11/04/2014 04:06 pm ET Updated Feb 02, 2016

In Our Fight Against HIV, LGB is Not Enough ... We Must Include the "T"

(co-authored by Marcel Byrd, Summer 2014 GMHC intern)

Advocacy for the health and safety of LGBT communities can't just be about adding the "T" at the end of our priorities. The needs and experiences of transgender people must be at the forefront of our agenda. This year, actress and activist Lavern Cox brought unprecedented mainstream attention to the lives and experiences of transgender people, and the transgender community also achieved several long-fought policy victories. For example, Medicare was expanded to cover gender affirmation surgery and New York State now allows transgender people to change the gender on their birth certificates without proof of surgery. Even with these advancements, transgender people still face incredible threats to their health, including a grossly disproportionate burden of HIV. In fact, 1 in 5 transgender women in the U.S. is estimated to be HIV positive, compared to 1 in 32 black, cisgender women--the next highest at risk group of women. On a global scale, transgender women are 49 times more likely to be living with HIV than the general population.

What makes transgender people, especially transgender women, so much more at risk? We know that discrimination and transphobia play a huge role. The National Transgender Discrimination Study found that transgender people in the United States experience twice the rate of unemployment of the general population. Additionally, over one-quarter reported high rates of postponing medical care because of discrimination, and 48 percent said they could not afford needed medical care. Nearly two-thirds experienced serious acts of discrimination and violence, such as physical and/or sexual assault, and approximately 41 percent attempted suicide. These and other statistics illustrate the effects of a world in which transgender individuals are misunderstood, feared, persecuted, and face life-threatening discrimination and violence.

The result? Many are caught in webs of inequality and injustice, which leads to higher rates of substance use, unprotected sex and, in some cases, sex work for survival. These are among the reasons why transgender people in the United States have STI rates four times higher than the general population. The solution includes increased funding for programs and services specifically designed to meet their needs, as well as public policy that addresses the structural drivers -- the social, legal, cultural and economic context -- of the HIV epidemic among transgender populations.

Transgender people lack the social and political attention that lesbian, gay, and bisexual people have obtained since the birth of the gay rights movement, particularly when it comes to health care. Leveling the playing field will provide greater health care access, reduce health disparities, and decrease overall costs to both health care providers and patients. However, in 42 states it is still legal for health insurance companies to discriminate against transgender people. While we celebrate the hard fought policy changes we have seen this year, we must not become complacent. We need policies that support the health and well-being of transgender people nationwide.

Historically, many national HIV-related initiatives and advocacy efforts have targeted men who have sex with men (MSM). However the rate of HIV infections globally among transgender people is actually higher than that of MSM, intravenous drug users, and sex workers -- the three other populations most at-risk for contracting HIV. Fortunately, there is an abundance of organizations already working to provide care for those affected by HIV in the U.S. The infrastructure already exists that can support transgender-specific initiatives. We need these agencies to prioritize prevention and treatment for transgender people and the funding to make it happen.

Gay Men's Health Crisis (GMHC), the world's first provider of HIV prevention, care and advocacy is committed to ensuring that transgender people feel welcome and are included in its programs and services. For example, this year it created The Alliance for Gender Identity & Expression Advocacy (AGIEA), a committee of staff and clients committed to improving the quality of life for transgender and gender non-conforming individuals at GMHC. AGIEA has ensured cultural sensitivity around the gender-related questions asked during GMHC's new client intake process and has also reviewed HR policies and procedures to ensure transgender and gender non-conforming issues are addressed. Currently, the group is updating agency signage so that it's more trans-inclusive and developing transgender and gender non-conforming cultural competency training for all GMHC staff.

While this kind of capacity building is critical, culturally competent HIV/AIDS services organizations and programs are not enough to address the disproportionate burden of HIV among transgender populations. We must also create a society in which gender diversity is understood, advocated for, and celebrated. Until that happens, these cycles of discrimination, violence and HIV infection will remain. And while policies that allow gender changes on identity documents and ease access to gender-affirming medical care are only part of the solution, they're one hell of a start.