Let me tell you about a woman I met. Let’s call her Trina. On the surface, we have some similarities. A woman of color and a bottle blonde, Trina grew up feeling like she never fit in. Shuffled between family members, she left home early in an effort to be herself, and ended up homeless at one point.
Like my husband, Trina is transgender. Unlike my husband, who grew up in a white middle-class family and has a master’s degree, she doesn’t have insurance (yes, even in this age of Obamacare), worries about paying for her hormones, and has had to do many things to be the person she is. That includes turning the odd trick or two.
Trina has HIV.
When she tested positive last year, it wasn’t a surprise to her or to the other women in her trans support group, which meets at her local LGBT center each Wednesday night. It’s one of the few places Trina feels at home, accepted, able to be honest. And many of the women are also HIV-positive.
Transgender women are 49 times more likely to have HIV than the general population. We first heard this number when The Foundation for AIDS Research (amfAR) released a report in 2014, “Trans Populations and HIV: Time to End the Neglect,” and this summer, the World Health Organization did a new meta-analysis of data from 15 different countries, which again showed that transgender women were nearly 49 times more likely to have HIV than the general population. Both studies argue that trans women are the most at-risk population on the globe. The numbers are even worse for those who are women of color; 56 percent of black trans women have HIV.
According to the Centers for Disease Control and Prevention, transgender women involved in sex work have HIV rates that are almost twice that of trans women not engaged in commercial sex work. They’re also six times more likely to be living with HIV than other female sex workers. Perhaps you’re ready to turn the proverbial page because you think women who do sex work deserve it. They don’t.
My friend Trina gave blowjobs to help pay for the hormones she needs every two weeks. Going off hormones would give her serious medical issues. The waiting list to get into her local clinic was two months. She’s had bad experiences with doctors who refused to treat her because she’s transgender. She’s not alone: The Task Force’s 2011 study, “Injustice at Every Turn,” reports that approximately one in five trans people in the United States has been denied medical care as a result of their gender identity. Trina has also shared injection needles—not for drugs, but at a pumping party, where trans women get low-cost fillers to create a more feminine look in their faces, breasts and hips.
As a once-homeless trans teen, Trina has had to do plenty of things that put her at risk for HIV. But like the majority of HIV-positive people today, Trina became HIV-positive during a relationship that she believed was monogamous. The man she loved was not monogamous—and he was not aware that he had HIV. Today Trina is on antiretrovirals and sees a doctor at a clinic who knows how to treat trans people living with HIV.
Those are few and far between.It’s time for all of us to wake up to this issue. As we revive the conversation around gay and bi men and HIV, it’s time to end this epidemic for trans people too.
In order for all of us—poz or not, trans or not, queer or not—to do right by trans women, we have to do more than tune in to “I Am Cait” once a week. We have to tear down and rebuild the systems that are here to care for trans and gender nonconforming people in a way that really works. We have to remove the stigma of being trans, of being positive, of seeking to take an HIV prevention treatment. That’s only one step, and there are many needed, but simply understanding and truly caring about trans people can take us quite a way.
Diane Anderson-Minshall is editor-in -chief of Plus Magazine and editor-at-large for The Advocate magazine. This column is a project of Q Syndicate, the LGBT wire service.