Lesbian and Gay Parenting Questions & Answers Column With Arlene Istar LevDear Ari

A column by Arlene (Ari) Istar Lev

HIV in the Trans Community

Posted By on September 7, 2010

Dear Ari:

I am an African-American HIV/AIDS outreach worker and some white gal who wandered into our support group meeting gave me a copy of Transgender Tapestry.  I was wondering why it didn’t mention anything about HIV/AIDS. I can’t remember how many sisters I have lost to this epidemic. An article I saw in POZ magazine recently said that HIV rates among transgender women are all in double digits. Can you explain this for me?
—Lauretta in Little Rock, AR

Dear Lauretta:

First of all, I want to thank you for bring this topic to the attention of our readers and asking me to address the issue of why there has been so little mention of HIV/AIDS in previous issues of Transgender Tapestry. The question of addressing HIV/AIDs issues among transgender/transsexual people –particularly if we focus specifically on people of color – involves the overlap of three marginalized and stigmatized communities. It does not take a rocket scientist to recognize how each of these communities is underrepresented and misrepresented within the media, and rarely the focus of medical studies, treatment protocols or prevention strategies. Truly the forgotten people, silenced and marginalized, trans people of color living with HIV or AIDS, are at the top of few people’s agenda’s. Sadly, although Transgender Tapestry has addressed these issues in the past, we have also failed to give it the attention it deserves. Hopefully your Dear Ari letter will be the impetus to change this glaring error.

Of course, I also must mention that Transgender Tapestry is the work of a small handful of people, and therefore represents their personal interests and experiences. I’m sure that articles addressing HIV/AIDS in general, as well as other health issues impacting the trans community would be a most welcome addition. The representation of trans people of color with Transgender Tapestry, as well as their personal contribution to the magazine, would certainly expand the value of this publication.

Let me start with some statistics about HIV/AIDS. Looking at statistics from 2003, there was an estimated 5 million new cases of HIV within that one year alone. An estimated 40 million people currently live with HIV/AIDS, approximately three million die each year of complications of the disease. About 1/3 of people living with HIV/AIDS are women, and close to 50% of both men and women living with HIV/AIDS are African Americans. If we include all people of color, the numbers go up to nearly 70%!!

Undoubtedly, people of color are impacted by HIV/AIDS in higher numbers than most white people. People of color, due to racism and poverty, rarely have the same access to educational resources, health insurance or medical treatment as white people, making them not only more vulnerable to contracting HIV, but less able to access necessary treatment. When we add in the complication of being a trans person of color living with HIV/AIDS, I have no doubt that the rate of transmission, illness, and death is off the charts.

Although it is difficult to determine actual statistics for trans people living with HIV/AIDS, rates of HIV among subpopulations of transgender people have been estimated to be as high 22-63%!! It is exceedingly hard to get accurate statistics for many reasons. One reason is the simple, but frequent complication of interpreting the meaning of the word “sex.” If 1/3 of all the cases of HIV are women, does this include transsexual women? Or are transwomen (pre, post, non-operative?) counted as men, as the medical/scientific community commonly assumes, privileging natal sex over personal identity? Since one of the highest transmission rates is between men who have sex with men (MSM), it highlights the challenge of determining how many of these “men” are not self-identified in that way. The layers and depth of secrecy involved in being an African-American male on the “down low,” i.e., having clandestine sex with (other) men, and potentially struggling with issues of both sexual orientation and gender identity, as well as racism and the dangers of viral transmission, is staggering. Even for this well-seasoned therapist.

If the above information has not left you reeling, let me add one more complication to the mix: 50% of all new HIV infections in the United States are among youth aged 15-24. As those of us in the trans community know, trans youth are coming out younger and younger, from all class and racial backgrounds. Youth are a population that that is dealing with ranging hormones, lack of access to information about sex education, birth control and HIV prevention, and the age-related challenge of fully understanding the implications of their decisions. They additionally have limited financial resources, and are extremely vulnerable to sexual exploitation and prostitution. Trans youth of all colors, but particularly young African-American female-to-male transsexuals, are in desperate need of trans mentors, who can help them traverse this dangerous territory.

As a therapist, I often bring up the issues of safer-sex practices. Like a broken record (an expression the youth I work with often do not understand), I ask about sexual behavior, access to condoms, and challenge clients about the safety of their sexual practices. One client told me she had a dream, where she was getting ready to have sex with someone, and I appeared at the door, waving condoms in my hand, and admonishing her to “play safe.” I can live with invading people’s consciousness, and their subsequent annoyance with me, if they will only do what they can to protect themselves.

Below are some resources for further information.

Trans Poz: Online Support and Research

AIDS Education and Training Center, National Resource Center, Transgender

Lurie, Samuel
Providing Health Care to Transgendered People