February 15, 2013
For the first time in the history of the Presidential Advisory Council on HIV/AIDS (PACHA), the Two-Spirit and Transgender (aka "Trans") communities were invited to present on the impact of HIV on their respective communities on February 7, 2013. Each of these compelling presentations revealed some key factors from their respective communities that have resulted in alarmingly high rates of HIV infection.
Speaking on behalf of the Two-Spirit community was Harlan Pruden of First Nations Cree and Dr. Karina Walters of the Choctaw Nation of Oklahoma. Both identify as Two-Spirit. The American Indian/Alaska Native population has traditionally held the Two-Spirit gender identity in high esteem; many Two-Spirit people were given the most important roles during ceremonies and celebrations. While the American Indian/Alaska Native population as a whole faces extreme barriers to quality health, the Two-Spirit population faces additional challenges that increase risk for HIV as well as other health issues. "The HONOR Project" was a five-year, multi-site Two-Spirit health study that took place from 2002-2007 and revealed a combination of trauma (historical, childhood and microaggressions); mental health issues; physical health and health risk behaviors; and culturally specific practices that have contributed to high rates of HIV among the Two-Spirit population. Twenty-two percent of the Two-Spirit individuals surveyed in this project self-reported being HIV positive; 73% of HIV infections among the American Indian/Alaska Native population are found in MSM. Perhaps most distressing is that HIV diagnoses among the American Indian/Alaska Native population have increased despite an overall population decrease, signifying the necessity of more research and resource commitment to fighting HIV in the American Indian/Alaska Native population.
The Trans panel consisted of Trans individuals as well as advocates for the Trans community. Unfortunately, more gaps exist than actual research on Trans health issues, but what research is available highlights the extreme disparities in HIV infection. A 2008 study revealed that while 12% of Trans women reported HIV positive, 28% actually tested positive for HIV. Among Trans men, 0-3% reported being HIV positive and 2% actually tested positive for HIV. The factors driving such high rates of HIV among Trans individuals include: social stigma (lack of family/peer support), employment discrimination, survival sex work, multiple injection risks, culturally incompetent prevention methods, and gender identity validation through sex. Furthermore, Trans people are more likely to face barriers to quality health care, and high rates of depressive symptoms predict both high-risk sexual behavior and HIV infection. The combination of multiple discriminations and high-risk behaviors has contributed to such high rates of HIV infection among Trans individuals, and it is clear from this presentation that further research is necessary to fully understand HIV as well as other health disparities among the Trans community. AIDS United recently awarded a Retention in Care grant to the Mazzoni Center in Philadelphia, PA, for an intensive retention initiative targeted exclusively to transgender women that includes a drop-in center where clients can receive wrap-around services.
PACHA passed resolutions to address HIV/AIDS in both transgender populations as well as Two-Spirit communities.
PACHA also passed the HIV criminalization resolution that was sent back to the disparities subcommittee at the conclusion of the previous PACHA meeting in October 2012. Among other items PACHA recommended that the Department of Justice (DOJ) and the Department of Health and Human Services (HHS)/CDC complete a written review finding opportunities to create incentives to eliminate HIV-specific criminal laws. They also recommended current criminal laws be modernized to eliminate HIV-specific statutes consistent with current medical and scientific knowledge and accepted human rights-based approaches to disease control and prevention, and finally to avoid imposition of unwarranted punishment based on health and disability status. This resolution was first presented in October by Catherine Hanssens, the Executive Director of the Center for HIV Law and Policy, on behalf of the Positive Justice Project's Federal Advocacy Work Group (AIDS United's Political Director, William McColl, serves as a co-chair of the PJP and helped draft early versions of the resolution).
To learn more about PACHA, click here.