The Trump Administration may have a particularly difficult time reconciling its plan to end the HIV epidemic with some of its own policies on the ground. In fact, the people most likely to have HIV in the United States are frequent targets of Trump's derision, culture-war fights, and policy agendas to deprive them of resources or legal and administrative status as protected classes.
One such group is trans people, whom the administration has tried to undermine by removing protections in public schools as well as banning from serving in the military. These issues have many trans activists wondering how they fit in a plan to end the HIV epidemic in the United States. The HIV.gov website declares, "Today we have the right data, right tools, and right leadership to end the HIV epidemic." On one level, this is true. Once-a-day pills are easy to take and can extend life expectancy to near normal levels, and if one becomes undetectable, one cannot transmit the virus to others. With federal programs like Ryan White to provide care to those without other forms of insurance, getting access to care would seem easy. And yet, people are still dying of HIV-related causes in 2019. Coming from an administration that has made it clear in public policy that it does not intend to extend civil rights protections to transgender people, trans activists are wondering how this plan will benefit their communities.
I spoke with transgender activist Arianna Inurritegui-Lint and her colleague, Natalia Pabón at the National HIV Prevention Conference in Atlanta, where officials from all the federal agencies involved in implementing the national "Ending the HIV Epidemic" plan discussed their strategies to implement this plan, which will focus resources (that have yet to be allocated) in 48 counties and five states that represent over half of all HIV diagnoses nationwide. It seems as though much of that funding will be granted to health departments, centers for AIDS research, and, potentially, community-based organizations. Inurritegui-Lint and Pabón, who attended the conference as representatives of Arianna's Center -- a nonprofit organization that serves the trans community of South Florida -- expressed doubts that the resources will go to support trans people having access to prevention, treatment, and care, given some of the administration's recent policies.
"In order to eradicate the virus, we have to be realistic and understand that [Trump administration officials] don't even grasp what the transgender community is all about," said Inurritegui-Lint, a migrant from Peru who attended law school in her home country before migrating to the U.S., where she is now pursuing a Master of Social Work degree. She is the organization's founder and namesake.
In 2017, a "banned words list" circulated from the Department of Health and Human Services, which censored terms like "diversity," "fetus," and even "transgender" in the budget documents for the Centers for Disease and Control and Prevention. What's more, in March 2017, this administration removed questions about gender and sexuality from the 2020 census, and just recently Trump banned trans people from serving in the military. Last year, due to Trump's policy of caging immigrants at the U.S./Mexico border, Roxsana Hernandez, a transgender Honduran immigrant, died of HIV-related causes in custody due to border patrol officials not providing her with antiretroviral therapy.
Studies show that trans people are still one of the most vulnerable minority groups to contracting HIV. According to a meta-analysis published in early 2019, 14% of all trans women are living with HIV, and 26% of Latina trans women and 44% of black trans women have HIV. Violence against trans women is well documented, and there has been some community advocacy to end violence against and homicides of trans women. But there is little to no national attention on issues that impact trans women of color's access to housing and health care, and these are often critical. For example, 19% of transgender people living in Washington, D.C. reported being denied medical care at least once in their lives due to being perceived as transgender.
And that discrimination in health care settings and employment has implications for the lives of trans women, quite literally. In the first three months of 2019 alone, three of Inurritegui-Lint's clients have died -- not from transphobic violence, but from HIV-related causes, which ultimately were linked to a lack of access to quality and culturally affirmative care. One of those women was Nyomi Giselle Taylor, who recently died of HIV-related causes due to lack of linkage to care in South Florida, according to Inurritegui-Lint. Velma Poe -- Taylor's mother -- also believes that resources for trans women like her daughter are scarce.
"I was planning to visit my daughter in July of 2019," shares Poe. "I am saddened that she didn't get the help she deserved." Poe told me her daughter moved to Fort Lauderdale in 2012 after graduating high school in Omaha, Nebraska. Poe described her Nyomi as "very courageous and creative. She knew who she was at a young age." Taylor's mother still keeps in touch with her friends and chosen family, including Inurritegui-Lint.
Inurritegui-Lint believes that the lack of resources (e.g., housing, employment, health care, etc.) kills as many people in her community as do homicides.
"This does not get headline news, because transgender deaths rarely get news -- especially if it's not tied to a horrendous murder," she said. "These deaths are a close look at the broken system in this country."
To make matters worse, Inurritegui-Lint and Pabón believe that organizations that are led by men that tend to serve more gay and bisexual men aren't interested in serving the trans community, when they are often the first places trans women will go for testing, prevention, or treatment services.
"These cis-male–led orgs are not supporting the trans community, and they are essentially the problem," said Pabón. "We need to call them out."
Diana Feliz Oliva, now a community liaison with Gilead Sciences, has been advocating for the trans community for over 20 years. She recognizes that if we want to stop HIV in 2030, it is going to take a comprehensive strategy:
"In an ideal world, we would have access to health care," said Oliva. "We also need to address education, housing, employment to really set up trans HIV poz people for success. When I finally transitioned and changed my legal name, it was the first time that I paid attention to my HIV status. After I took my first shot of hormones and changed my name legally, I became more coherent to my health, but it wasn't until my transition."
Any plan to end the HIV epidemic has to include trans women. Housing, employment, and their health care needs outside of HIV are all well documented issues that have to be addressed to engage trans women in HIV testing, prevention, treatment, and care. It seems unlikely that an administration can strip away the few protections trans people have and, at the same time, address HIV adequately. In theory, HIV treatment was available for Taylor, but without her other needs being met, it seems to not have been as easy as taking a daily pill.