On September 27, 2014, San Francisco AIDS Foundation will honor Cecilia Chung, the first recipient of the Cleve Jones Award for excellence in the fight against HIV/AIDS, at its annual Tribute Celebration. Cecilia’s long history of advocacy for the transgender community has advanced the health and well-being of individuals in San Francisco and beyond. She recently sat down with SFAF to share her story and give context to the current landscape of health care equality, HIV, and stigma relevant to transgender men and women everywhere.
You’re recognized nationally as a civil rights advocate for transgender people. What do you see as your biggest accomplishment or contribution to the transgender community?
I’d like to preface this by saying that I don’t feel that I personally have done enough to take credit for all the changes and advances in the community in terms of ending stigma, especially around HIV education. As the saying goes, “It takes a village,” and I just so happened to be fortunate enough to be part of the process and to witness some of the transformative work that happened in the community.
I think that my biggest accomplishment was the opportunity to be part of the first group of Community Health Outreach Workers (CHOW). It was during that time [the early 1990s] that they started a transgender program—prior to that there was no specific focus of the transgender community. At the same time, in 1993, the Human Rights Commission held a discrimination hearing against transgender people.
What was your role during the Human Rights Commission discrimination hearing?
I and many other transgender advocates at the time got to sit on different panels and talk about our own struggles and challenges. This hearing led to a report about the findings on discrimination against the transgender community. The findings were not unusual: there was a lot of discrimination around employment and housing for transgender men and women at the time. There was a lack of economic opportunities for the community. Some of the additional findings were around health care discrimination. There were also ongoing problems with law enforcement—many transgender people felt that they were being harassed.
What happened as a result of the hearing and the report?
The Human Rights Commission came up with recommendations for sensitivity training, addressing service gaps, and laws and policies to make sure that the transgender community was protected. Eventually the San Francisco Board of Supervisors voted to add gender identity as a protected category – that happened in 1994.
It was also during that time that the Tom Waddell Health Center started to provide transgender-specific services – such as hormones – and created a safe space for transgender patients. At the time, there was a high prevalence of advanced HIV diagnoses in trans women seen at the Tom Waddell Health Center. The health team was very concerned about this high prevalence as well as lack of linkages for the community, and so they created what we now know as Transgender Tuesday at the clinic.
It was a really amazing time and I felt really blessed and very fortunate that I was able to witness all those advances and also witness the entire city coming together to advocate for the community. It really helped reduce the amount of stigma that we experience here in the city. It doesn’t mean that stigma and discrimination doesn’t exist – but I think that compared to many other cities, San Francisco is like a beacon of hope.
You have also been involved in ensuring that transgender men and women have access to the medical and health services that they need. Can you tell us more about how these services have been expanded for transgender people in San Francisco in the years that you’ve lived here?
The creation of the Transgender Civil Rights Implementation Task Force, back in 1998, was one of the big successes that we’ve seen in San Francisco. Then the adoption and passage of the resolution to expand health services to include transition-related services for employees of the city and county of San Francisco was really a huge step forward.
I benefited from it was well, because in early 2000, I was an employee of the Department of Public Health and I was able to use that benefit to do a corrective surgery on a previous surgery I had when I transitioned.
It took another few years for us to work with the state of California to pass the Insurance Gender Non-Discrimination Act, AB 1586, which addresses the issues of discrimination by insurance companies when it comes to providing medically necessary care to patients. Before this, insurance companies would deny service coverage if the gender of the person on the policy didn’t match the gender the patient would present.
Which would mean a transgender man who needed OB/GYN services would routinely get denied. And likewise a transgender woman who needed a prostate exam or to treat issues that are traditionally thought of as “male specific” would get denied. But AB 1586 started the process of eliminating these kind of exclusions from insurance plans.
And of course through that – about 10 years later now – we have the Affordable Care Act, and we have Medicare, which have actually removed exclusionary language barring transgender people from getting transgender-related medical services. In San Francisco, under the San Francisco Health Network, we also have been able to provide these related services to the uninsured in the city.
What’s your perception of where we are in San Francisco now in ensuring equitable provision of care or resources to the transgender community? What do we still need to change?
I think of it as a dance – it’s always two steps forward and one step back. We still need help around economic development. There are not a lot of employment opportunities – part of that is because it’s a very competitive market. But also a lot of our community members might go from having an amazing career before they transition to being uncomfortable putting themselves out there and taking risks to be competitive with other job seekers after they transition. We have to identify different ways and means to address that.
The Transgender Economic Empowerment Initiative that I helped start, as part of the LGBT Community Center here in San Francisco, is part of this effort. It includes a workforce development curriculum, plus help with resume writing, interviewing, and dressing for success. On top of that it has a mentoring component so that transgender job seekers can talk to others who have gone through the process. Truth be told I think that most of that time that’s what we really need – and it’s not unique to transgender people. We all once in a while want someone right next to us, need a shoulder to lean on and someone to talk to. Having a supportive environment really helps to cultivate success among the community.
Looking to the future, what are your goals for improving the health and wellbeing of the transgender community?
Despite a lot of big advances, we are still seeing a high burden of HIV rates among transgender women. Not just here in the states, but around the world.
I think that it is no surprise to anyone that we are starting to really look upstream and focus more on the drivers of HIV. Not just by treating HIV as a disease but treating HIV as a symptom of oppression, social conditions, or economic inequity. So it’s not surprising that we need, in addition to all the medical advances, to get to the place where we can do more structural interventions to change minds and attitudes and create better support systems.
I didn’t start doing all of this because of all these reasons. I did this because it’s my life – it’s my friends’ lives – at stake. I’ve lost a lot of friends already, and I really don’t want to see this continue. That’s why I became a vocal advocate. That’s why I fought so hard. Because I was also fighting for my own life. If there’s a takeaway message, it’s that I want to share these experiences with others. So they can also become the leadership that the movement really needs, to transform the entire epidemic.
Meet Cecilia at San Francisco AIDS Foundation’s annual Tribute Celebration at the Exploratorium on September 27,2014. Buy tickets for the event, here.
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