Investigator Champions for Gender Minorities

Apr 26, 2017

Davey Smith, MD, MAS, is an Investigator and Professor of Medicine at our University of California, San Diego (UCSD) Clinical Research Site. He also serves as Co-Director of the Center for AIDS Research (CFAR) and Director of the CFAR Translational Virology Core at UCSD. Dr. Smith’s research mainly focuses on primary infection and HIV reservoirs and he has been involved in a number of ACTG Network trials studying these topics. In the clinical setting, Dr. Smith sees a variety of participant populations; however, one group of individuals he works with frequently that has been hit particular hard by the HIV epidemic is gender minorities. He recalls that when he began providing transgender care, he was not an expert in the field or in the issues that these individuals face on a daily basis. He often used the incorrect pronouns and first names and was not always confident in how to handle complex medical issues affecting gender minorities.

“In the beginning, I asked for a lot of forgiveness from participants when I used incorrect pronouns. I also asked a lot of questions from clinical experts when confronted with difficult clinical situations. Along the way, I met hundreds of wonderful people who had unique struggles in life and it was my privilege to help them,” said Dr. Smith. “What struck me most about these individuals was the bravery they exhibited in the medical process and in their daily lives. Bravery is a learned skill that takes practice and I try to practice it every day, especially in my advocacy for my community, which includes transgender people.”

In 2001, along with his colleagues, Dr. Smith started “The Tuesday Night Clinic” to provide services for sexually transmitted infections (STI) among men who have sex with men with the overarching goal of reducing HIV incidence. After a year, the team conducted a ‘needs assessment’ and found that men who have sex with men were not the most impacted population for HIV and STI; it was actually transgender women. With that knowledge in mind, the clinic expanded to include this population and to provide hormonal services for gender alignment. “The Night Clinic,” as it is now known, currently operates four nights a week with three clinical providers and multiple onsite clinical trainees.

“One of my favorite places is “The Night Clinic.” It provides clinically and culturally competent care to the greater LGBTQ community in San Diego,” said Dr. Smith. “The clinic creates an environment for people to be more open about their gender expression and invites an opportunity for all to think about what gender might mean for others. One of my daily goals is to ask participants the gender pronouns they prefer and also share the gender pronouns I prefer: he, him and his.”

Dr. Smith believes that for gender minorities, pronouns can be ubiquitous reminders that others do not value their gender identity. For many members of the general population, pronouns can roll off the tongue without forethought and thus unmask a subconscious judgment of another person’s gender. This happens without that person’s consent or consideration.  Dr. Smith is of the opinion that pronouns matter because they give agency to a person’s own decision about their gender identity which one does not know unless they ask or are told.

Dr. Smith’s socially conscious approach to working with gender minorities has been influenced by his own background. Growing up in a small town in the Deep South in the mid-1980s, Dr. Smith struggled with his sexuality. The fear of AIDS and a lack of acceptance of homosexuality in middle Tennessee left him disheartened and scared.  Nevertheless, he saw a path forward by pursuing medical school and in doing so found an extremely loving and supportive LGBTQ community. It was that community, in the midst of trying to survive an epidemic, which inspired him to pursue work in the field of HIV research.

In 1996, Dr. Smith began his Internal Medicine residency at the UCSD Hospital under the tutelage of Dr. Chris Mathews.  Upon completing his residency, he was given the opportunity to oversee his own clinic within the UCSD Owen Clinic which provides HIV primary care at UCSD.  When he joined the teaching faculty at UCSD, Dr. Chip Schooley and Dr. Connie Benson taught him to always look beyond his lab and the local clinic and to tackle problems from a global perspective. To this day, he feels blessed that these giants in HIV research remain both his mentors and his friends.

Dr. Smith is extremely proud that the ACTG Network has been a strong advocate for populations impacted by the HIV/AIDS epidemic, especially men who have sex with men. Like sexual minorities, gender minorities are disproportionately impacted by the epidemic and Dr. Smith is certain that the ACTG Network will continue to advocate for these individuals.

“We still do not have all the knowledge on how best to prevent or treat HIV among gender minority populations and this is where the ACTG Network can become a leader,” said Dr. Smith. “To be this leader, the ACTG Network needs to gain a full understanding of the complex issues of gender identity. I think that this understanding comes first from being open and having a desire to learn more.”

Dr. Smith notes that the secret to the ACTG Network’s success has always been its study participants’ willingness to contribute to clinical trials and this willingness has been fostered through mutual trust. As the ACTG Network moves forward, he plans to continue to champion the causes of the LGBTQ community with respect and understanding and encourages all of his colleagues to continue to do the same.

His message to everyone involved with the ACTG Network is quite simple:

“My involvement with the ACTG Network is a highlight of my career. I love working with smart, passionate, hardworking people who seem to wake up every morning thinking about how to make people’s lives better.  I am actually inspired by every conference call!”

Thanks for inspiring us as well, Dr. Smith!