HIV Risk and The Transgender Population

Those who identify as transgender make up a segment of our population that has an extremely high HIV risk. While making up one percent to five percent of the general population the transgender community has an HIV infection rate that some experts estimate as low as 15 percent and as high as 60 percent. Yet finding medical resources, support, and HIV education can be difficult. Let's take a look at HIV in the transgender community and see if the lack of resources contributes to the high HIV risk.

Transgender Defined

The term transgender is actually an umbrella term that encompasses a variety of gender expressions including:

• Crossdresser
  One who wears clothes usually assigned to the opposite sex

• Bi-gender
  Those who feel their gender identity encompasses both male and female.

• Transexual
  Those who find their gender identity is in conflict with their anatomical sex. These individuals feel their physiological body does not represent their true sexual self.

The Statistics...What the Numbers Show

Accurate statistics are hard to assemble. Because of social stigmas, issues of disclosure and problems with defining identity, accurate data is hard to collect. Some studies have been conducted and the numbers are frightening. While the figures vary from study to study, the incidence of HIV in the transgender community is nonetheless far too high.

• A study in Atlanta collected data among transgender sexworkers and found 68 percent of them were HIV infected.

  A Collection of HIV Facts

• There have been a number of studies conducted in San Francisco. One study surveyed transgender people seeking hormones in a public health setting. Of those, 15 percent were HIV infected. In a more recent study, 35 percent were found to be HIV positive.

• A study in Los Angeles showed 22 percent of transgender people were HIV infected.

What Contributes to the High HIV Incidence?

While transmission routes in the transgender community are much the same as any other population, there are some factors that place those who identify as transgender at a higher HIV risk.

• Prevention
  Because of disclosure fears and risks, identifying and finding the transgender community is difficult. This in turn makes it difficult to target prevention messages to the transgender community. In addition, prevention messages are often biased according to gender. If one doesn't identify as that gender, the prevention message may not be received at all.

• Physiologic Health
  Often those who identify as transgender perceive their anatomical "parts" differently than the medical community would. Without a common point of reference, health promotion and education becomes difficult. For example, an anatomical male who identifies as female may refer to his anus as his vagina. The medical community is seldom sensitive to this identification, making health promotion and education difficult.

• Sexual Risks
  Those identifying as transgender often experiment with their own sexual orientations and attractions. In addition, many are involved in money for sex in an effort to support substance addictions or to make money for the purchase of necessary hormonal therapy. Some reuse or share needles to inject their hormones because of the insurance industry's unwillingness to cover hormonal therapy. Like any population, these sexual behaviors and sharing of needles increase HIV transmission risk.

  State Drug Assistance Programs

Issues With HIV Care

Caring for people living with HIV is very difficult, regardless of who you are. But those indentifying as transgender face even more hurdles in getting the care they need. Two of these hurdles include:

• Sensitivity
  Finding a medical provider who is sensitive and aware of transgender issues is difficult. Many transgender people avoid medical care because they have a hard time finding providers sensitive to their needs.

  Culturally Sensitive Care

• Hormonal Therapy
  Hormonal therapy is an essential part of a transgender person's healthcare. Unfortunately, many insurance companies don't pay for hormonal therapy. Many AIDS Drug Assistance Programs (ADAP) refuse payment as well. Finding safe ways to get the hormones they need and the clean needles they need to inject the hormones is a daunting task that can lead to sex for money, sharing needles and substance use.

What Can Be Done?

Like all problems, much can be accomplished through education. Examples of what is needed include:

• Providers must be educated as to the needs of the transgender community.

• Insurance companies need to be educated regarding the importance of hormonal therapy, the ramifications if hormones are not a covered drug, and the need to include coverage for hormones in their drug programs.

• Prevention messages and education needs to be targeted to the transgender community in a manner that is sensitive to their needs, concerns and fears.

• Providers must provide a safe place for those identifying as transgender to disclose their gender identity.