The 2014 Harvard Study revealed what many nonprofit leaders in Charlotte already knew — it’s nearly impossible to get ahead here if you are poor. However, the study didn’t address what many LGBTQ nonprofits and advocates also knew, which is that the ladder of success is nearly nonexistent for Charlotte’s poor LGBTQ individuals.

Black folks like to say that when white people get a cold, Black people get the flu. If that’s the case, then Black LGBTQ people, especially transgender women, get pneumonia.

The challenges facing Black trans individuals aren’t getting any better, but local organizations and even national ones offer a roadmap to how communities can strategically help these individuals who are often ostracized by society at-large and even within segments of the LGBTQ community. Ironically, the LGBTQ community’s response to the AIDS epidemic has revealed the best chance at successfully addressing the enduring challenges impeding economic mobility for Black trans individuals.

One organization in Florida may offer a pathway to success. Similar to the Charlotte-based Regional AIDS Interfaith Network (RAIN), Metro Inclusive Health started in the 1990s as a response to the HIV/AIDS epidemic that ravaged LGBTQ communities. Headquartered in St. Petersburg, Fla., Metro now has locations in Tampa, Clearwater and New Port Richey, including an LGBTQ Welcome Center and new sex-positive tea café and retail shop.

Both RAIN and Metro have morphed in their own ways over the years as more funding became available to combat HIV and as more LGBTQ people had to deal with some of the same issues that impact people with limited income. Affordable housing, health insurance inequities, food insecurity and lack of transportation have all caused additional disparities in the LGBTQ community that limit the community’s success stories for economic mobility. These disparities have grown the service needs for nonprofits. 

These problems are exacerbated when coupled with ethnic discrimination and gender non-conformity. National surveys show that trans individuals report significant discrimination in hiring and access to services. Poverty rates also tend to be higher among these individuals which is why Metro and RAIN expanded beyond simply treating individuals impacted by HIV/AIDs.

Photo credit: Metro Inclusive Health

“It’s vital and very, very important to be able to provide care to all,” said Rebecca Nessen, Vice President of Strategic Initiatives at Metro. As LGBTQ individuals faced discrimination from more mainstream service organizations, HIV service organizations stepped in to find ways to make connections to care more inclusive.

As more government money became available to combat AIDS and now COVID-19, these organizations expanded. Metro provides health and wellness services including comprehensive medical and social services case management. Non-medical offerings include support groups, behavioral health counseling as well as transportation and financial assistance. Services are available to anyone, despite their HIV status.

Nessen says a key to success is having an ear to the ground to identify how they must adapt to meet the communities’ needs. Those needs are varied when you consider that there are multiple communities within the acronym of LGBTQ+. For example, Metro began offering hormone treatment therapy for transgender people in 2015. More recently, they started voice-feminization lessons as well to meet the needs of the community. Programs are constantly added and removed.

The organization offers many of its services in-house, serving as a hub for community and for healthcare — a one-stop shop. Truly listening to clients and creating a staff that resembles their clients has helped both Metro and the locally-based RAIN see trends and challenges before the general public is aware that something is brewing.

“Having staff with lived experience is just invaluable to being able to connect with people that need these services the most,” says Nessen, “There’s nothing more powerful than being able to have a peer connect with a client or a patient.”

This is sage advice for Charlotte area nonprofits. Building a staff with lived experience along with creating an agile organization that can move to fit the needs of clients rather than donors are the building blocks for success.

Last month, Metro opened a new facility in Tampa that doubles the nonprofit’s impact in the area. With over 100 services and programs, including primary care, behavioral health, psychiatric medication management, HIV medical care and case management, STI education and prevention including testing, PrEP, nPEP and telehealth ,the building houses a variety of health and wellness services. According to a press release, the space will be home to dozens of social programs offered at little to no cost to LGBTQ youth, seniors, young adults and the trans community while also creating a “grand hall” experience that is ideal for community events. That rental revenue will allow Metro to focus on expanding services.

“Healthy communities make successful communities,” said Jeff Vinik in a recent That’s So Tampa blog post. The Vinik Family Foundation made a substantial gift of $100,000 to support Metro’s “Raise the Roof” campaign to redevelop the 30,000 square foot facility. Vinik is most known as the owner of the Tampa Bay Lightning and a minority owner of the Boston Red Sox.

This location in Tampa’s Ybor City neighborhood represents a geographic area where 62% of residents are Black or African American and 22% are Hispanic, increasing the access to care among communities of color. “With Tampa Bay’s fast growth as a highly desirable place to live, work and play, the health equity services provided by Metro Inclusive Health are paramount to our communities long-term sustainability,” continued Vinik.

Photo credit: Metro Inclusive Health

Hard to Reach

One of the biggest challenges for health and wellness organizations remains connecting with hard to reach individuals to make them aware of the support that is available.

Susan Reif, a coordinator of the newly formed Gender+ Task Force, sees this challenge here in Charlotte.

“We are failing to reach the most vulnerable people that are in our community,” she said, “The organizations that we’re working with in the transgender community tend to be more white, more affluent. We need, as a community, to figure out how we can work better with the population that we know are the most at-risk for many poor outcomes.”

Transgender individuals who move to Charlotte from other cities tend to leave for places such as Atlanta, New York and Miami because they are looking to live somewhere that they can be their authentic self and get a job, she said.

The taskforce includes partners such as RAIN, Planned Parenthood, the Mecklenburg County Health Department, the Relatives, Time Out Youth and others. However, Reif worries that even with this collection of partners they still aren’t reaching local sex workers and the Black and Brown trans individuals who live in low-income areas of Charlotte.

It formed in March 2020 and is piloting concepts to better educate local organizations on how to work with gender minorities in a way that is neither discriminatory nor stigmatizing. For example, they have provided training for organizations including local housing shelters and law enforcement agencies to target specific focus areas.

In an effort to figure out exactly what is needed and available, the task force created the Mecklenburg County transgender/nonbinary survey. The group hopes to assess the needs and services for gender minorities — transgender, transsexual and gender non-conforming people. Not only do they want to determine unmet needs and how to address them, but they also want to identify the current services available in order to improve client navigation.

RAIN has forged partnerships with local groups that can assist their clients. RAIN’s case managers help clients navigate Charlotte’s complex maze of service providers to ensure that clients get assistance. The Task Force hopes to expand this idea in order to build systems that best connect individuals to existing services. Responses are being compiled between now and December 1.

Reif says the short-term goal is to improve the collaboration of services and increase publicity of available programs. The long-term goal is to improve the well-being of gender minorities.

Community Service Model

Through collaboration, RAIN is focused on how best to serve its clients with an ever-expanding scope of work. Like Tampa’s Metro, the organization began with a focus on individuals impacted by HIV/AIDS, but now provides wraparound support to a variety of people, predominantly those who are LGBTQ.

RAIN offers treatment, education, access to medical care and medications, emergency assistance and other resources which impact health and quality of life. Wraparound support is a key part of RAIN’s case management.

Just ask Winston.

On his 21st birthday, he learned that he was HIV positive. His then-partner didn’t disclose his status. Instead of celebrating his rite of passage into adulthood, Winston was an emotional wreck.

“Everything was falling apart at the time,” he said.

He sought out RAIN. In the organization’s early days, it would have only been able to address his medical care, but this Spring they quickly connected Winston with health resources — mental and physical — as well as food and housing assistance.

“They pretty much helped me get my life back together. They let me know it’s not the end of the world,” he said.

Winston now has an apartment and food. He says his finances are also improving.

“If it wasn’t for them, I would probably be losing my mind,” he said.

Personal health isn’t a priority if a person doesn’t know where they will be sleeping or how they will get their next meal.

Executive director Chelsea Gulden says that clients, including those not living with HIV/AIDS, struggle with the same challenges impacting many Charlotteans such as access to affordable housing and transportation. In August, RAIN announced the Housing as Healthcare initiative after acquiring The Havens to provide safe, affordable housing for individuals living with HIV or disabilities. They are still working out the kinks, but former RAIN executive director Deborah Warren chairs The Havens’ board. This is another example of RAIN’s evolution to meet the needs of a community that has often relied on itself.

Gulden agrees with the importance of always listening to your clients to stay acutely aware of trends and challenges. Being agile is vital in serving the various needs of our community. The one-size-fits-all approach that so often accompanies philanthropic efforts isn’t working.

Organizations such as Metro and RAIN serve a smaller subset of the population, but their approach of customizing care for individuals, although labor and resource intensive, is our best hope of closing the economic mobility gap, not only in the Black LGBTQ community, but city-wide.

Research assistance provided by Chris Rudisill.

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