Structural Violence, Discrimination Keep Transgender Women Living With HIV From Accessing Health Care

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Structural violence perpetrated by anti-transgender laws and racism, as well as discrimination in health care settings, keep many transgender women living with HIV from seeking the care they need, panelists said in "What You Need to Know: HIV Among Transgender Women and Barriers to Care," a recent webinar sponsored by The Well Project and Positive Women's Network-USA (PWN-USA).

Globally, the HIV rate among transgender women is 49 times that of the corresponding general adult population, Tonia Poteat, Ph.D., PA-C, of Johns Hopkins University noted in the webinar In the U.S., between 2007 and 2011, 90% of newly diagnosed transgender women were African American or Latinx, she added.

The combination of structural racism and anti-transgender discrimination causes particularly severe trauma in this group. Forty percent of respondents to the National Transgender Discrimination Survey reported that they had attempted suicide at some point. In addition, transgender women face practical issues such as difficulty in obtaining identification that reflects their current gender, which impacts their ability to obtain employment or access services. Another barrier to receiving medical care is discrimination in health care settings. Almost 20% of survey respondents had been refused medical care because of their gender identity.

Despite these obstacles, transgender women persist, Tiommi Jenae Luckett of the Well Project said. The Positively Trans survey among transgender people living with HIV in the U.S. South found that 71% of respondents maintained an undetectable viral load. This was achieved even though 30% said they had no health insurance, and gender-affirming health care was the top health concern for respondents. HIV discrimination topped the list among legal issues faced by this group. More than half of survey respondents lived on less than US$ 12,000 per year. This reflects the fact that two-thirds were people of color, Tiommi noted. In addition to the experience of racism, almost 60% also reported workplace discrimination because of their gender identity.

Transgender Latinx also face these issues, Arianna Lint of the Well Project added. These problems are compounded by language barriers and a fear of the U.S. immigration agency (ICE). Latinx are afraid to access clinics because they worry that their immigration status will be shared with ICE. That fear is especially acute for transgender people who arrived in the U.S. because of threats to their lives in their home countries. In Latin America, the life expectancy of a transgender woman is 35 years, Arianna said. Globally, 27 murders of transgender people were reported last year.

In addition to individual acts of violence, policies and laws inflict structural violence on transgender people, Naina Khanna of PWN-USA noted. These include laws that target people for their gender presentation or identity, as well as anti-discrimination legislation that excludes gender identity. Besides the gender-free bathroom bills that are under attack, the following laws are on the table in state legislatures: exclusion of transition-related care from health insurance, prohibition of changing the gender listed on one's birth certificate, legal denial of access to public facilities and services based on "religious freedom" and prohibition of access to school locker rooms and restrooms. On the federal level, removing transgender as one of the protected categories under the Title IX anti-discrimination law for students is also being debated.

"The current administration and the current Congress are no friends to many communities we care about, including women of trans experience, people of trans experience, and certainly including communities of color," said Khanna. She asked readers to call their local LGBTQ organization for information about the legislation proposed in their state and opportunities to help oppose those laws.