I was recently asked why AIDS Project Worcester (APW) supports programming for transgender people at our agency. Part of APW’s mission is to provide services and support to communities that are at increased risk for HIV infection. Nationwide, transgender people are at extremely high risk for HIV/AIDS, even higher than other populations that are most often identified as being negatively impacted by HIV infection such as injection drug users (IDU). Below I’ve outlined why this problem exists and what we can all do to fight this epidemic among transpeople.
The Grim Reality
Transgender people face harsh stigma and discrimination in our society. This fact has been carefully documented by numerous community assessments that have been conducted across the United States for more than ten years now. For example, a community assessment survey conducted in San Francisco found that 60% of transgender respondents were unable to find regular employment and more than half of respondents had recently experienced homelessness. I can report similar problems for Worcester’s transgender population based on my own experience serving this community. Transpeople in Worcester are often underemployed or unemployed and/or facing homelessness due to discrimination based on their transgender status. When people are marginalized in this way they may turn to underground economies, like sex work, or alcohol and drugs to cope with stress which puts them at increased risk for HIV infection. Sadly, neither Worcester or the state of Massachusetts provides explicit anti-discrimination protection for transgender or gender variant people despite the apparent need.
Another symptom of anti-trans stigma in our society is rampant violence against transpeople. For example, every month throughout the world two transgender people are murdered because of who they are. Community surveys have also found high rates of reported sexual abuse among transgender populations. For example, one community survey conducted in San Francisco found that about 55% of transmen (FTM) and 68% of transwomen (MTF) had been forced to have sex at least once.
The high incidence of HIV infection among transgender populations has also been well-documented for over ten years. A recent analysis of twenty-two studies conducted across the country found that about 30% of transwomen (MTF) tested HIV+ during surveys while about 12% of transwomen (MTF) reported being HIV infected during interviews. Despite the clear need for more data and community interventions, our federal government has yet to conduct national studies to find out more about the prevalence of HIV infection amongst transpeople.
Transgender communities have been advocating for better HIV/AIDS services for several years, but the response at state and federal levels has been slow and faltering. During the Romney administration in our own state, the scantly funded state-wide transgender health program was cut. That means that right now there is currently no one charged with advocating for health and social services for transpeople within our state’s health and human services infrastructure. Massachusetts’ HIV/AIDS data for transgender people are currently documented under the category of men who have sex with men (MSM). This is inappropriate for two reasons: transwomen (MTF), who are often at highest risk for HIV infection in this population, are NOT men and should not be classified as men and the data for transpeople within the MSM category is not broken down in terms of numbers of transwomen (MTF) or transmen (FTM) who are infected or receive services. Federal authorities use a similar mechanism for tracking HIV/AIDS data for transpeople in that they are simply lumped into the MSM category. Also, there are currently no federally-supported HIV prevention interventions that are specific to the needs and experiences of transgender people.
What We Can Do
Support legislation that protects transgender and gender variant people from discrimination. In Massachusetts, a bill entitled “An act relative to gender discrimination and hate crimes” has been re-introduced and would provide transpeople with protection from discrimination across the state. Please call or write your state representatives and encourage them to support this vital piece of legislation. For more information about this legislation or how to talk to your representatives, check out: http://www.masstpc.org/legislation/callinghelp.shtml.
Help make your workplace safe for transgender staff and customers. Encourage your employer to adopt an anti-discrimination policy that includes “gender identity and expression”. Provide transgender sensitivity and culturally competency trainings for your employees and coworkers. Provide unisex or gender neutral bathrooms, showers, and/or changing rooms whenever possible. Encourage your place of employment to purchase health care insurance that covers transgender-related health care.
Advocate for improved trans-related health research and services. Transpeople are a part of our communities and our nation and their lives are worth protecting! Engage in dialogue with Massachusetts public health and human services authorities and push for better inclusion of transpeople in programming related to recovery from violence, hate crimes, substance abuse, suicide prevention, and HIV/AIDS. Take the Centers for Disease Control (CDC) and other federal authorities to task and ask them why they continue to neglect the HIV epidemic that is raging amongst transgender populations across our nation. State and federal health authorities are accountable to US, the public, and they must provide appropriate services to ALL of us.
Jesse Pack