Transgender Women Living With HIV
June 10, 2016
Living With HIV
Across the globe, transgender women (transwomen) are affected by HIV to a much greater degree than other groups. It is estimated that the proportion of transwomen living with HIV is 49 times higher than in the general adult population. This is true whether transwomen are living in low-, middle-, or high-resource countries. Worldwide, the prevalence of HIV among transwomen is about 19 percent; this means that 19 out of 100 transwomen in a given population will be living with HIV. By comparison, the global estimate of HIV prevalence among female sex workers is 12 percent, and the estimate for men who have sex with men is 13 percent. The overall global estimate of HIV prevalence is 0.8 percent.
The U.S. Centers for Disease Control and Prevention (CDC) reported that, in 2010, the largest percentage of new HIV diagnoses in the country occurred among transgender people. As in the cisgender (non-transgender) population, transgender people of color are many times more likely to be living with HIV than their white counterparts. From 2007 to 2011, 99 percent of new HIV diagnoses in the transgender community occurred among transgender women. Of these newly-diagnosed transwomen, 90 percent were African-American or Latina, and over half were in their twenties.
Not Being Seen or Served
Despite bearing such a high burden of HIV, transwomen have been historically underserved as part of the response to the HIV pandemic. Often, transgender women are not even "seen" because they are combined incorrectly into other categories, such as men who have sex with men. Or existing data systems do not ask the right questions about people's sex and gender and thus fail to count transgender individuals. It can also be challenging to "see" transgender women because, due to past negative experiences or fear of discrimination, many transwomen choose not to identify as transgender when seeking services.
The Good News
In the past few years, awareness of how ill-served the transgender population has been by the global response to the HIV epidemic has come to light, and changes are (slowly) being made. In 2014, the World Health Organization (WHO) published the results of a study of the Values and Preferences of Transgender People that was conducted to better understand HIV-related experiences of transgender people across the globe. The results of this study were woven into the Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations that the WHO released the same year. According to Kate Montecarlo, founder and chair of the Association of Transgender People in the Philippines, the WHO made a "remarkable imprint on history when it comes to transgender health and HIV advocacy among transgender women -- in particular separating transgender people from men who have sex with men" and acknowledging the specific health needs of transgender people.
In July 2015, the WHO issued a policy brief on Transgender People and HIV, which encourages countries to establish laws that decriminalize nonconforming gender identities, protect against discrimination, and work toward legal recognition for transgender people.
In the U.S., the White House Office of National AIDS Policy (ONAP) convened a recent meeting of experts and community members to discuss ongoing efforts to improve health outcomes in the transgender population. They outlined a list of specific new steps that would be taken to enhance prevention and care efforts for the transgender community.
There are many intersecting issues common to transgender women that can make life challenging and make it more difficult for them to access the care they need. These include a range of social and structural inequalities that negatively affect the health outcomes of transwomen living with HIV. As the National Center for Transgender Equality (NCTE) explains, "transgender and gender non-conforming people face injustice at every turn: in childhood homes, in school systems that promise to shelter and educate, in harsh and exclusionary workplaces, at the grocery store, the hotel front desk, in doctors' offices and emergency rooms, before judges and at the hands of landlords, police officers, health care workers and other service providers."
The stigma and discrimination faced by people living with HIV is fairly well documented and understood. Studies have shown that stigma and discrimination -- or the fear of them -- keep people living with HIV from getting tested for HIV, getting linked to or having access to care, staying in care, getting HIV drugs, and taking their HIV drugs correctly (adherence).
To assess the weight and scope of stigma and discrimination specifically among transgender and gender non-conforming people in the U.S., the NCTE and the National Gay and Lesbian Task Force conducted a National Transgender Discrimination Survey. Released in 2011, the study of over 6,400 participants reported discrimination in many areas of life, including employment, housing, education, health care, family life, public accommodation, and legal documentation. Sixty-three percent reported having experienced discrimination serious enough to impact their ability to support themselves financially and emotionally. Transgender women of color, especially African-American transwomen, bear the heaviest burden of discrimination. This is most likely due to the fact that the combined effect of anti-transgender bias and structural racism is greater than the sum of their separate effects.
Serious discriminatory events can often be traumatic, leading to lasting negative effects on a person's ability to function in the world -- physically, mentally, emotionally, socially, and/or spiritually.
The negative feelings and sense of rejection that come from experiencing discrimination can also lead to low self-esteem, social isolation, depression, and even thoughts or acts of suicide. The NCTE reported that an astonishing 41 percent of survey participants had attempted suicide.
If you are thinking of hurting yourself or committing suicide, please tell someone immediately. In the U.S., you can call 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255). To find a suicide hotline near you, try www.suicide.org/suicide-hotlines.html; this website lists U.S. hotlines by state as well as hotlines by country (click on the "International Hotlines" link at the top of the main page).
Transgender people worldwide face extraordinary levels of physical and sexual violence. The National Coalition of Anti-Violence Programs reported that, in the U.S. in 2013, severe hate-based violence against transgender people, people of color, and HIV-affected people was alarmingly high. Transwomen were six times more likely to experience physical violence when interacting with police than survivors of violence in general. Violence, like stigma and discrimination, can result in trauma and lead to lasting negative effects on a person's ability to function and remain healthy.
Importantly: if you are feeling threatened right now, call 911 or the National Domestic Violence hotline in the U.S. at 800-799-SAFE [1-800-799-7233; or 1-800-787-3224 (TTY)]. You can also search for a safe space online at Domestic Shelters (https://www.domesticshelters.org/). If you live outside the U.S., please go to the Hot Peach Pages to find help near you. You can also search for shelters and services at SAFE (Stop Abuse for Everyone).
It is important to remember that, if someone threatens you, it is NOT your fault. You deserve to be treated with respect and to be safe. Often, women who have been abused have been humiliated to the point that they believe that they deserve whatever abuse comes their way. This is NEVER true.
More From This Resource Center
This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
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