Risk Prevention Misc..



There are few support services available to seropositive Transgendered people. Likewise, mainstream AIDS Service Organizations offer almost no education directed to Trasgendered people. Not surprisingly, there have been few research studies on Transgendered people and HIV. In all of these ways, the transgender communities have been overlooked and only recently has media and society started to access the situation with funding and consulting.

A neglect of this population seems particularly ironic when one considers the results of the research which has been done on Transgendered people and HIV. A study in Atlanta Georgia found that 68% of Transgender sex trade workers sampled were seropostive. Similar research in Rome discovered that 74% of Transgendered people surveyed were seropositive.

With this information it has made Vancouver BC's Downtown Eastside the fastest growing number of HIV incidence in North America and considered by Health Officials to be of epidemic proportions and have only recently called it a medical emergency.

The high incidence of HIV within transgender communities must be understood in relation to the everyday problems faced by the Transgendered. HIV is much more than a virus; it should be situated alongside some of the most pressing issues Transgendered people face:

Sex Work;
Some transsexuals use prostitution as a means to survive financially. Prostitution can provide money needed for hormones, electrolysis and surgery. It can also be a way for a transsexual to affirm her or his identity and choices.There are a number of factors which could put sexworkers at increased risk for contracting HIV;

*some people may consume alcohol/drugs while working and make decisions while in an unclear state.
*some people may have unsafe sex for more money.
*many Transgendered sex trade workers state that they always use condoms with their clients, but rarely with their primary male partners.
*transgender sex trade workers are at high risk for violence and assault on the street. In one study 35% of transgender survey respondents had been sexually assaulted by a client in the past year.

Transsexuals can lose their homes once they begin to live in their chosen genders, due to a hostile landlord, an unsympathetic family member or a confused lover. This is perhaps true for Transgendered youth, who may be kicked out of their homes. Finding a new place to live may be difficult and Transgendered people are regularly refused entrance into youth and homeless shelters. This creates a situation in which Transgendered people need to make money quickly for shelter. Prostitution can offer one means of financial security. Along with one night stands that can lead to temporary nightly housing and one night stands in bath houses also become a hazard of this lifestyle.

Identifying oneself as transsexual or Transgendered is an extraordinarily difficult process. We live in a world where little boys are expected to grow up and become men, while little girls will grow up and become women and mothers.

A Transgendered person experiences conflict between who and what they are expected to be and who they really want to be. Isolation, loneliness and insecurity can contribute to a Transgendered individual's low self-esteem, as can the social stigma associated with transsexuality. Some Transgendered people may use alcohol and/or drugs as a way to cope, or as a way to deal with one's depression. Many Transgendered people consume alcohol or drugs because they do not want to acknowledge their transsexuality. Others drink before going out cross-dressed in public. And then there are those individuals who live on the street who may use alcohol or drugs to deal with the hardships of street life, or even just to keep their bodies warm. Street Transgendered people often end up in a vicious circle, trying to make enough money for surgery, electrolysis and housing; using drugs to cope with these pressures and spending a great deal of their money on their addictions.

There is a wide range of sexuality's within transgender communities. Some Male to Female transsexuals are attracted to men and consider themselves to be heterosexual. Like wise some Male to Female transsexuals find women attractive and call themselves lesbians. Female to Male transsexuals may also identify themselves as heterosexual, gay men. bisexual or asexual. Transsexuals and transgenderists who in some way identify as queer - male to female transsexuals who are lesbians or bisexual women, female to male transsexuals who are gay or bisexual men - face increased isolation within lesbian and gay male communities. Some lesbian bars and groups refuse entry to transsexual women. Similarly some gay men express contempt and disgust for female bodies and are not open to involvement with Female to Male transsexuals who do not have a penis (or even those who do). The rejection queer transsexuals face within mainstream lesbian and gay communities further compounds issues of self-esteem. Transsexuals may have difficulty finding sexual partners within these communities. Furthermore individuals may not practice safe sex with lesbian and gay male partners or may not feel comfortable negotiating safe sex with them, because of these self-esteem and rejection issues.

HIV Prevention
Transgendered People:
Specific Needs and Concerns
-Preventing the transmission of HIV the virus thought to lead to Aids, is a concern for everyone. The basic rules for preventing the transmission of HIV apply to Transgendered people: avoid any unprotected contact with body fluids (blood, semen, vaginal fluids or urine).

Male to female transsexuals who still have a penis for instance, still have to cover it with latex before any penetration, so that no pre-ejaculatory fluids are transmitted. Similarly

Female to Male Transsexuals need to make sure they do not expose their partners to vaginal fluids or menstrual blood.
-As outlined above, there are a variety of social factors which impact on the sexual behavior of Transgendered people and which may place them at increased risk for contracting HIV. In addition to these factors, there are some sociological and physical questions which may explain a high incidence of HIV within transgender communities.

Among these questions are:

Excessive dosages of hormones, unmonitored by a physician
Transsexuals and transgenderists have trouble finding doctors who will prescribe them hormones. Many people turn to underground markets for their supply. Individuals who obtain hormones in this manner are generally not monitored by a physician as to the potential negative side effects of their hormones. Often transsexuals take large doses of hormones in the hopes of changing their bodies more dramatically or more quickly. More over, transsexuals are often not completely honest with their physicians about the dosages they take for fear of no longer being able to access hormones through that physician.
-The use of hormones can involve some minor and potentially serious consequences, including significant changes in cholesterol and blood sugar levels, problems with circulation (phlebitis), nausea and mood swings. For these reasons it is recommended that transsexuals and transgenderists be monitored by a physician. It is also important that a good working relationship be established with a doctor, sot that an individual can be honest about the hormones they may obtain from a underground market.
-There is not available research on the long-term effects of using hormones. However since hormones change the chemical composition of the body, it is possible that they also impact on one's immune system and general state of health. Such a possibility could be directly relevant for a seropositive person. who needs to be aware of any possible reasons why her or his immune system may be compromised. Once again there is an urgent need for studies on this matter.

Injection hormones obtained through an underground market
-Hormones are available in three forms; pills, patch & injection. HIV may be transmitted when transsexuals share needles to inject themselves, their roommates, their lovers and/or their clients with hormones. To date no Aids education programs address this issue. Many transsexuals inject themselves and others with hormones without identifying themselves as injection drug users. In many instances, these individuals do not make use of needle exchange services. The needs of this population are not being addressed by current needle exchange Aids education programs.

Tucking and skin abrasions
-Male to female transsexuals and transgenderists who still have a penis need to hide it from view. To do this, the penis is stretched back between the thighs, reaching back towards the individual's anus. Transsexuals may wear a special piece of fabric (a"gaff") to make sure that the penis remains hidden from view.
-The act of hiding one's penis is referred to as "tucking." It is especially necessary when a person wears a short tight dress or skirt. Tucking can have some minor consequences, however: the skin of the penis, as well as that on the inner thighs, can become rough, abrasive and cracked. The possibility of broken skin creates some special concerns around the transmission of HIV.
Transsexuals who have skin abrasions need to make sure that no one ejaculates on or near their genitals, since HIV could enter the bloodstream from a partner's ejaculatory fluid through these breaks in the skin.

Surgically constructed vaginas
-There is no research on the risk factors associated with the transmission of HIV in the case of a vagina which has been surgically constructed. We do know, however, that there are some particular physical conditions of post-operative Male to female transsexuals, and that these could explain how an individual contracts HIV.
- Most surgically constructed vaginas are created by inverting the penis. I the case of a small penis, scrotal tissue may be used to create adequate vaginal depth.
Before having genital surgery, a Male to female transsexual may need to remove all hair on the scrotum, since this excess skin lines the walls of the new vagina.
The possibility of hair in the vagina may cause discomfort during sex and may lead to small rips or tears in the skin through which HIV can enter the bloodstream.
-Most surgically constructed vaginas are not self-lubricating. Transsexuals who enjoy penetration should use a water-based lubricant to avoid tearing the vagina.
- Some vaginas are created using a piece of the colon which lines the vagina and provides lubrication. Individuals who have had this kind of operation need to be especially careful when engaging in sexual activity. HIV may penetrate the lining quite easily, as the tissue is more absorptive than skin.
- Transsexuals should make sure their male partners wear condoms before having sex. Sex toys (dildos) should also be covered with a latex condom. People should also use
latex gloves and lots of water-based lubricant for any hand-genital penetration (fisting).

- Male to female transsexuals remove facial and body hair permanently through electrolysis. Transsexuals should ensure that their electrologist follows proper hygiene and sterilization procedures. The electologist should wear latex gloves to prevent the transmission of HIV, as well as Hepatitis. All the equipment used in electrolysis should be sterilized before use (i,e., tweezers).
- There are three primary methods of sterilization:
Chemicals, in which equipment is immersed in a chemical solution.
An Autoclave, a small oven which "bakes" the equipment at a temperature sufficient to burn off all viruses.
Glass Bead Sterilizer, in which small glass beads are heated and the instruments are placed among the glass beads to kill any viruses.

-The Canadian Organization or Professional Electrologists (COPE) recommends that electologists give each client their own needles; these are used only for that person.

Other electrologists use disposable needles, which are used once and thrown away. COPE requires that practitioners who wish to be a member of the COPE association use disposable needles.

- We're just beginning to think about what HIV/Aids means to TRANSGENDERED people - how we're at risk and why we've been over looked until now. It is evident that we are in need of further research in this area, which focuses on TRANSGENDERED bodies and lives in the context of HIV/Aids.

- These pages are intended as an introduction to the issues of HIV/Aids for TRANSGENDERED people. You may however, have additional questions. If you're a seropositive TRANSGENDERED person, or a health care/social worker who is trying to find TRANSGENDERED -positive resources for a client, feel free to contact us at High Risk Project (HRP).



HIGH RISK PROJECT SOCIETY 449EAST HASTINGS STREET, VANCOUVER B.C., V6A 1P5 Tel;(604)255-6143 - fax;(604)255-0147 - email; hrp@direct.ca

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