It's no mystery that having to live with poverty, homelessness, unemployment, drug addiction, or discrimination makes a person more vulnerable to HIV infection. So what are we to make of the fact that, as a whole, transgender people are much more likely than a member of the general population to be facing not just one or two of the problems I've just named but all of them?
Transgender people often live in extreme poverty. A 2011 national survey of nearly 6,500 transgender people found that they were four times more likely than the general population to live on a household income of less than $10,000 annually. Maybe that's because they have rates of unemployment that are twice that of the general population, and nearly all (90 percent) have experienced discrimination on the job that's related to their gender identity or expression. More than one quarter (26 percent) have lost a job due to discrimination related to their gender identity or expression, and nearly 20 percent have been homeless at one point in their lives.
So we should not be surprised to learn that transgender people experience rates of HIV that are four times higher than national averages. And transgender women in particular are extremely vulnerable to HIV. The U.S. Centers for Disease Control and Prevention (CDC) estimates that approximately 28 percent of transgender women are HIV-positive. And a Boston-area survey of transgender women conducted by AIDS Action Committee's TransCEND (Transgender Care and Education Needs Diversity) program, a community-based HIV prevention and health education program run by and for transgender women, estimates that one in three transgender women is HIV-positive.
The need for targeted HIV outreach, education, and prevention to the transgender community is great. And the need for November's Transgender Awareness Month should be obvious. The month is dedicated to educating the public about the transgender community and the pressing issues facing transgender people. It includes the annual Transgender Day of Remembrance, which takes place Nov. 20. Community events will be held across the country calling attention to the often violent acts of discrimination that transgender people routinely face.
Much can be done to mitigate the discrimination. Congress can start by passing the Employment Non-Discrimination Act (ENDA); the U.S. Senate did so Nov. 7, but the House has yet to take up the measure. Meanwhile, only 17 states and the District of Columbia have enacted anti-discrimination laws that explicitly protect gender identity. In my home state of Massachusetts, lawmakers passed an equal rights law in 2011 that prohibits discrimination based on gender identity in housing, employment, education, and credit, but it carved out protections in public accommodations. A bill currently before lawmakers would remedy this, and Massachusetts lawmakers should pass it.
The Affordable Care Act explicitly bars discrimination based on gender identity in health care settings that receive federal funding. Nevertheless, much work remains to be done to educate health care providers about treating transgender patients with respect. It starts with the very simple act of referring to their transgender patients by the patient's preferred name and pronoun -- even if the name and pronoun do not "match" the patient's biological sex. And it continues to understanding some of the unique health needs of transgender people, including their devastating vulnerability to HIV infection.
This month, if you are not transgender, take a moment to educate yourself about gender identity and expression. And if you are transgender, take a moment to get tested for HIV.