"We can't address [HIV] eradication without addressing social inequality," Cecilia Chung told TheBody.com. Chung is the senior strategist at the Transgender Law Center, which works towards changing laws, policies and attitudes towards trans and gender non-conforming people.
In 2015, Chung developed and directed Positively Trans, a project to develop self-empowerment and advocacy by and for trans people who are HIV positive. They developed a survey to identify the needs of trans people living with HIV. Over 400 people responded, and 157 people completing the entire survey. Despite increased positive media attention, they found that trans people remain disproportionately impacted by stigma, violence, criminalization and barriers to resources, including health care.
Of the people who sent in complete responses, 69 percent identified HIV-related discrimination as among their top five priorities. Forty-one percent reported that they had gone six months or longer without medical care since their HIV diagnosis. The most common reason provided? Previous or anticipated discrimination by a health care provider. Other reasons were economic barriers (costs of health care or transportation), not having a health care provider or fear that someone they knew would see them.
Forty-three percent reported earning less than $12,000 per year. In addition, 40 percent did not fully know their rights as a person living with HIV and 44 percent did not fully know their rights as a trans person. Tiommi Luckett, the communications coordinator for the Well Project, notes that these factors are combined. "When you're poor, you have less access to knowledge about your rights," she stated. Those with the least access to resources are also the most hesitant to draw attention to themselves because that attention often leads to discrimination, violence and/or criminalization. Luckett recalled that, to access HIV-related services, she was required to sign a form acknowledging that it is a felony in Arkansas not to disclose HIV to sexual partners. But, she adds, no information was provided about how to disclose or what to do in instances when it may not be safe to disclose. "It was by working with HIV organizations that I learned my rights," she said.
Among respondents, 41 percent also reported having been incarcerated or detained. "More often than not, because we are trans, we are targeted, sometimes simply for walking down the street," stated Luckett. The practice of arresting trans women, particularly trans women of color, as suspected sex workers has become so frequent that it even has a name: Walking While Trans. Several jurisdictions also allow police and prosecutors to use condoms as evidence of sex work, a practice that discourages carrying condoms.
For those who do have access to health care and antiretrovirals, even a short stint behind bars can mean a loss of access to medications and an inability to maintain an undetectable load. Before she was diagnosed with HIV, Luckett spent 12 days in a men's jail in Arkansas. She recalled a trans woman who arrived at the jail with her antiretrovirals. "Jail staff did not allow her to bring her medications in with her," Luckett remembered.
Ending economic injustice and the criminalization of trans people is key to eradicating new HIV transmissions, say Chung and Luckett. "If you've been arrested and have a record, this impacts your chances of economic survival," points out Chung, noting that employers often refuse to hire people with records. She emphasized the importance of efforts such as Ban the Box, which prohibits potential employers from asking about convictions on initial job applications. More than 100 cities have passed Ban the Box legislation and, in 2015, Obama ordered federal agencies to do the same. Chung also calls for wider criminal justice reforms, such as sentencing alternatives, and for non-trans people to help fight against discriminatory laws such as North Carolina's HB2.