By DARBY HICKEY
The District’s annual report on HIV/AIDS data, released June 20, claims to “herald a new era in treating HIV” — and yet there is not a single mention of the impact of the epidemic on the city’s transgender communities.
Without a doubt, the government’s response to the AIDS crisis has improved by leaps and bounds in the past decade. Spurred by community organizing and advocacy, the Department of Health has transformed its performance across an array of categories. From auditing city funds to condom distribution to routine testing, the District has made tremendous progress – as noted by the HIV/AIDS, Hepatitis, STD and TB Administration’s “Annual Report.” Overall new infections are down, AIDS-related deaths are down and the city is spending its own money on evidence-based needle exchange programs after an end to years of congressional meddling.
How ironic, then, that while officials recognized one major area of weakness – increased rates of HIV infection among black women in poor neighborhoods – a swath of D.C.’s women went unrecognized, ignored and excluded from the data and the discussion.
Transgender women – already combating disturbing levels of violence and discrimination in our city – have some of the highest HIV prevalence rates. The federal Centers for Disease Control (CDC) recognize that although “information is lacking,” transgender communities in the U.S. are among the populations at greatest risk for HIV infection. According to the CDC, one meta-analysis of “29 published studies showed that 27.7 percent of transgender women tested positive for HIV infection.” A needs assessment from 2000 found that one in three D.C. transgender women self-reported as HIV positive.
Part of the problem is that transgender women are routinely categorized as “men who have sex with men” – while actual transgender men (some of whom do have sex with other men) are also routinely neglected in AIDS data and reports. According to the Center of Excellence for Transgender Health, the same meta-analysis mentioned earlier “reported a rate of 2-3% (about 1 in 50) among trans men.” This is significantly higher than the overall rate in the US.
Some grassroots organizations in D.C. collect extensive information on transgender clients. However, such data cannot make it up the chain – neither the D.C. Health Department nor the CDC currently have in place mechanisms for properly documenting transgender people living with HIV. Considering that just a few years ago the District had basically no useful epidemiology numbers, some might say that it is an important first step to get any sort of solid statistics. But, since data collection and analysis was being overhauled anyway, it would have made sense to build in mechanisms for capturing transgender information – as well as that of other marginalized groups.
Without good numbers, you can’t do good planning — identifying the communities most affected by AIDS, allocating resources accordingly, etc. Now that there is reliable data, anyone wanting more funding in D.C. explicitly for programs for the transgender community might be told that they don’t have the numbers to back up their request, which is true — but not because HIV is not seriously affecting the transgender community.
Fortunately, the District and CDC are moving in the right direction, thanks to the tireless efforts of advocates locally and nationally. The CDC is taking cues from the Center of Excellence in Transgender Health. D.C. officials don’t need to wait on the federal agency, however. The Department of Health should act proactively to put into place its own systems (modeled on best practices) so that when the next “Annual Report” is released, D.C.’s transgender residents finally will be part of the picture.
Of course, numbers are no magic wand. Every AIDS program in the city must be open and welcoming to transgender people. Police in D.C. must stop confiscating condoms and treating them as evidence of prostitution. And the mayor’s office and the Office of Human Rights initiatives to address discrimination and stigma against transgender people must continue. It is the year 2012 and we know that stopping AIDS isn’t just about statistics and antibodies – social inequality plays an equally important role. But we need all three – human rights, solid data and the latest medicine and technologies – to turn the tide on HIV in DC.
Darby Hickey is a D.C.-based writer. Reach her at firstname.lastname@example.org.