Trans People and HIV: An At-Risk Population the World Ignores
A new report by a leading HIV/AIDs research group highlights that trans people are at particular risk of contracting HIV, but they are not often recognized as an at-risk group. Why is this, and what can we do about it?
In its new report, called “Trans Populations and HIV: Time to End the Neglect“, The Foundation for AIDS Research (amfAR) details how trans people can be one of the most burdened populations when it comes to HIV.
By carrying out a systematic review of studies published between 2000 and 2011, the amfAR research found that about 19.1 percent of trans women worldwide may have HIV. The limited amount of data we have on HIV prevalence among trans populations (more on that and the weaknesses of this study below) suggests that in terms of global numbers, trans women are as much 49 times more likely to have HIV than the general population.
Perhaps more shockingly, the United States appears to have an average level of HIV prevalence that is higher (at 21.6 percent) than in what are considered low and middle income countries (17.7 percent). That said, some reports suggest that trans men in the United States are less likely to contract HIV than trans women, but that the figure is still higher when compared to the general population. Moreover, those classified as black trans women are nearly three times at greater risk than white or Latina trans people.
Why are Trans People Vulnerable to Contracting HIV?
The report identifies several factors, including low self esteem which can lead to risk-taking behaviors, sexually risky behaviors including sex work, and, interestingly, intravenous drug use — but not necessarily of the kind (like heroin) that we would normally associate with an increased risk of contracting HIV.
The report notes that trans people, facing incredibly high medical treatment bills, may turn to the black market in order to secure the hormone treatments they need to live gender aligned. As a result, they put themselves at risk of contaminated drugs or may be more likely to reuse contaminated needles. In a similar way, trans people may be more likely to seek out body modification practitioners who, with things like injectable silicone, may again increase their risk of contracting HIV.
The report also identifies a number of impediments to tackling HIV rates among trans people. A chief problem is a lack of awareness about the issue among the general public and a lack of attention from world governments. For instance, the report found that in 2012, only 43 percent of countries even had national HIV plans that specifically included trans people in their strategies, though some nations like South Africa have recently taken steps to address this issue.
Another barrier to adequate treatment is also that mainstream health services can often be hostile environments for trans people. Discrimination and a denial of services can be an issue, as we noted just last week in the story of one trans woman from Illinois who was denied hormone treatment despite the fact that the Affordable Care Act means healthcare providers cannot discriminate on grounds of gender identity. Previous research has shown that nearly one in 5 trans people in the United States have faced health care related discrimination at some time in their lives.
This may mean that trans people are less likely to get tested for HIV, that they will often forgo medical treatment, and that due to the disproportionate levels of poverty they face, may not be able to obtain the specialist care they might need.
The Drawbacks of this Research
There are some important caveats to this study. Firstly, most of the data available for this review focuses on trans women. Trans men and gender fluid people aren’t well represented in literature and in particular HIV studies tend to overlook them, so when we say the trans population we may in fact be talking more about trans women.
There’s also the fact that much of the current available data, and a significant proportion in this review, tracks trans people engaged in sex work. While that may have elevated the numbers when it comes to overall HIV prevalence among trans populations, there is enough data to at least say that HIV is a problem for the trans community, and one that is not being addressed by HIV strategies.
What Can We Do to Help Trans People Fight and Deal with HIV?
After looking at this data, amfAR makes several recommendations. Chiefly, HIV awareness campaigns must elevate transgender issues and make them central to prevention efforts. That will include reaching out to trans communities and working with them to reduce their HIV risk. Funding, too, must be increased and funds should be allocated specifically for trans-outreach: this can take the form of ensuring that trans-supportive healthcare settings are created and well maintained, and that access to sexual health services and mental health services are all readily available for all trans people. Healthcare workers should also receive specialist training so they can give high-quality and professional care to trans communities.
To facilitate all this, though, amfAR says that lawmakers and governments must dedicate themselves to creating laws that reduce stigma, discrimination and social barriers, for instance employing specific legislation to combat the high levels of joblessness and homelessness (for instance ENDA) that trans people face.
It’s only through this multifaceted approach that HIV awareness groups believe we can significantly reduce overall HIV numbers, but particularly those among minority populations. Sadly, and yet again, this research shows just how deadly and pervasive discrimination can be.
If you would like more information specifically relating to HIV support services for trans people, please click here.
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