BY DOUG WIRTH, DANIEL DROMM, AND JIMMY VAN BRAMER | In recent years, there have been great strides in treating and preventing HIV and in reducing the number of new HIV infections in New York. Yet HIV is an ongoing crisis in the transgender community, and it often goes unacknowledged.
According to the most recent data from the US Centers for Disease Control and Prevention, 27 percent of transgender women are HIV-positive, and HIV prevalence among transgender women is nearly 50 times higher than among other adults. The epidemic is especially pervasive among transgender women of color — approximately 90 percent of transgender women in New York City diagnosed with HIV from 2007 to 2011 were black or Latina.
What accounts for these huge disparities? One of the most critical factors that impacts transgender women of color is lack of stable employment, largely because of workplace discrimination. Without a secure job and access to stable housing, transgender women of color may turn to sex work as their only means of survival, dramatically increasing their risk of contracting HIV and other sexually transmitted infections and of being the victims of violence.
Among transgender women of color, there is an alarming crisis of violence. The Human Rights Campaign reported that in 2015 there were more transgender violence-related fatalities in the US than in any other year; at least 21 transgender people died as a result of violence last year, and nearly all of them were transgender women of color. Many transgender women of color have experienced physical and verbal harassment, which contributes to depression, substance use, anxiety, and psychological trauma.
It’s undeniable that unstable housing has a direct impact on health outcomes; it’s virtually impossible to stay in care consistently if you don’t have a safe, secure place to live. Unfair and discriminatory treatment by landlords and housing authorities has created a housing crisis among transgender individuals — one in five has experienced homelessness and more than one in 10 have been evicted due to their gender identity in the US. Leaving people without stable housing will lead to new HIV infections and many preventable AIDS deaths.
When it comes to quality of health care, transgender individuals regularly encounter stigma, prejudice, and gaps in knowledge about transgender health. Data from the Human Rights Campaign shows that 19 percent of transgender women of color reported being refused treatment due to their gender identity, and 28 percent said they have been harassed in a doctor’s office. Transgender women who have ID that does not match their gender identity may be embarrassed to enter an environment that will not be sensitive to recognizing their gender identity. As a result, transgender individuals often end up avoiding care altogether. Those who are HIV-positive are less likely to consistently stay on antiretroviral medication that would lower their viral load and help them become virally suppressed, giving them a better chance to live longer, healthier lives and making it much less likely that they would transmit HIV to others.
We have the knowledge and resources to treat and prevent HIV — but we need to turn our attention to the T in LBGT and address this crisis in the transgender community. It is essential to expand the availability of quality, culturally competent transgender health care, ensuring that providers have the training and sensitivity to address the specialized health care needs of transgender individuals and create a safe space for them to access treatment. Care coordination is particularly beneficial for transgender people, as it ensures that care is tailored to the needs of the individual, and it provides supportive services that help people stay in treatment and improve their health. Also essential is access to pre-exposure prophylaxis (PrEP) — a treatment regimen that is over 90 percent effective in preventing HIV-negative people from becoming infected.
The Blueprint to End the AIDS Epidemic in New York State by 2020 highlights the need to address health disparities and the disproportionate rate of HIV infection in the transgender community. More funding is needed for expanded access to HIV prevention and treatment, and trans-specific health programs in particular are often underfunded and overlooked. We must include the transgender community in the health care conversation to open the door to equitable health care and life-saving treatment.
Several community-based organizations and health care providers in New York City are working to provide comprehensive support to the transgender community, including Apicha, Callen-Lorde Community Health Center, Community Healthcare Network, Housing Works, the Lesbian, Gay, Bisexual & Transgender Community Center, Mt. Sinai Hospital, Bronx Lebanon Hospital Center, and grantees of the Amida Care Fund at Stonewall Community Foundation such as Audre Lorde Project, the HEAT Program, and Translatina Network. Amida Care is committed to helping transgender members — who comprise seven percent of Amida Care’s total membership — access respectful, culturally competent care. Provider training in transgender health and HIV prevention methods such as PrEP are essential, as is access to housing options and workforce training.
Quality health care is a right, not a privilege. It is time to acknowledge and break down the barriers that are preventing the transgender community from accessing the high-quality, culturally competent health care they deserve. We can and we must do a better job of reaching this underserved community and help them access the comprehensive care they need. Too many lives are at stake.
Doug Wirth is president and CEO of Amida Care, Daniel Dromm is a member of the New York City Council representing the 25th District in Queens, and Jimmy Van Bramer is the Council majority leader, representing the 26th District in Queens.