like you said systematically, that has predated Trump. But, you know, just seeing some of the things that were put into place, the cooperations with the Department of Justice under both Obama and Biden, but to see this administration come in and like gender, they're proposing this attack on gender ideology, like, what is that? And they themselves don't even have a definition of it. But it is to say that we don't exist, we don't matter, the things that are happening to us. And again, I go back to the fact that I served this country and gave eight years of my life. And so to come back and not being a, that is not a really good feeling to say I fought for the Right for you to hate me. And with all of that, all of the, you know, privileges that I myself acknowledge and enjoy, every day I step out of my house, I have to say to myself, it's today, the day that I don't make it home. That's a reality for me. That is a constant fear that myself and others like me live with every day. And so tying that into health care, when that is our lived reality, how do you expect us to engage in conversations about those other things that are most times seeming to be foreign? You know, where you're saying that, one, from one of the richest countries in the world, we are not entitled to fundamental universal health care. That's one. And then two. So you say, I don't, you know, healthcare is not something or it's not a right for me. So then you say, hey, you should be aware of all of these things that could harm you. That again. And, you know, and I want to kind of get into that, our approach around advocacy in this administration, the impacts to other health systems when we're not providing that preventative care and funding for those preventative cares, how those will be impacted, you know, because we're no longer talking to folks from a heart's perspective, or even, I venture to say, logical people. So taking to them analytical and fiscally responsible conversations is kind of the, you know, the focus of the hour for me, because it's like I'm. I'm gone and trying to get again those people to see the humanity, which is sick to me. You know, it's both sick and weird.
- [29:13]
A
At the same time, because intellectually it is, and I'm being polite about it, it is absolutely illogical. And I think that does bring us into 2025. My God, what a year.
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B
And it's longer than a year. It's only been.
- [29:29]
A
It's only been what? Yeah, I mean, it feels like decades.
- [29:34]
It feels like one of these dystopias that I used to read as a teenager. But you used the term gender identity earlier on. And it's something that this administration, along with diversity.
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Equity and inclusion, viva, which has.
- [29:56]
Really driven me in everything that I've done.
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But the very people who were opposed to.
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Gender affirming care in an odd way, are the people who use gender affirming care, Perhaps not quite in the way that we're talking, but Donald Trump's hair, I ask you.
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If he just let himself be BALD like the 80 year old he is.
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But no. This is molded into the most extraordinary sculpture. Take Elon Musk. Elon Musk of 20 years ago looked very, very different from the buff, chipped, very powerful, strong front hair that he has now. That is a clear example of gender affirming care. So let's get into the bizarre, horrific, contradictory world that we live in.
- [31:02]
I mean, there's so much that the administration has done, but what are the things that really bother you from supporting the trans and yourself being a member of the trans community?
- [31:16]
B
And I, I, I have to center it this way because there's been many times just being in this work where I'm just like in autopilot, and that comes from military training, where it's like, okay, I have a mission and a directive, and that's where I'll stay focused. And, you know, that does away with kind of light up a lot of the emotions to it. But there was a particularly poignant moment where myself, our chief medical officer and our CEO, we were in D.C. with other health centers as a part of the consortium, and we were visiting legislators. And I think.
- [31:52]
There was a moment when we were having discussions just around. This was back in February, just around some of the things that were to come. And it's not to say that we didn't have for two years their roadmap when Project 2025 and folks who are still saying, oh, no, that's not real, and that's, you know, they're not attached to it. But we've hit three quarters of the aims of Project 2025 just within the first quarter of the year. So, you know, continue to, you know, scream to your blue in the face that that's not real. But nonetheless.
- [32:26]
Just looking at and things like passports, gender marker changes on passports for folks who have gotten and done all of the things.
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You know, had gender identity documents, you know, your identity documents change, I'm sorry to bring them into congruence with the identity that you, the gender identities you're present at. But, you know, as a person who was both traveled internationally and also have a historical perspective to place with traveling to also some of these other countries that are very hostile to LGBTQ members. That is something that could cause real harm and being connected in a lot of the communities that I am. I remember a particular story of a trans woman, woman in the ballroom community that was sexually assaulted and held and cycled without any contact to the US Consulate in Dubai, you know, the United Arab Emirates some years ago, and a, you know, a horror story of, you know, law enforcement, you know, detaining her and all of these things, and her being essayed. But you know, that in and of itself, the dangers and just understanding how, you know, horrible and harmful this administration and the steps that they will go to harm trans individuals, it's like nothing that I've ever seen. But just bringing it back to the work that I do every day to get a call from CDC and say we are allowed to provide services under our grant, but we cannot provide any of those services to trans individuals.
- [34:12]
Like 44%. Like, I'm not listening to the scientists that have, you know, analyzed this data and compile these numbers. Who said that? 44%. 44%. That's, you know, closer to 50 than we're ever going to get. And that in and of itself, and for me, I always bring it back to again, that human factor, because in any other community, even when we're talking about violence against trans women in any other, in any other community, if these things existed or happened, the response in and of itself, domestically, and of course, we don't know what it would be like in this administration, but previous administration, it would have been immediate and like nothing we've ever seen before. And so for it to go the way that it does, where it. We have folks who are consciously silent about these things, who won't even acknowledge the humanity in these same individuals to give rise to say, this is a problem, this is going to also impact long term our other systems of care, you know, because if we're having folks that are presenting for something that quite honestly could have been present, prevented, you know, with treatment and other methods and methodologies to those preventions of those health conditions.
- [35:34]
It causes a ripple effect. Hospitals, close clinics, can't you continue to provide the care? And then we have deaths. And so even forecasting around those things within five years, the impact is that detrimental. And so in an undo and this looking at what it has undone, you know, the decades of work that we've poured into the response around HIV and AIDS and then, you know, just getting trans individuals into care, you know, and within one year to see how that has happened, you know, so, yeah, it's, it's, it's a lot. It is a lot.
- [36:14]
A
And Tati, it's, it's, it's also scientific as well. I mean, some of the early assertions from the administration that people were always going to be defined by the sex they were given at conception. Well, there is no sex at conception. And the process, the biological process of.
- [36:43]
Becoming male, male, female, intersex, what have you, is something that is much more complicated than the politics would have you.
- [36:58]
Trump at the start of his administration listed a number of executive orders that I think took a lot of us by surprise, targeting directly the trans community. And I know that the Community Health center and I was part of these conversations, decided that we had to take a solid firm stand against them, even if it exposed our.
- [37:26]
Overall strategies and our overall programs. Do you want to talk a bit about those executive orders and what the Community Health Centre did?
- [37:34]
B
For sure. And absolutely. That again, goes back to, like I said, some of the alarming things, excuse me, federal funding threats. Our CDC award was terminated. And that is something that we had to fight back against.
- [37:50]
Joining forces with other FQHCs in conjunction with Lambda Legal and ACLU to fight back to save that critical funding. As I said, again, getting a phone call from a project officer within CDC to say, yes, you can continue to provide the prevention services under this grant, but none of those funding, none of that funding can be used for trans people. And as a trans person, I'm sitting here like, wait a minute, what is happening?
- [38:18]
A
But you, But Tati, let me interrupt. And this was, I'm going to put a question to you in this sort of same way that I put a question to Emily and her response to me was to back off.
- [38:35]
But here you are getting a call from CDC saying you can keep the grant and do the work, even though the work is designed for trans communities, but you can't do it, you can't do the work for trans communities. How do you square that circle? Is it something you can talk about? Are there ways of serving trans people without having to articulate that these are trans services?
- [39:03]
B
Absolutely. And so before we get into the strategies around that, what I want to say also is that is something to understand the nefariousness of this administration. Like they have gone so far as to say for even individuals and organizations that will decide to do those types of things that will say, okay, just to be compliant. So we'll on the back end refer to, you know, our communities of however, you know, you feel that is appropriate for us to get the funding. But what they're saying is that if you're doing those things, then you are considered non compliant. But for us, again, what we're saying is that we see people, we don't see persons of identity tags. We understand the importance of that and seeing folks for who they are and how they choose to identify. But for us, it is understanding the conditions that are contributing to folks coming to the spaces that they are experiencing housing instability. For us at San Francisco Community Health center, that is A huge component or a population of individuals that we're serving. Trends are not when we're talking about folks that are.
- [40:15]
Having some of these social determinants being their barriers to care, what we're addressing those needs and but you know, having executive orders that are attacking dei, you know, all of the work that both ACLU and other partner organizations like Trans Law center and others, you know, that have fought for rights of trans individuals to have a sense of belonging and psychological safety within their workplaces and be able to use. Again, get getting back to kind of that conversation around bathrooms. I've used a bathroom that I've wanted before any of those things came into play. And for most of us it's like we just want to use the bathroom. Like, I don't care what you're doing in the salt, one of that other stuff. But, you know, and there's something to also be said that when you're looking at some of these things that they kind of get into the deep, you know, the deviancy that those things don't happen. And I'm not to say that, you know, they just don't exist, but the likelihood of it happening in that low to the point to say that it just does not. But you know, again, it is a weird dynamic when we're talking of getting so to the point where it's like we're policing folks's rights to use the restroom, when really what it kind of gets down to is the questioning of folks's personhood. You know, you're coming into the bathroom to ask me to prove my gender. Like, and some of the instances that we've seen both within social media and that have been kind of, you know, talked about around cisgender individuals who have been approached. And so, you know, even just getting into this strange discussion, like you said, around folks who are so against gender affirming care. And I liken to say that health care is gender affirming care. You know, gender affirming care is healthcare in and of itself, period. Stop. That's preventive care, all of these things. Because when we start to analyze on the other side of it, suicide risk, all of these, you know, all of these things that are heightened for folks who are having to suppress who they are as opposed to living in their truth. And so all of the access, you know, costs and expenses that are associated with that in and of itself are worth saying, let me see you for who you are. Surgery is not for everyone. And that's another part of the discussion that they try to weaponize that, oh, these folks are trying to change their genders and get taxpayers to pay for these surgeries. But then we're seeing these very same folks who demonize when they're affirming care, who are getting fillers and, you know, like I said, hair plug treatments and all of these other things that are part of affirming who you are in your gender. And so, you know, it's just this weird dichotomy that exists within those conversations that, as I said, when you're talking to politicians, it just kind of gets spacey. And I'm sorry to continue to use that word, for lack of a better term, but it just gets weird. Like, what time are we living in? And like you said, this weird dystopian reality, like, what is happening here? I go back to Aldous Huxley's book Brave New World, and I'm constantly taxing, like, what world are we existing in where we're selecting populations of people to say, you don't matter, you're invalidated. You don't exist. And so it's like, you know, what is this?
- [43:34]
A
So I'm really struck by your use of the word erasure, that the intention is to erase the trans community.
- [43:44]
What other things.
- [43:47]
Is the Community Health center and partners doing? I mean, you mentioned the lawsuits that the Community Health center is part of, led by Lamda Legal.
- [44:01]
But on the front line. What else is the center doing?
- [44:06]
B
Absolutely. And just like I said, this is a space that none of us would have expected to be in. We're even seeing attacks on federally qualified health centers. And so continuing to do your coalition building because we recognize, both with ourselves and our partners, that even for philanthropy and pharmaceutical companies kind of step in and, you know, city and county and state funding, none of that will amount to, you know, replacing or putting or, you know, being a fill or backfill for the funding or of loss of funding from the federal government. And so we're having to come up with new ways of providing care to those very same individuals that we have been tasked with providing essential health care for. And so, you know, gender affirming care is a huge component of care for trans individuals. And when we're saying that, you know, for most folks, they go immediately to surgery, there's so much more of that is, you know, that goes into that. And I likened it also to folks to say, when you're having a hard time understanding, like, what is gender affirming care? I will say that most trans folks are most concerned about youth, them for who they are. As opposed to who you want them to be than they are about what style, where it's provided, and all of these other things, you know, yes, those things matter. And not to say that they don't, but what I'm saying is, if you're finding me telehealth, if you see me for who I am, I am comfortable in receiving my healthcare that way, you know, but having an option, again, that even of itself is a privilege, you know, it's about having those options. And it's not. Not to say that just because of me living in my truth, that that pushes me to this sector of. Because that is what they're saying for gender affirming here. You can provide all the other things, but don't you dare have a conversation around affirming this person in this, you know, as this administration have now come up with gender ideology. And again, I say, what does that mean? Because it's not something. It only becomes a thing when they're attempting to weaponize it. And that's what we see happen, because that's not something we've ever even talked about previous administration, like, I get it, like breaking down the word, but it's like, that's not a thing in the way that they are trying to weaponize it.
- [46:23]
A
And I think there's a need. There's a need for sort of public education that goes well beyond what we've done in the past. I mean, I think there is this sense that, you know.
- [46:38]
Biological men who think, and I'm using that in inverted commas, if you're on audio and not on video, that they are women. You know, they throw on a dress, put on some makeup, and there we are said to say, done it. That's them done. They're a woman. But in fact, the processes of going, of. Of becoming the authentic people that they are are both long, complex. If they involve surgery, they are excruciatingly painful. I remember a trans man describing his journey and, you know, having pieces of skin taken from his arm to, you know, recreate.
- [47:31]
Male genitalia. This is not something you do on a whim. This is not something that you do to be woke. And I just. I don't know. There is just a need, I think, for. And I suppose that speaks. It speaks to an ultimate optimism that people, when they do see everything, when they do have the facts, will recognize the authenticity of the people and see them as people rather than medical conditions from the health perspective. But.
- [48:07]
There'S no threat to teenage girls using a lavatory.
- [48:13]
B
No. And I laughed earlier when you kind of mentioned this, because I've had folks to say some of the most bizarre things. And I. It's one of those things where it's like, when you're in a situation like that, you use comedy as, like, kind of the way out, you know, not focus on the traumatic aspect of it. But when folks say things like, oh, you were born a man, and that's how you always be, and coming back and saying, honey, none of us. It would be very uncomfortable for my mother to have birth a man, like, out of her right. I was born a child.
- [48:49]
And so the decisions and, you know, you can get into the scientific discussion, but again, what I said from the beginning, we're not talking to folks from a logical perspective. And so you can't even get into chromosomes and all these other things because they themselves are going to try to shift the conversation. And that is why it is important, critically important. And that is another part of the health center being responsive. We have not changed one thing about the way we provide information and resources because we're living in such a climate of misinformation and disinformation, and most times where the loudest voices are the ones seen as the experts when they themselves are not. We're having legislators have conversations around biology and science who have never ventured a dog day. And, you know, I don't say that to be mean, but probably many of them probably didn't excel much in school in these very same subjects. And so it's like to have these conversations around, you know, the process of individuals and even lighting it to my own. It is. If I could wake up and say, oh, I think I am this, I would probably wake up and say every day, I'm a billionaire, I'm a millionaire. You know, but just to give it away to folks, I'm that altruistic. But if it was that easy just to say, oh, you know, I think I'm a woman, and that makes me a woman. You know, there's. It is a lifelong process, even for trans individuals to get to that space of honoring this is who I am. And so to say, it's just like this flippant, fleeting. Oh, they just make it up and it's all feminine. It is in art, as you said, arduous, oftentimes challenging. You lose friends, you lose family, you leave.
- [50:41]
Employment opportunities.
- [50:47]
And so to continue to come back to this space of invalidating individuals simply for deciding to live in their truth of who I am. And for many folks, you know, I've had the Experience of talking to folks who are not born in this country, for them, it is also a matter of life and death.
- [51:10]
A
Yeah.
- [51:12]
B
Being trapped in this dark box of knowing deep down inside this is who I am, but the world doesn't see that. That's painful. But being in this literated space of being able to voice, this is who I am and this is how I would like to be respected, addressed all of these other things, that is on the beautiful side of that. But it is not an easy journey to get to that. Like I said, I, I've, you know, had the opportunity within community to mother 21 individuals that were not birthed from me, but because of them being, being who and how they are and who they love, their families, decided we want no further contact with you. Yeah. You know, and going to them and say, you matter, you are of value and, you know, you have the right to exist and be who you are. And so for many trans individuals, you know, building that up within yourself, but to come in and as I said, have both your government and your president who said you all of these, you know, horrible things, and it's not just isolated to trans individuals, unfortunately, you know, this is who this person is. But as I said, from a systematic, you know, from a systematic perspective, what they're saying, these systems are not designed for you.
- [52:40]
A
Now, Tati, you mentioned.
- [52:45]
That the center is actually, how shall I put it, sort of like a beacon of hope for people from other countries.
- [52:52]
Whether they are coming, they find themselves living with hiv, but particularly.
- [52:59]
Trans women and trans men. And so it begs the question, has the center been affected by other aspects of the Trump administration's approach, say, to immigration, particularly from.
- [53:18]
Latin America? And it hasn't had wide coverage, but even San Francisco has been affected by ice. And has the center had its run ins with ice?
- [53:32]
B
Yeah, we had actually one of our clients or one of our clients to be detained. And so when you're talking about in the context, as we, you know, early on in the podcast, we talked about our staff and the composition of our staff, many folks who are from community who are actively a part of these communities that we're serving, that was a particularly frightening event because also we have folks who are receiving services that are undocumented. And so, you know, we do not get into that when we're providing healthcare services around someone's status. And so when we're having folks, as I said, we provide street medicine. And so when we're getting folks in, you know, having them getting into care through these systems or pathways and we get them to that space where they're ready to come to our health center. Hearing about something like that, where folks are being, you know, detained or, you know, put into custody at our health center, that violates both the sanctity and sanctuary of healthcare. And so there's this escalation. And so for us within staff, that was a very activating event because we also have staff members who now themselves are, regardless of their immigration or citizenship status, they're afraid to come to work, they're afraid to provide the services, they are afraid to come and access the services. And so all of these things that are part of this administration that continues to say that they care about people in America first and all of these other things, but it's like you're contributing to the very harms of those very same people that we are supposed to be tasked with serving. And so it was very scary, as I said. And just, you know, from an administrative perspective, where do. How do we respond to our people who are also hurting and fearful while we are also being tasked with providing those services?
- [55:36]
A
So what was the outcome for.
- [55:41]
This person who was detained? Do we know?
- [55:44]
B
I actually do not personally know within community. I have heard that the person was released from custody, but. But I cannot confirm this. I don't want to, like, get into that, you know, that specifics of that. But as I said from a community perspective and an organizational perspective, I will say it was very scary and caused us to kind of look at and analyze our policies and procedures around safety in and of itself.
- [56:09]
A
Well, because what it means is that ICE was.
- [56:14]
Circling around our clinics, our centers. And I say, ah, there I am. Conflict of interest between podcaster and subject and organization. The San Francisco Community Health center has a number of.
- [56:33]
Clinics and centers around the Tenderloin. And, you know, the anxiety that ICE was hanging around, watching people coming in and out, I cannot imagine the terror that must have been both for clients and for staff. I'm trying to think, Tati, and we always do this when we come up to the top of the hour. Well, let's wrap this up on a positive note.
- [57:01]
B
And.
- [57:04]
A
I don't know how to do that in the context of this crisis. I mean.
- [57:12]
I do think there are powerfully strong trans women and trans men who are leading the campaigns against.
- [57:27]
This discrimination and these attempts to erase the trans community. And I think that is wonderful because it's the community that leads and it's the allies who support it's not the other way around. So I'm very. That is very.
- [57:46]
What Can I say heartwarming, but how do you see things playing out for the remainder of the Trump administration? Or do you dare not think about it and just take one day at a time?
- [58:00]
B
No.
- [58:03]
I would, I would not be who I am if I was one of those persons to put my head in the sand if I've never had a moment or an opportunity to kind of put my hand in sand and say, oh, you know, I'll just wait for it to be over. And so in that same way, I think it comes back to, and I say this is a part of the blessing and the curse. It comes back to us recentering of who we are, both in the moment and those who are kind of, you know, adjacent to the movement of understanding. You know, both Gay Pride, the celebration, the month of Pride, came out of a radical moment. And so for us to understand that, yes, it has morphed into this celebratory kind of event, but these were radical moments that took place within our society that said, no more, no more. And so in that it is for us recognizing that these even the response act up to AIDS back in the 80s, those were radical movements, the fight for inclusion and belonging. Those were radical moments coming on the heels of the civil rights movement. And so for us to get into that space that there is not one civilization, second or moment that we have to turn a blind eye to any of the things that are happening and even, you know, for us that are here in the United States, to understand the impact of, you know, PEPFAR and usaid, what that does on a global level, I am talking with trans individuals in Thailand who most of the funding for their clinics came by way of usaid. And so when to see that funding go away.
- [59:51]
What is the response then for trans individuals in Thailand, for HIV and aids, for both treatment and prevention? And so we have to wake up, we have to give rise, we have to give voice, and increasing our advocacy efforts, but also understanding that the only path forward is together. The only path forward is together. We can get into the pits and corners of our isms and schisms and all of these other things that separate us. But when we fundamentally understand that, I need you, Ben, just as much as you need me, for us to continue to exist in such an interconnected society, because those things that we are doing are not absent of those types of on the other side of that coin of privilege, like who's being impacted and affected. And so if I am sitting here in this space of saying, oh, this is only happening to us in the United States, I would be a fool. And so, as I said in that understanding and recentering, that it is going to take each and every one of us collectively fighting against these things, giving a rise and a voice to these things and understanding. And I say for even folks who, who come back to say, you know, I have a real hard time understanding this trans thing, and I, I get it back to people understanding that the human factor, I am a daughter, I am a mother, I am a teacher, I am a missionary, all of these things. I am a veteran. And none of that changed the moment I said, I am also trans. You know, I'm a trans doctor, I'm a trans veteran. All of these things, you know, only became better when I was able to live in my truth. And so for trans individuals around this country, they're still your family member, they're still your sibling, they're still a person. And so that in and of itself gives rise enough to say that I can care about the things that affect and impact you. And so in this fight, it's not something that we can do alone. And for all of the challenges that we face both within the fight against HIV and AIDS and violence and all of the other things that trans individuals are facing, we can't do it alone. So we need our advocates and our activists and other allies.
- [62:14]
A
And you mentioned Thailand and you mentioned the international response, and that's a good moment for me to give a shout out to Gate Global Action for Trans Equality and the equally fantastic leader, Erika Castellanos, who is also a good friend of the pod.
- [62:36]
So we're in it together.
- [62:38]
What would you ask our listeners and our viewers to do? How can we support.
- [62:47]
The center? How can we support the movement's campaign.
- [62:53]
Against the threat of erasure?
- [62:56]
B
Absolutely. And I mean, of course, funding, as I talked about, you know, 73% of our funding comes from the federal government. And so in the absence of that, just thinking about, like I said, all of the services, rich services that we provide for the community, including our community living room, which is a drop in space for folks to come in and get a hot meal during the day, but all of those things are supported through funding. And so for folks to connect with community health centers, because they're here at San Francisco Community Health center, and in their mind, they automatically go to structured corporate without really understanding, like, we're a grassroots organization that are being served by folks that come from community. And so in that just being able to provide meals for folks that are experiencing housing instability, but connecting with organizations like San Francisco Community Health center and supporting both the advocacy efforts and the efforts to provide care to the community is critically important. But getting involved and coalition building and when we have things that come up that we just want shared on social media that we may need to get out, including a recent policy brief that we released around the potential dangers of any restrictions to gender affirming care, supporting those efforts because I will say, as I said, in this era of misinformation and disinformation, it's critically important for us to get the necessary information to the communities that are being impacted and for their voices to be heard.
- [64:31]
A
Well, we'll include links in the show notes both to pages on the Community Health Center's website on how people can help in a range of ways, including whether or not they're able to make some kind of financial contribution. But we'll also provide links to the Center's Facebook, Instagram, TikTok and other social media sites that people can sign up to and can then share the posts that you will release. Tati, it's been an absolute honor having you on the show today. I feel a sense of extraordinary awe at what you are doing, your passion and your determination. And I really hope that our show today has sort of given folks an insight into into that and why it is so important to be with you and to be on the right side of history and be with the Community Center. So thank you so much for being on the show today.
- [65:40]
B
Thank you. Thank you for having me.
- [65:43]
A
Well, that's it for this episode. Thank you to Dr. Merton. Thanks also to Eric Aspera, our director and producer from a short in the ARM media. And of course, a big thanks to you. Please do look at the show notes and see how you might possibly be able to support the mission of the San Francisco Community Health Center. But regardless, if you enjoy our podcasts on audio, please make sure to subscribe there. And I know I'm sounding a bit like a broken record, but we really are encouraging people to like and subscribe our YouTube channel and its address and I strongly encourage you to go there is YouTube.com.
- [66:32]
Podcast. So with that, have a great week and a safe week everyone.