HIV/AIDS
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.
Homelessness;
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.
Addictions:
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.
Sexuality:
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).
Electrolysis
- 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.
Conclusion
- 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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