Transgendered People: High Risk for HIV, Low Access to Health care

What is required to meet the needs of transgendered people who are HIV-positive or at risk for infection? Because of widespread discrimination, transgendered people are reluctant to identify themselves or to participate in programs to increase HIV/AIDS awareness in their communities. Therefore, reliable information about this group has not been readily available until now.

A 1996 report of the Transgender Advisory Committee to the AIDS Office, San Francisco Department of Public Health, has helped fill in the information gap about transgendered people and their healthcare needs.

According to the Advisory Committee, transgendered people are a high-risk population with underserved medical needs. The Advisory Committee conducted 11 focus groups to determine what kind of prevention and treatment programs are needed.

Focus groups represented diverse transgender styles, sexual preferences, and ethnic background. Despite their differences, transgendered individuals shared many of the same experiences. They tended to have a low self-image and to fear discrimination and insensitivity from the healthcare establishment. Many are unemployed or on some kind of public assistance. They were less likely than other community groups to seek information about HIV from healthcare service workers. The focus groups also revealed the practice of unsafe sex, and participants commented on hidden populations, noting that many transgendered people exist at the poverty level and resort to prostitution out of economic necessity. Alcohol and drug use in this group is also high.

The Advisory Committee concluded that a peer-based approach, like that of Project Soul, would be an effective strategy for educating transgendered people about HIV and drawing them into programs of prevention and treatment. The prerequisite for this, they conclude, would be sensitivity training for people who currently provide health services to transgendered people. In other words, educate the educators first. As one focus group participant put it:

We're an abomination to society, to the medical and health community. Medical and mental health services are not educated about transgender people. If they're not educated, how can the community get educated from them?