Stigma, HIV and the Transgender Community

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."

Staring the Tea Party Straight in the Eye

This nice lady is Debbie Riddle.  She is the Congresswoman representing House District 150 in the Texas House of Representatives.  She has held that office since 2002.

She is MY representative in the Texas House.

And she hates transgender people.

I have several personal philosophies that govern my activism.  Very high on the list is this:  never be afraid to go where the battle is.  Marriage equality, anti-discrimination ordinances, anti-bullying policies--these things don't come easily.  They are not achieved by "bench warmers."  So every time I get the chance, I love to seize the opportunity to engage the other side on their home turf.  Such an opportunity presented itself a few days ago.

I was at a monthly luncheon put on by a genuinely fine group to which I belong: the Spring-Klein Chamber of Commerce.  Spring is an old suburb of Houston; neighboring Klein is a somewhat newer area, younger, and with more McMansions.  Like most of Houston, it is a prosperous area; and like most of Texas, it is, on balance, conservative.  Debbie Riddle represents our area with a shotgun in one hand and a "Don't Tread on Me" Tea Party banner in the other.  She was recently dubbed "the 4th most conservative representative in the Texas House," and she has sponsored every type of far right whackadoodle legislation you can possibly imagine, from our new "campus carry" law, designed to turn our state university system into one giant shooting range, to a ridiculously redundant Religious Exemption bill that accomplishes nothing, other than making sure that Ms. Riddle got to deliver one last good, hard slap across the face to same sex couples in Texas.  But the most onerous is a bill that she has been crafting and introducing on the House floor for a while now.  This bill would make it a crime for a transgender person to use the public restroom that matches their sexual identity, with a healthy fine and jail time for anyone caught doing so.  Sort of a statewide "bathroom bill," if you will.  She is, to use a phrase, a "piece of work."

I love belonging to organizations like the Spring-Klein Chamber because, while most of the members are conservative (some very) there is a keen interest in including me and my viewpoints in the name of diversity.  Some of this is a morbid fascination with "the open gay guy," and some of it is a genuine spirit of inclusiveness.  And the respect I have for the group is mutual.  So I will admit to a certain amount of glee when I discovered that Ms. Riddle was to be the speaker at the membership luncheon--with Q & A.

In all fairness, it was Ms. Riddle who brought up the bathroom bill.  In the midst of patting herself on the back for accomplishments such as single-handedly securing the Mexican border and killing public school funding, she said this.  It's not word for word, but it's very close:

"I remember a time when we didn't have to put up with nonsense like who was going to use which bathroom.  Men used men's bathrooms and women used women's bathrooms.  Now we have all these freaky people who might decide that they feel like a woman that day and want to use the women's bathroom.  Well, I don't know about you, but I don't want my 8-year-old granddaughter to see something like THAT in the bathroom.  That's why I'm working on my bathroom bill.  I don't want pedophiles in women's bathrooms, and I'm sure you don't either."

When Q & A began, I made sure she could not avoid my hand.  Courteously, Ms. Riddle came directly to the back of the room where I was sitting, and I stood up.  This is what I said:

"My name is John Lazo, and I am a member of the chamber and one of your constituents.  I should tell you up front that I am also hold a seat on the Houston Ryan White Planning Council, I am a member of the Houston GLBT Political Caucus and I am a volunteer with Houston Unites, which is working for passage of the Houston Equal Rights Ordinance.  I don't have an issue with the Religious Exemption law.  It is unnecessary and redundant and was clearly intended as a rebuke to marriage equality, but I can live with that.  But please, PLEASE, before you introduce any more "bathroom bills," will you accept my invitation to meet with some of the transgender people that I am working with on the HERO campaign?  They are not freaks, and they are most certainly not pedophiles.  They are decent people who work hard, pay their taxes--and vote.  and they just want to use the restroom that makes common sense."

By this time the entire room had turned around and was staring intently at us--two people who could not be further apart on the political spectrum, eyeball-to-eyeball.  Walking away from me and returning to the front of the room, Ms. Riddle replied:  "This gentleman asks a very sensitive question.  My door is always open.  But the priority for me is and always will be keeping predators out of bathrooms."  And on to the next question she went, which was about open carry.

So to wrap up, let's try to follow the logic.  We don't want pedophiles in public bathrooms.  So the way to accomplish that is to prevent a transgender woman, who has undergone or is undergoing reassignment, and who looks like a woman, from using the woman's bathroom--the bathroom that corresponds to her gender identity.  And if that is the case, then one of two things must be true.  Either A) all transgender people are pedophiles or B) a sexual assault committed in that bathroom is the transgender woman's fault.

The beauty of the American system is that there is a process available to a citizen whose elected representative is in the business of crafting discriminatory legislation.  It's called the election process.  And my next campaign commitment is to volunteer, canvas, and phone-bank as hard as I can for whoever is running against Debbie Riddle.  Only 10,000 people actually voted in the 2014 contest that elected Debbie Riddle.  And a little truth goes a long way.