Imagine surviving childhood trauma, sexual assault, homelessness, an HIV-positive diagnosis, and multiple suicide attempts. That’s a snapshot of the life of one Amida Care member, a transgender woman of color living in Brooklyn.
Unfortunately, her story is all too common for people of transgender experience and gender-nonconforming individuals. Transgender individuals experience higher risk for violence, murder, and suicide, and triple the rate of unemployment compared to the general population. They also face overwhelming barriers to accessing quality, culturally competent health care, including stigma, discrimination, and a lack of knowledge about the community’s health needs.
A symptom of these socioeconomic and health disparities, the HIV epidemic disproportionately affects the transgender community — transgender women are 49 times more likely to be living with HIV than the general population. New York City and State are working to find solutions to these issues, which must also be addressed by health care professionals and government leaders across the country.
PERSPECTIVE: Transgender Awareness Week
With Transgender Awareness Week having concluded this past Monday, it is particularly timely to emphasize the need for advocacy for the rights of the trans community. Health care is a right, not a privilege. It’s critical to ensure that trans individuals are able to receive respectful, high-quality, culturally competent health care, including gender-affirming services, access to HIV prevention methods, HIV testing, and linkage to treatment. Being engaged in treatment and care is essential for people living with HIV to become virally suppressed, which means they have the chance to live longer, healthier lives and cannot transmit the virus to others. More than one third of New York City’s trans women living with HIV were not retained in care in 2014, and negative experiences with health care providers are a contributing factor to that fall-off. If trans individuals feel uncomfortable and unsafe visiting their health care provider, they are unlikely to return.
Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are highly effective in preventing HIV-negative people from contracting HIV, but access still remains a significant issue, often due to lack of insurance. As of November 1, New York State Medicaid Special Needs Health Plans (SNPs) expanded to accept transgender HIV-negative New Yorkers. Previously, New York SNPs only enrolled eligible individuals who are HIV-positive or people who are experiencing homelessness.
The expansion enables Amida Care, the largest of the three Medicaid SNPs in New York, to help HIV-negative transgender individuals stay negative. Amida Care has a long history of helping the transgender community — which comprises seven percent of its total membership — access high-quality, culturally competent health care. It also works with community-based organizations to help members access support for housing, employment, and legal issues. Amida Care recently partnered with Community Healthcare Network to devote a day of the seventh annual Transgender Health Conference to educating health care professionals about culturally competent transgender care.
Community-based health organizations have been working with New York City and State to push for smarter and better policies to help make the end of AIDS a reality for the trans community and all New Yorkers. Funding to end the AIDS epidemic has brought the number of new HIV infections down incrementally in New York State, from 2,509 in 2013 to 2,436 in 2015, but much more work needs to be done to reach the goal of fewer than 750 new HIV infections by the year 2020. By investing in the comprehensive care needed to keep people living with HIV healthy, the government can save millions in costly hospitalizations and in-patient care. Preventing one new HIV infection can save as much as $500,000 in lifetime medical costs.
Attention to transgender health care must go beyond HIV treatment and prevention. Health care must take a holistic approach that empowers individuals to access the full spectrum of care and services that are needed to live authentic lives. We also need policy reforms that break down barriers to gender affirmation so that transgender individuals can live authentically. In 2015, a New York City Council bill took effect allowing transgender individuals to more easily change their gender on their birth certificates by eliminating the surgery requirement. Since then, more than 730 change applications have been approved, a dramatic increase from the approximately 20 change applications approved annually prior to the bill’s implementation. Accurate identification for transgender individuals is critically important to access employment, housing, and health care.
New York City and State are at the forefront of a national conversation around transgender health, but broader progress depends on others stepping up. New York’s initiatives can serve as a model for the nation and can be adapted to meet the distinct needs of specific cities and states. Efforts to provide competent care and improve health outcomes for trans individuals are essential not only to end the HIV epidemic but also to ensure that they can live their best, healthiest, and most authentic lives.