Older transgenders and transsexuals and HIV: Risk and invisibility By Tarynn M Witten, PhD; AE Eyler MD Ten percent of all AIDS cases occur in people age fifty and older. As with their younger counterparts, people of color are at highest risk, with gay/bisexual men and heterosexual/bisexual women accounting for the vast majority of sexually acquired cases. Research to date has largely ignored the impact of HIV on the "gender community": transsexual, transgendered and cross-dressing persons. Even less is known regarding persons who experience gender identification elsewhere on the theoretical continuum, such as those who exhibit a gender-blended self-perception. In addition, most HIV-related services, both preventive and supportive, do not include "T-friendly" assessment or support. Misperceptions regarding members of the gender community also cause difficulties for persons with non-traditional gender identities seeking healthcare, resulting in delays in entering the healthcare system and the provision of inappropriate services after contact has been made. Because of the social invisibility of the gender community, reports of medical mistreatment reach the media only when breaches of medical ethics are most glaring, such as the case of Tyra Hunter, who died following an assault in 1995. (She had been refused care by the responding emergency services personnel who believed, due to her transsexuality, that she had aids.) Despite the lack of research regarding HIV in the gender community and the paucity of outreach to this population, pilot projects, such as that sponsored by the University of Minnesota, have shown that the many members of the gender community are at high risk for HIV/AIDS, and that culturally-appropriate educational interventions are readily accepted. Our own research has revealed that the majority of male-to-female (MTF) transgenders and transsexuals present for medical gender transition services after the age of 40. (FTMs have often resolved their gender identity issues at younger ages.) In addition, gender identity is often somewhat fluid at earlier ages, and is best represented along a continuum. Previous survey research has identified the following HIV risks which particularly affect the gender community: T-people are frequently dependent on prostitution and "survival sex" for income following the loss of employment during gender transition process, and, due to lack of economic resources, often must rely on non-prescription obtained hormones and silicone preparations and non-sterile injection equipment. For persons in more secure economic settings, the biggest risks for infection stem from the combination of lack of appropriate information regarding HIV prevention (such as the relative risk of sexual activity following sex-reassignment surgery) and the emotional consequences of beginning sexual experimentation in one’s true gender at older ages (which often result in risk-taking behavior, i.e. the "fifty year-old adolescent"). This presentation will familiarize healthcare workers and HIV advocates with the dynamics of HIV infection and treatment issues in the gender community, and will present clinical tools for outreach and service provision to this invisible population. This research is part of the University of Michigan Medical Center Comprehensive Gender Services Program Longitudinal Transsexual and Transgender Aging Research Project. |
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