U.S. Trans Survey -- Injustice (Still) at Every Turn

The impact that the 2009 National Trans Discrimination Survey (NTDS) has had on the advocacy and activism fighting for transgender equality is difficult to adequately describe. The data contained therein, highlighted the pervasive and deleterious impact of structural and interpersonal transphobia, was instrumental in securing many of the policy wins the transgender equality movement has had in the past 5 years. For myself, engaged in community organizing in the District of Columbia working to improve the way systems and service providers interact with the city's thriving and sizeable trans community, the NTDS was one of my most cited studies. It allowed us the ability to concretely demonstrate the way intersectional identity impacted lived experience and provided a call to action for organizations and programs to protect the most vulnerable among us. The experiences described within -- which aligned so well with the lives of my trans friends, colleagues, mentors, and family -- remain part of the bedrock upon which my advocacy is based.

Given how important the NTDS has been to my work, it was a great honor to be one of the roughly 50 advocates, government officials, community members, and survivors who could attend the in-person launch event for the 2015 US Trans Survey (USTS) here in Washington D.C. on December 8th. Running throughout late summer and early fall of 2015, the USTS is the largest survey ever conducted to examine the lived experiences of trans and gender non-conforming people in the US and build upon the lessons learned from the NTDS. The data collected was designed to be comparable to federal or national datasets, such as those collected from the Behavioral Risk Factor Surveillance System, than the data from the NTDS, with a more representative sample from within the trans community. With nearly 28,000 respondents and thousands of data points, the USTS easily supplants the NTDS as the largest survey of its kind in history and will undoubtedly provide the launching pad for countless additional research projects.

The launch event felt like a family reunion -- it was incredible to see so many activists, researchers, community organizers, and old-guard advocates for trans equality in the same space. Many of the activists who inspire my work and my most influential mentors were in attendance, and in some respects the mood was celebratory. The trans community has made incredible legal and policy gains in the past five years -- often because of the work of many of those in that room -- and is seeing more visibility in media and political spaces than ever before. The USTS, much like the NTDS before it, was eagerly anticipated as a pivotal tool in the fight to build on those gains, and those of us in the room were excited to see the data after a long year of waiting after the close of the survey. However, there was an unmistakable air of trepidation and loss. After a year of "bathroom bills" and unbelievably toxic rhetoric directed at trans people, the gains of the past five years feels vulnerable and at-risk in this shifting political environment. And if this event was a family reunion of sorts, the notable absence of those we've lost -- local activists like Roberta Gills from the DC Trans Coalition, young leaders like Andrew Cray, or the innumerable trans women of color lost to violence since the release of NTDS -- was inescapable. Only a few weeks earlier, trans communities across the country had met to memorialize those lost in 2016 and recommit to those who continue to survive.

A panel of experts -- Sandy E. James, lead survey author and project manager, Mara Keisling, executive director of NCTE, and Sharron Cooks, Philadelphia based community activist -- were convened to discuss the findings, moderated by Columbia Law School's Ashe McGovern. The panel examined some of the key findings, their political and policy implications, and the way these key data points play out in the day-to-day life of trans people in this country. For all the progress that had been made since the NTDS, the survey found:

... disturbing patterns of mistreatment and discrimination and startling disparities between transgender people in the survey and the U.S. population when it comes to the most basic elements of life, such as finding a job, having a place to live, accessing medical care, and enjoying the support of family and community. Survey respondents also experienced harassment and violence at alarmingly high rates.

The compounding impact of multi-focal discrimination is a recurring theme throughout the data. The early impact of discrimination -- with 77% of respondents who were "out" in K-12 settings facing some form of mistreatment, 24% facing physical violence in schools, 13% facing sexual violence in schools, and 17% facing such severe harassment that they were forced to drop-out -- influences the pervasive economic hardship and instability faced by the community.

Barriers to accessing health care, such as those introduced by a lack of appropriate ID documents -- with 68% of respondents unable to update their name or gender markers on any of their documents -- or insurance -- 25% of respondents reported having routine or transition related care denied by their insurer -- contribute to the broad health disparities seen by trans people. Access to health care often does not mean access to quality or culturally competent care, with 33% of respondents who saw a health care provider in the previous year facing some form of discrimination, 24% of respondents having to teach their provider about transgender people to get appropriate care, and 23% of respondents refusing to see a doctor when they needed care for fear of mistreatment.

These health disparities culminate perhaps most starkly in the realm of HIV. Survey respondents were living with HIV (1.4%) at nearly five times the rate of the U.S. population (0.3%), with transgender women facing even greater HIV burden (3.4%). Nearly one in five (19%) of black trans women were living with HIV. As astounding as such disparities are, those of us who work in the field know that the HIV burden can be even more stark in some local communities. The pervasive violence, economic discrimination, and lack of access to education and public accommodation are integral to understanding HIV among the trans community. The mantra that "Housing Is Healthcare", the foundation for housing programs like Housing Opportunities for People With HIV/AIDS (HOPWA), is particularly salient for a community which sees 33% of respondents reporting having ever been homeless and 12% - nearly 4,000 trans people -- reported being homeless in the past year.

This report and the disparities highlighted within, much like the NTDS before it, is incredibly important. The data set is rich and provides researchers and advocates an incredible tool in our fight to reach trans equality. But it is important to note that this research simply isn't enough. The scope is broad and no longer can it be said this population lacks statistically significant sample sizes. However, in its breadth some critical needs can be missed. HIV research around the risks for trans masculine individuals is nearly non-existent, and the findings in the USTS showing that only 0.3% of trans masculine respondents reported being HIV positive seems to support the conclusion that they are not at any heightened risk. Yet more than half of all trans masculine respondents reported a lifetime history of sexual assault, and in a 2015 study by the DC Trans Coalition 5% of all trans masculine respondents living in D.C. reported being HIV positive. Much more research is needed.

The incredible vulnerability of the trans and gender non-conforming community cannot be underscored strongly enough. In D.C. alone, where AIDS United's offices are based, the last few years have seen the murders of Deeniquia Dodds, Deoni Jones, Gaurav Gopalan, Lashay Mclean, and Tyli'a "NaNa Boo" Mack, and an unbelievable number of violent assaults that easily could have been fatal. As we talk about in our 2015 annual report, AIDS United understands that HIV continues through complex and deep-rooted social and economic inequities. We work from within a framework of social justice that centers the impact of racism, poverty, homophobia, transphobia, and the need to work intersectionally. Our friends at the Drug Policy Alliance highlighted on World AIDS Day that we cannot end the HIV epidemic without including the unique needs of people who use drugs in our policy response. This too is true of the unique needs of the trans community. As long as our systems and policy perpetuate the inequity and inequality the trans community faces we will never be able to end the epidemic.

The launch of the USTS and the lived experiences of so many of my friends, family, and partners reflected back at me through the data contained within left me struggling to describe the complex emotions I was left feeling. Even now, a week after the event, I cannot name whether it is primarily hope or sorrow that I feel. But one thing that I know for sure is that I walk away from that event recommitted to centering the lived experiences of our most vulnerable communities in every aspect of my work. It is my hope that, as trans people continue to face structural and interpersonal violence, that this firm commitment to the trans community is shared among those of us working to end the HIV epidemic.

Kiefer Paterson is a syringe access policy organizer at AIDS United.