Almost 20% (exactly 19.1%) of the world’s transgender women live with HIV (according to the Human Rights Campaign), with the percentage lower (though still at 17.7%) among trans women in low-income and middle-income countries (according to Stefan Baral, Tonia Poteat, Susan Stromdahl, et al, 2012, in “Worldwide burden of HIV in transgender women: a systematic review and meta-analysis”). This – it can therefore be said – highlights how HIV is indeed a big issue in the trans community.
All the same, said Michael David C. Tan – editor in chief of Outrage Magazine, and executive director of Bahaghari Center for SOGIE Research, Education and Advocacy, Inc. – this population continues to be largely neglected.
In the Philippines, for instance, August 2021 data from the Department of Health (DOH) showed that only 2% of the newly-infected cases involved transgender women. “This is, nonetheless, deceiving,” said Tan, since “it is worth noting that for many years, trans women – for example – were considered as men who have sex with men. This erasure meant that they were not specifically mentioned; and so their issues were not specifically addressed.”
For Jaya Jaud – vice president of the Mujer-LGBT Organization, Inc. and vice chairperson for Mindanao of the Lakanbini Advocates Pilipinas, Inc. – it helps that trans people, particularly trans women, are now among those considered as key HIV populations. This means that “there are at least some efforts to emphasize trans people’s needs,” she said.
Jaud specifically delivers HIV-related services in communities in Zamboanga City; and there, “we deliver all the interventions,” she said, from HIV testing to provision of antiretroviral medicines to those who test HIV-positive (and even “ensuring that they are adherent to taking their medicines”) to providing pre-exposure prophylaxis (PrEP).
STILL NOT ENCOMPASSING
But Magdalena Robinson – chairperson of the DANGAL Pilipinas National Network of MSM and TG, and president of the Cebu United Rainbow LGBTQI+ Sector Inc. (CURLS) – said that when it comes to rendering HIV-related services to the trans community, “I don’t want to use the words ‘doing enough’.” This is because while it is true that there are trans-specific HIV-related endeavors right now, but “it’s more like a ‘trial and error’ for me.”
Robinson lamented that while discussions on this are many, actual efforts are lacking because – for her – identifying trans people and thereby their needs continue to be academic. This is why “there’s an advocacy we want to push – i.e. coming up with a trans framework – to provide comprehensive solutions to the needs of trans people in the Philippines.”
To date, though, this framework has yet to be developed, much more passed and implemented.
HIV is also still largely considered as a medical concern – i.e. existing efforts focus on preventing getting infected with HIV (e.g. taking PrEP), HIV testing, and accessing ARVs if one is HIV-positive.
But both Jaud and Robinson said that HIV is – indeed – not just a medical concern.
For the Centers for Disease Control and Prevention (CDC) in the US, many issues make trans people have higher risk for HIV infection. These risk factors include “higher rates of drug and alcohol abuse, sex work, incarceration, homelessness, attempted suicide, unemployment, lack of familial support, violence, stigma and discrimination, limited health care access, and negative health care encounters.”
For Robinson, at least trans women are already included in HIV-related data (i.e. thus the knowledge on the severity of HIV among trans women in particular). But the use of available data is “an entirely different thing together”. Particularly, “I think the trans community needs to be empowered and capacitated to use (the available data) because they should be the priority (on who will) take action on the problems within their community,” she said.
Jaud, meanwhile, stressed other issues affecting the trans community that also affect HIV-related efforts – e.g. mental health issues of trans people that affect health-seeking behaviors; engagement of some trans people in sex work, which does not only put them at higher risk for HIV infection, but – for those who are not involved in the sex industry – affected perceptions of PrEP as “something used by those in the sex industry”; gender-based violence due to the absence of trans-specific anti-discriminatory policies that put trans women’s lives in danger; and so on.
Even in the trans community, others may still feel excluded – e.g. trans men and how HIV may also affect them.
To ensure “that no one is left behind, I think it’s important for the trans men community to step up and find areas of engagement,” Robinson said, adding that the neglect of trans men in HIV efforts now is akin to the experience of trans women before. “Really demand from (program) implementers, telling them that we’re also at stake” and so be included in priorities.
Jaud added that if trans women were once considered as “men who have sex with men”, trans men are now counted under “woman”. For her for now at least, “it’s their obligation to take care of themselves.”
Considering all these other factors (some of them apparently linked to HIV, though other not as directly linked), Robinson said that trans people’s issues need to be considered holistically – e.g. when a trans person is not given services to transition, his/her/their health-seeking behaviors are affected (for example they may not go to health care facilities for fear of being discriminated), and this in turn puts them at risk for HIV infection. When considered this way, it starts with “non-recognition of our identities. And because of that, we (are not able to transition properly. From the start), this is a barrier to achieve full wellness… since trans people opt not to avail of services,” she said.
MAKING INCLUSIVE EFFORTS
The continuing ignoring of trans-specific needs could mean that the situation will just worsen, said Jaud. “If the prevalence was low in the past, it will just go higher,” she said.
Admittedly, Robinson said, those working in HIV advocacy are giving support to trans people. “But we are left behind in terms of prioritization,” she said. “There’s a need for a lot of advocacy to be done still. They may be in support of (us) now, but the support is lacking.”
For Outrage Magazine’s Tan, two points are worth highlighting here – i.e. the prompt response of HIV-related service providers to respond to the needs of trans people; and he necessity to include trans voices when coming up with HIV policies and programs that also affect them.
“The government, for instance, only started looking at data of trans people a few years ago. Meaning, for so many years, they were forcibly made invisible. Due to this invisibility, their needs have not been given solutions. Even NGOs continue not to focus on trans people,” Tan said. Also, even now, HIV-related NGOs servicing trans people “at times have the guts to speak for the trans community; meaning, trans people are not given the opportunity to talk about issues specific to them, and how they think these should be addressed.”
In the end, said Jaud, people – no matter their SOGIESC – should be more proactive when looking after oneself, including when dealing with HIV, e.g. community organizing including in barangays (“This is a way to make their voices heard”), getting tested, accessing PrEP, etc. “Let’s take the responsibility (in our own hands).”
As for Robinson, “create some noise, join forums, engage (stakeholders), etc. We need to participate even when we’re not invited. People will just dismiss (us) if there’s no clamor from the community; so make some noise.”