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The recently-appointed Medical Director of the Terrence Higgins Trust sits down with Vada to discuss her vocation as a doctor and campaigner for inclusive sexual health services and education.
Dr Kate Nambiar has, as she describes it, some big shoes to fill. She is speaking to me from her home in Cardiff about her new role as Medical Director at the Terrence Higgins Trust. At the time of our interview, it’s a role she has been doing for a few months, alongside her other responsibilities working as a Gender Clinician and Endocrinology Specialist for the Welsh Gender Service, having trained as a HIV and sexual health doctor in the NHS.
“It’s completely different to my role as an NHS doctor,” she says of the new job at the HIV and sexual health charity. “Moving away from frontline work, directly seeing patients in the sexual health and HIV context, to thinking more about how we can make a difference as an organisation, influencing opinions and putting out information and education. It’s a really valuable thing to be able to do.”
In addition to this, Nambiar tells me that the Terrence Higgins Trust role has allowed her to revive her passion for HIV and sexual health. Working for the Welsh Gender Service has meant that she had somewhat moved away from this specialism. “The opportunity to work for THT was a really lovely way of being able to reconnect, and to be able to contribute, to the field of HIV and sexual health,” she explains. “And not to lose that experience and skill set that I’d built up over time, but to use it in a different way.”
Nambiar studied medicine at the University of Oxford and Imperial College London. It was during this time, in the mid-nineties, that she began her transition. “I had a really rough time,” she recalls, having experienced transphobia from peers. Having gone from doing well at medical school before her transition, Nambiar subsequently experienced depression and started to struggle with her exams. Whilst pastoral care wasn’t something that was on the agenda for many medical schools at the time, Nambiar was assigned a personal tutor and her vocation for sexual health was awakened.
“They assigned me a doctor who worked in sexual health,” she tells me. “So when I was having a really tough time, I would just get in touch with her and we might have a chat. She honestly was the rock that helped me get through med school.” As a consequence, Nambiar spent a lot of time in and out of the sexual health department, where her mentor worked. “I would end up meeting people there and realising that this is a really nice place, and there’s some really lovely people who work here.”
Although she may have fallen for sexual health straight away, Nambiar certainly dabbled in other medical specialisms before settling there. “But I always had at the back of my mind that it was a really nice experience working in sexual health. And so when I decided to take the plunge, there was sort of an immediate feeling that I’d found my tribe and my niche of people that I can I can relate to, which was brilliant.”
As a sexual health and HIV doctor, Nambiar tells me that she felt like she was making a difference. “People feel happy to discuss stuff, which they wouldn’t talk to anybody else about,” she explains. “And then we come along and are able to give somebody an intervention to make them better. Now that sounds like that’s what medicine’s all about, but a lot of times in medicine, it’s really difficult to actually to see the whole of that person’s care through, as they are often grappling with several complex and chronic medical problems.”
She also acknowledges that life as a sexual health and HIV doctor isn’t always rosy. When she started working in the area in 2003, it was a “time of very rapid change,” as Nambiar describes it. During the late-nineties, there were huge developments in highly effective antiretroviral therapies for people living with HIV, yet these drugs were often associated with a huge number of side effects and other issues. “The challenge of looking after and managing people’s health, particularly those who presented late, with multiple opportunistic infections, was huge. You would be trying to encourage people to test at a time when HIV was still hugely stigmatised. We’ve moved on massively from that, but it was a really challenging environment to be in.”
How did she stick at it, I ask. “When I was working on the wards, I was looking after people who presented with really awful life-threatening opportunistic infections,” she says. “Then I’d be treating people through to getting better, to recovering, to them thriving and doing really well. That was incredibly rewarding. Those experiences infused me as part of my upbringing in medicine.”
Further to the challenges that the HIV virus brought to the specialism of sexual health, Nambiar was also on a mission to bring about inclusive sexual health services for people of all genders. Clinic T is a service she set up for trans and non-binary people, alongside colleagues in Brighton. “Oh my God, yes, it’s absolutely vital,” she replies, when I ask Nambiar about the importance of gender-inclusive sexual health services. “The main reason we set up Clinic T was that people came to us and said that we need this service. And if people are actually telling you that, then it’s incumbent on us to actually listen and to do something about it.”
Trans and non-binary people in Brighton told Nambiar that they didn’t feel that sexual health services were appropriate for their needs. “Some people were saying that they were getting misgendered. Some people were saying that they’re trying to explain things about their gender, but doctors just didn’t didn’t understand where they’re coming from. And generally, sexual health services didn’t feel like a very welcoming place for trans and non-binary people.”
Nambiar also explains that there was a short-sighted notion circulating that there were too few trans and non-binary people to justify setting up specific services for them. “I think at that time a lot of people just hadn’t thought about trans people as potentially needing sexual health services,” she says. “Or maybe the idea that this isn’t the right thing to do with a lot of effort for a small number of people.” As a result of this, Nambiar and colleagues undertook research to demonstrate the sexual health inequalities when it came to trans and non-binary people. “The specific risk of STIs and HIV, as well as the needs that people had as a result of the medical or surgical transitions, simply weren’t being talked about.”
The demand for the service was apparent, with Nambiar telling me that when Clinic T began as a pilot, people used to queue around the building trying to be seen in the clinic. “We literally couldn’t see all the people who’d turned up that evening,” she recalls.
As well as helping the trans and non-binary community of Brighton, Clinic T also helped Nambiar. “I think it’s one of the best decisions I’ve ever made, because not only did I feel that the service has helped loads of people, but it’s helped me push aside all of that internalised transphobia, and it helped me reconnect with my community.”
From the seaside of Brighton, Nambiar moved to Cardiff, where she currently lives. When I ask her about the move to the Welsh capital, she tells me she felt like a need for a change of scene. “From a personal point of view,” she begins. “I love it here. The community here is really lovely. It’s a lovely queer community.” While she acknowledges that the city’s diverse queer community is not mirrored across the whole of Wales, she says she feels “nothing but warmth and acceptance” in Cardiff. “I also have a real sense of hope and opportunity for what we can do here with the Welsh Gender Service.”
When I ask Nambiar about the future of HIV prevention, she says we can’t be complacent. “We can’t sit back and rest on our laurels, or expect things to happen if we do nothing about it.” The World Health Organization’s goal is to end the HIV/AIDS epidemic as a public health threat by 2030, just seven years away. Does Nambiar think we can achieve this? “When it comes to HIV prevention, particularly looking at reducing the transmission of the virus, the low hanging fruit essentially has been picked,” she replies. “Now we’re looking at the hard part of the work that needs to be done.”
She argues that it’s unrealistic to sit in a clinic and expect people to engage with you. “There’s so many populations out there that are hidden, who don’t engage with traditional models of sexual health services. If that’s the only model of HIV testing and treatment we have, then we’re never going to get there.”
It’s a sentiment Nambiar channelled when establishing Clinic T. She recognised that for trans people to use the service, they needed to have a sense of trust with those providing the service. “But if you see yourself reflected in services that you’re going to use, then it doesn’t necessarily make you feel welcomed; it doesn’t make you feel that it’s appropriate and necessary for you,” she reasons, saying that for a service to be inclusive, it needs to go the extra mile. “So I felt that it was important for me to feel that I was part of the trans community in Brighton, so that people trusted me and trusted our service.”
At the time of our interview, conversations around burnout and working conditions in the NHS are circulating on a daily basis. Nurses are going on strike, doctors unions are considering industrial action. I return to something that Nambiar eluded to at the start of our interview: mental health. How does she keep burnout at bay, I venture. “It’s a really good question, because I’m not immune to burnout,” she replies. “It sounds a bit cliched and cheesy, but the sense of being able to make a tangible, positive different to the people we are serving and looking after, that’s something that drives me.”
It seems clear to me that whilst Nambiar is busy juggling many roles, it is her sense of vocation that feeds her. “It’s something that is hard to vocalise and put into words,” she begins. “It is such a valuable thing and a privilege to be able to help people. I find that it’s sort of nourishing for my soul to be able to be part of a bigger collective of people, who are working towards the same goal.”
Being part of a “network” of healthcare professionals is something that gives Nambiar a sense of self, and this is particularly true of the family, as she puts it, she works with in the HIV sector. “We’re looking out for each other, I’ve never seen that anywhere else in medicine,” she tells me. “Sometimes it has felt really difficult, and I’ve come to rely on others and call on them for help from colleagues that we might not work with on a daily basis, but they are part of a bigger environment.”
Reflecting on her career as a doctor to date, Nambiar sounds hopeful and grateful. “It’s an amazing thing to feel part of,” she says. “It’s something I’ll never take for granted.”
Dr Kate Nambiar is featured on Vada’s latest digital cover, photographed by herself. She is a sexual health and gender identity doctor, and Medical Director at the Terrence Higgins Trust.