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By Salwa Choucair
The School of Nursing’s mission, values and vision specifically state a call to action for social justice, diversity, inclusion and advocacy. The recently launched Pride Community Clinic (PCC) personifies all of these and more.
In partnership with the Alamo Area Resource Center (AARC), a community-based non-profit agency, the Center for Medical Humanities and Ethics at UT Health San Antonio opened the clinic to serve the uninsured and underinsured lesbian, gay, bisexual, transgender and queer (LGBTQ) community six months ago.
“The thrust of nursing is to advocate not only for patients but to provide a safe environment for them,” says Peter Andrew Guarnero, Ph.D., M.Sc., RN, assistant professor/clinical and director of nursing for the PCC. “I can’t say enough about AARC or thank them enough for their sense of vision and their willingness to open their building to us. We see people who may be living on the margin, and some are disabled. We are accepting the most vulnerable who do not have resources and do not feel comfortable going to what I would characterize as a straight health care provider. They believe they will not be respected at most clinics.”
Currently, the PCC is open monthly from 5 to 8 p.m. inside the AARC’s day clinic located on Frio Street on the west side of San Antonio. The clinic serves the homeless LGBTQ populations and the local transgender community, two of the most vulnerable and underserved populations in the city. It provides primary care, sexual health, mental health, hormone-replacement therapy, sexually transmitted infection testing, and connection to HIV Pre-Exposure Prophylaxis (PrEP). Patients are seen free of charge and must be at least 18 years old. All volunteers and health care providers are trained to be sensitive to LGBTQ issues.
An interdisciplinary effort with the Long School of Medicine, the PCC is a student/teaching clinic and gives nursing and medical students the opportunity to work together as a team to determine a patient’s treatment plan with a supervising physician on hand.
“It’s been very gratifying for me personally,” says Dr. Guarnero, who also serves as the co-faculty advisor for the UT Health San Antonio Pride organization. “We are very proud of our clinic, and I am personally very proud of all the medical and nursing students who have participated. They have been wonderful in terms of organization and advocacy. I am very hopeful for the future particularly with these students who are completing medical school and nursing school and moving on to the next phase in their professions. They will not only be cognitive clinicians but also compassionate. To work with this community, one has to have a strong sense of oneself but also a sense of justice and compassion and they have it.”
Every volunteer and health care provider at PCC attends a Safe Space training session offered at UT Health. The purpose of the Safe Space program is to educate faculty, staff and students to be supportive of all individuals regardless of sexual orientation, gender identity or gender expression and to create an environment of support for the LGBTQ community. Offered by students and taught by students, the training also includes a panel of transgender individuals who share their health care experiences.
“This is intended to broaden their perspective,” says Dr. Guarnero, “and to help them understand that the way they present themselves to the patient can determine if the patient is going to engage and continue to come see them. We also hope to develop our Safe Space training by becoming more focused when conducting a patient’s assessment.
How do we take a sexual history? What kind of questions do you ask a lesbian versus a gay man versus a transgender person? How do you tailor an assessment according to the person who is sitting in front of you? This is a human being. How do you ask the questions without being threatening? How do you lower the barrier?”
Dr. Guarnero became involved in Safe Space training and the UT Health San Antonio Pride organization six years ago when he returned to his hometown of San Antonio to work at the School of Nursing. However, he has been working in gender and sexual minority health care for more than 30 years and remembers when he first became aware of the inequality and lack of understanding shown to this population in health care in a previous workplace.
“It was one of those pivotal moments where you have to challenge yourself to broaden your perspective to try to understand the patient’s experience and to teach some of the nurses around me, because I started to hear trans-phobic remarks regarding patients, and that was very disconcerting.”
He points out that this negative experience with frontline staff which many individuals in the LGBTQ community face is not unique to San Antonio or South Texas. It is found across the country.
“My hope with this clinic is for both the students and health care providers to gain a very deep sense of compassion and social justice. I also hope they see themselves as advocates for the vulnerable and to then teach other health care providers about being more sensitive to the client population—no matter the client. That any client would come to your office or clinic or hospital and have equal access to quality health care.”