World AIDS Day, the color red, and how About.com sucks

So, today is World AIDS day. Before I get talking about AIDS stuff, I’d like to make a note of something that’s pissing me off about all these event days: the color of your shirt does not actually do anything. Already today I had someone reprimand me for not wearing red. I have one red shirt, and it’s dirty, get over it. This is the third thing like this that’s happened since the beginning of the semester. There was “wearing purple magically ends bullying” day, and “wear every color of the rainbow over the course of the week because that somehow raises awareness for stuff” week (which may have just been my uni, I’m not sure). Unless you have a red shirt that says “World AIDS day”, wearing red does nothing (and frankly, wearing a red shirt with HIV/AIDS statistics on it would be better, or dispense with the color theme entirely and just hand out fliers or someshit). Otherwise, you’re just wearing some shirt and no one knows or cares why.

Now that that rant is over, I can begin the next one.

I really just wanted to look up some general HIV/AIDS statistics for the trans community. I’ve seen a lot of numbers quoted all over the place, but didn’t have any specific articles in mind or saved so I did a quick search. The best I could find was this, which is trans woman-specific. Basically everything else was fail. Most studies focused exclusively on sex workers. A lot of the statistics are horribly broad, giving ranges like 15-68% (of course, 15% is still relatively high). Some of the statistics are African-American specific, yet for some reason claim to represent all trans people (the wording in this article is vague and weird to me, and goes back and forth between talking about just AA trans women and all transgendered people, also note the horrendously wide statistic). There are good studies out there, they have been quoted other places, but they are not very easily found. This is obviously a huge problem for any activist or casual researcher trying to get basic information to share with the public.

In amongst my searching I found a particularly striking example of total fail. About.com’s pages on HIV/AIDS are pretty extensive, but their page on HIV in transgendered people is so craptastic it makes me want to tear my eyes out. What’s worse is that this is the first page I get when searching for HIV rates in trans people. I’m going to spend the rest of this article basically tearing them a new one. Let’s begin shall we?

They begin, as these things always do, by defining transgender. They admit that there are people who identify outside the binary:

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

Except they suck. This term is technically correct, as I have heard it described by people who identify as bigender. However, according to the definitions given, I don’t exist. There are no terms given for people who identify as neither male or female, who identify as having a gender that moves between (and around) male and female, people with neutral genders, or people with no gender. We can only talk about having gender in terms of having a male and/or female gender, apparently. If you’re going to include nonbinaries in your definition, be a little more inclusive please.

They go on to quote statistics, which in and of themselves are not too bad (take a look at them though, especially note where the highest and lowest rates are drawn from. I think they have a lot to say about how class plays a serious role in HIV infection rates). It’s when they go on to account for the higher-than-average rates that everything breaks down and I get really angry.

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.

First sentence: huh? What? Seriously, read that first sentence over again. I’ve never heard this anywhere else and it is completely weird to me. Lots of trans people question their sexuality, wonder about it etc., but that doesn’t automatically entail sleeping with a wide variety of people in some sexual “experiment”.

Second sentence: trans people are sex workers to support drug habits. The paragraph itself concentrates more on sex work to pay for transition and hormone-needle sharing, but the very second thing this paragraph says is that lots of trans people have addictions. Now, I’ve heard the sex work thing raised before, but it is typically explained by the poverty resulting from discrimination. And I’ve heard the “sex workers are druggies” stereotype. Never have I seen this particular combination. They seem to be quoting studies like this one*, but at least this actually cites the numbers and admits the wide range of results among studies (“the extent to which IV drug use is a factor in the transmission of HIV in the transgender community is not clear.”)

*this study is problematic in its own way; 90% of those selected are POC, most of the other studies it cites focus on sex workers, and no questions are asked about sex work or economic status in the interview. I really wonder where they went to collect this sample. One plus: they actually had trans people conduct the interviews.

And another thing: why the hell does needle sharing comprise half the paragraph on sexual risks? I feel like these are unrelated topics.

In the paragraph before, which notes the discrepancy between how medical professionals and trans patients view and may speak about trans bodies, we have this sentence: “For example, an anatomical male who identifies as female may refer to his anus as his vagina.” What the crapping hell? I think I know where this is coming from: some people who engage in anal sex refer to the anus as “cunt” (I’ve never heard it as vagina though). I’ve never seen a trans woman do this, though. I guess it happens. But who would do this when talking with a doctor? I feel like people are smarter than that. Also note the pronoun fail. Someone who identifies as female is not a “he”.

The article then goes on to say this:

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.

Like this website, for example. The article extols the need for further education of medical professionals at the very end, and is itself a really good example of that need.

By the way, you can contact the about.com medical review board and tell them all about how crap this article is. I plan to.

Obama’s AIDS Policy

I may be a bit late to the party here, but I’ve been reading the new National AIDS Policy Strategy and Implementation. Overall I like it, good goals are set and a comprehensive plan is outlined, so hopefully we actually, you know, DO it. It’s a step in the right direction, but it could definitely do better, so I’m going to nitpick the hell out of it.

This report basically ignores two groups that I consider important to any discussion of HIV infection and transmission: trans people and sex workers.

On the first, it’s not that trans people aren’t mentioned in the reports, we actually are: 8 times in the Strategy and 6 in the Implementation. Only two mentions (one each) are independent of a grouping with “LGBT” or “gay and bisexual men and transgender individuals”. It admits that infection among trans people may be as high as 30% (NOT one of the independent mentions, though it does sort of identify trans as a distinct group from “gay and bisexual men”, so let’s call it two-and-a-half), but does not include much in the way of specific protections to help trans people, concentrating its “populations with greatest need” portions on men-who-have-sex-with-men (MSM), black, and latino communities. Looking at the numbers provided, the highest risk groups according to the report are black injected drug users (IDU), 2.7% for black women IDU and 1.8% for black men IDU, and MSM, 1.7% for black MSM, 0.7% for latino MSM, and 0.3% for white MSM. Even if the 30% figure is inflated, it represents a clear outlier. White MSM as the group with the highest NUMBER of infections is a product of sheer mass, and the fact that transpeople didn’t make it to the big graphs in the report is a product of small numbers, but the difference in proportions is shocking.

In terms of the goals of the AIDS policy, goals for transpeople are decidedly lacking. While MSM, black, and latino communities each have a goal of 20% fewer new infections by 2015. The only place where transgendered individuals are mentioned separately in the implementation is to say “By the end of 2011…CDC will expand its work evaluating adaptations of specific interven¬tions for transgender populations and issue a fact sheet recommend¬ing HIV prevention approaches for transgender persons.” Less than 3% population gets a 20% reduction in new infections, but as high as 30% gets a pamphlet? It’s really indicative of how little treatment transpeople have gotten that the government is citing proven prevention methods for other groups in the study, but we still need to do more research on what works for transpeople, and that it’s going to take at least another year to even figure it out.

The policy also fails to address stigma-based infection. While the reports focus some attention on reducing the stigma of being infected with HIV, it does very little with the fact that stigma is often implicated in higher HIV rates and lower survival rates amongst infected individuals. No mention is made of the fact that LGBTQ people that are rejected by their families are at higher risk for HIV infection (Rejecting behaviors in parents and caregivers lead to high rates of depression, substance use, attempted suicide, and high risk for HIV infection). The report does admit that prejudice may be implicated in poorer prognoses for HIV among POC and transpeople, but couples this information with the statement that “Heterosexual providers may not be comfortable asking about sexual history when taking a patient’s history and this may limit appropriate care.” equating harassment, racism, and denial of healthcare to prudish discomfort. And the implementation of the plan makes no suggestions, as far as I saw, for addressing this, the only changes to the behavior of healthcare providers being better coordination of resources. Any comprehensive policy of healthcare should take steps to reduce prejudice people experience from their doctors, so SOMETHING should be included here, at the very least tracking reports of prejudice directed at these programs filed by HIV infected individuals (given that the report already expands regulatory agencies to track effectiveness of programs).

As for treatment of sex workers, there is none. I would love to site numbers that say there should be, but there aren’t any of those either (in the United States…very little information is gathered about workers and their clients. As with Western Europe, many of the HIV cases that do occur amongst sex workers in the U.S. are attributed to injecting drug use rather than sex). In fact, when searching for this, I had to specify “United States” because I kept getting nothing but statistics from Africa and Southeast Asia. We know more about sex workers in Vietnam and Côte d’Ivoire than we do about those in the US. I think this is important, partly because of stereotypes about contracting STD’s (including HIV) from sex workers. It may be that they are not at much elevated risk, as condoms are considered standard fare amongst sex workers (though recent legislation may change that in some places), but surely the report should have contained a request for more information. If we are willing to distribute needles to IDU, than we should be willing to address other illegal activities to reduce HIV infection (other than trying ham-handedly to eradicate them). I don’t even have as much to say here as I did about transpeople, because there’s nothing to quote or pick at at all, just silence.

On a slightly different note: I did find it interesting to see how HIV rates so clearly outlined intersection. Women are slightly more likely than men to be infected, POC more likely than whites, queers more likely than straights, the poor more likely than the middle and upper classes. The only anomaly in this is queer women, which is understandable given the vectors of transmission.