It’s not just about doing the right thing. It’s about helping to end HIV.
It is well established that HIV’s biggest ally in its undying efforts to destroy lives is stigma.
In an era where antiretroviral medications can keep people with the disease alive into their seventies and beyond, and a once daily pill can prevent those at risk from contracting it, stigma has remained HIV’s closest accomplice.
So it really is no surprise that groups buried in multiple layers of stigma – minorities, the economically disadvantaged, injection drug users – remain some of HIV’s last strongholds.
But none are more stigmatized then transgender people, who often fall into one or all of the above categories on top of being a sexual minority that few people still understand to this day. Or want to.
When groups are stigmatized, they end up with barriers to health care. First, they may be stigmatized by their parents or peers. For young people, it can mean ending up on the streets. It can mean doing whatever you need to go to get by. It can mean breaking the law.
When you’re broke, criminalized and lonely, it’s not easy to get healthcare. And even if it is available, it’s not a priority. Although it seems like an oxymoron, when survival is paramount, health care often gets put on the back burner in this country.
“Hope is the biggest incentive for anyone to survive,” said Cecilia Chung, senior strategist for San Francisco-based Transgender Law Center. “Without hope, everything else is secondary. If you don’t have your family and you don’t have a support system and you’re constantly being stigmatized and put down, what is the point in extending your life?”
But of late there have been glimmers of hope for people who are transgender, such as legislative victories granting protections in employment. Recognition by the scientific community that as a group transgender people need studying in the context of public health. Even long overdue acknowledgement by the U.S. Centers for Disease Control that HIV infections among transgender people must be monitored separately and not lumped into the category of men who have sex with men (MSM), as has been the case for many years.
What This All Means
In addition to men who have sex with men, people in prison, injection drug users and sex workers, transgender people have been identified as a “key population” by the World Health Organization when it comes to the fight against HIV. That means special attention needs to be given to this group, as well as the others, or we never will stop transmission of HIV.
This is why lesbian, gay and bisexual people need to get on the bandwagon and support transgender equality. It’s not just about being nice, decent, or politically correct. It’s about doing your part to help stop HIV, and not forgetting the “T” in LGBT.
Advocates for transgender people say it is a fair assessment that there historically have been moments when the LGB community has been exclusionary and judgmental. Some “transphobia,” as it is referred to, exists even in the trans community itself, said Bamby Salcedo, president and founder of the Trans-Latin Coalition.
Sean Strub is the founder of Poz, the trailblazing magazine that gave people with HIV a national voice two decades ago. Now, he directs The Sero Project, which works to end laws criminalizing people with HIV. Transgender women often face criminalization as it pertains to sex work.
“Few people are at greater risk of HIV infection than transgender women,” Strub told Imstilljosh. He said that when it comes to the LGB community’s treatment of transgender people as it pertains to the quest for equal rights, “I don’t see it as being about leaving behind transgender people, but instead understanding that trans rights is leading the way and if we get behind that, it encompasses a broad range of issues that seem to be more directly affecting LGB people. Focusing on the trans work is the answer, for all of us.”
Where the Ignorance Lies
Being transgender is just that – it’s about gender expression. Terms like transsexual are offensive, because being a transgender person has nothing to do with sexual activity.
A person’s gender is based on how they identify one’s self. If a transgender person goes by Bamby, the pronoun used should be “she.” If the person goes by Chaz, it’s “he.”
Just as all people may be gay, straight, bisexual or anything in between, the same holds true for a transgender person. A transgender man assigned female at birth may like men and consider himself gay. A transgender woman assigned male at birth may like women and consider herself a lesbian.
Ignorance surrounding trans issues is pervasive, even in the gay, lesbian and bisexual community. The Gay and Lesbian Alliance Against Defamation publish this media reference guide which offers journalists direction on how to fairly and accurately report on transgender people. It can explain a lot of questions people may have but are too embarrassed to ask. It also serves as great information those who want to be respectful of the transgender community.
Examples of ignorance can be even more offensive and detrimental when it comes from someone in authority, such as a police officer. For example, most transgender people will tell you that when approached by law enforcement, the officer will repeatedly say, “Is that your real name?” Salcedo said.
Even places that in theory should be safe havens often are not. Amaya Perez-Brumer, one of a small but growing number of social scientists researching the trans community, said people in Mississippi do not even want to go to the doctor’s office. She said subjects she has spoken with in Jackson say that people in the waiting room snicker and take pictures with their cell phones.
“Transgender health and wellness is contingent on competent medical care (at all levels, from receptionist staff to insurance processes) and intersects with the daily-lived experiences of discrimination, victimization, rejection and stigma faced by sexual minorities,” Perez-Brumer told Imstilljosh.
A doctoral candidate in socio-medical science at Columbia University and a recipient of a National Institutes of Health grant to study transgender health issues, she has heard “countless accounts of being turned away from medical care, being told, ‘We don’t treat your kind.’ I want to emphasize that this is not a Mississippi problem, this echoes narratives from trans people across the country and globally.”
The HIV Factor
The truth is that little is known about HIV transmission among transgender people because of the historically inadequate surveillance. Lumping them into MSM did not provide for a true snapshot of the epidemic among transgender people.
It is well known, however, that sex work is prevalent among transgender women, Chung and Salcedo said. It is not surprising that people who face discrimination in traditional employment, housing and often have been ostracized by their families do whatever is needed to survive.
But research shows that most transgender people who become infected with HIV do so from their partners, not a john. Salcedo believes that is how she became infected.
Chung noted that it doesn’t help matter when transgender sex workers apprehended by police can be persecuted for prostitution if condoms are found on their person. She said New York City and San Francisco have acted to change those laws, and that such changes are needed nationwide.
Data provided by the CDC also shows:
- Surveillance in countries that do have appropriate data for transgender women show they are at 50 times greater risk than other adults at reproductive age for contracting HIV.
- In New York City between 2007 and 2011, there were almost 200 new HIV diagnoses among transgender people, with 99 percent of them among transgender women. Among those, more than half had medical documentation of substance abuse, sex work, homelessness, incarceration and sexual abuse. About 90 percent of these newly infected transgender women were either Latina or African American.
But There’s Good News
The good news is that every day, stories about progress toward transgender equality and greater visibility emerge in cities and states across the nation. But for two dozen positive stories in an eight-week, there can be two dozen stories of transgender people who have been murdered.
But things are improving. Jacqueline Mathis is a Davenport, Iowa woman currently transitioning. She does not have HIV and is in good health. Her mother is supportive, and she lives in a state where transgender people have protections in employment.
Mathis briefly had a situation where a supervisor at her work was insisting she “dress like a man” and use the men’s restroom. But when Jacqueline cited her protections under Iowa law, the supervisor dropped his demands.
Mathis also was harassed one night by someone in a Davenport gay bar (she does not believe the person doing the harassing was gay) and the person walked off with her phone.
Police treated Mathis with respect when she called for help, and the phone was quickly retrieved. While life is anything but easy, she is grateful for her mother’s support and for living in a progressive state.
Salcedo said for things to get better for transgender people it is going to take “real investment from our governments and from federal institutions.”
So far, 18 states provide protections related to gender identity and employment. Strub said people like Chung and Salcedo being open about their HIV have allowed the trans community of people with HIV to select their own leadership. This has been an important development in HIV activism in the African American community and the overall HIV-positive community, he noted in a recent column.
“As the broader trans movement gains steam and is better understood and supported, it will make it easier for trans women and men to get tested and access treatment,” he said.
For Mathis, living as a woman means she is finally living. Period. “I’ve had an internal struggle my entire life,” she said. “With something like this, you can’t bury it.”