14 percent? 27 percent? 69 percent?
These are estimates of the percentage of MTF transgender persons in the Houston metropolitan area who are infected with HIV. These numbers come from a variety of studies done between the years 2008 and 2015. The studies represent a dizzying variety of methodologies for identifying and tracking transgender people infected with HIV. And as of now there is no way to be sure that any of them are correct.
In my capacity as an HIV activist and advocate (and, for that matter, consumer) I spend a lot of time attending meetings, seminars, and symposiums that deal with the prevention, early diagnosis and treatment of HIV. Most of these events are worthwhile, and most provide good information to their attendees. But I've noticed a trend, or theme, that has started to come up over and over again in these presentations in recent months--a theme that is both startling and disturbing. And that theme is this: every time the subject of HIV infection among the transgender population of the United States comes up, the message from the podium has been the same: we don't know how many transgender people are infected with HIV. It is difficult to identify transgender people with HIV. It is difficult to get transgender people with HIV into treatment. We don't know; we don't know; we don't know.
I, for one, am weary of this answer. I guess you could also say I'm wary of it, as well. In recent years we have honed the process of tracking HIV infection and treatment to an unbelievable degree. We have statistical documentation for practically every gender, demographic and racial subgroup you can possibly name. Here in Houston, for example, we know, almost to a person, the number of new infections among African-American MSM's between the ages of 18 and 35. We know similar information about Hispanic women, gay men over the age of 40, even the incarcerated. And this information drives our efforts to provide effective prevention, intervention and treatment for these populations.
So why has doing the same for the transgender population become "Mission: Impossible"?
I believe that this problem stems from the general stigmatization of transgender people, and that we first must work to END that stigmatization before any progress can be made on matters of health. The barriers to transgender people in all aspects of dealing with HIV--prevention, identification and treatment--are so pervasive as to seem overwhelming to those of us who are not a part of their community. High rates of unemployment. High rates of substance abuse. Economic disadvantage. Sex work as a means of survival. High rates of incarceration. Homelessness. Domestic violence. Loss of family. The practice of unsafe sex due to either coercion or fear of losing relationships. And the list goes on and on.
If these stigmas sound familiar, they should. 30 years ago, at the beginning of the AIDS crisis, one could have identified all of these stigmas about the gay male population of the United States AT LARGE. But we fought against these issues. We fought for the end of stigma. We fought for acceptance and understanding. We fought for our health. And now it's time for us to help our transgender brothers and sisters do the same.
How do we accomplish this? An article appearing on the HIV/AIDS informational website Avert.org talks about steps that have been taken in India to prevent stigma against the transgender community from getting in the way of HIV prevention and treatment. Here is just a sample of the common sense steps that have been taken there:
"In India, HIV services have been targeted at transgender people – reaching an estimated 83% of the transgender population. They have also made marked steps in officially recognizing transgender people, also called Hijras, as a third gender. This means that local authorities need to ensure that they have health and social programs that meet their needs, whilst also giving them the right to vote. Providing welfare, employment initiatives and housing can address the factors that make transgender people more likely to have risky sex.
"In Tamil Nadu, a southern state of India, transgender women, or ‘Aravanis,’ have a history that goes back centuries. However, in the present day they face many of the structural factors that make transgender people at risk of HIV. One study in India found that 46% of transgender women questioned reported being subjected to forced sex. Many Aravanis also consume alcohol excessively, to 'manage rough clients' or 'forget worries.' In 2008 the state government established a 'Transgender Welfare Board' to address the problems faced by the community. The scheme ensures access to education, providing different forms of income generation such as land, and putting housing and health measures in place.
"Many transgender people have now been issued with official identity cards stating their gender as ‘Aravani,’ addressing the barrier to healthcare faced by transgender people who don’t have official identification. They also run an official ‘Transgender Day,’ promoting the culture, tradition and healthcare of transgender people, and therefore self-esteem. States in India such as Tamil Nadu that have a history of transgender people organizing groups to advocate for their own rights, tend to also have the highest standards of care and the most community-based organizations meeting transgender people’s needs."
Common sense in India--common sense that is desperately needed here. We must start including the transgender community in our HIV conversations, while at the same time working to eliminate those stigmas that cause barriers to this community concerning HIV issues. My goal is never to attend another meeting where HIV statistics among the transgender community are represented as a big "question mark." It's time for the United States to take the lead on this front. As the old cliche goes, "If we can put a man on the moon..." This should not be "Mission; Impossible."
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