By Gin Nguyên Pham and Emmett Schelling
Nearly two years after the onset of COVID-19, our community is still working to assess the effects of this devastating pandemic and the lack of medical access that continues to grip transgender and gender-diverse communities. In 2021 the nation looked on as Texans were embroiled in a 10-month battle at the State Legislature, fighting for their basic human rights regarding things like abortion access, the right to healthcare, and the ability for youth to participate in sports with their peers. The lack of access to gender-affirming medical care continues to hinder the transgender and gender-diverse community’s ability to live a self-determined life, no matter if in a major city or rural part of the country. The language and sentiments surrounding this pandemic, from calls to action to “flatten the curve,” to the anxiety around human contact and intimacy, are reminiscent of another ongoing issue impacting our community—the HIV epidemic.
Throughout the last decade, we’ve witnessed great bounds in visibility for trans and gender-expansive communities across the world, paralleled by the ways we’ve been able to redress stigma around transgender identity and HIV. But in the face of the decline in new HIV transmissions, as reported in the 2021 UNAIDS Global AIDS update, the world has not met the 2020 goal of reducing new HIV transmissions to fewer than 500,000. Of the 1.5 million new transmissions, 2 percent occur among transgender women, with best estimates that transgender people are 50 times more likely to be living with HIV. The numbers are clear—we cannot be left out of this narrative. In fact, it is time for us to lead the conversation.
That’s why, this year, the Transgender Education Network of Texas (TENT) joined the Houston Health Department in the Ending the HIV Epidemic (EHE) initiative to build a roadmap to address the ongoing epidemic in Texas and across the country. TENT works to amplify the voices and experiences of transgender and gender-expansive community members living with HIV. This past summer, the organization held “Trans Voices: Virtual Town Hall on HIV and Gender Expansive Communities,” an online event that further solidified the urgency in addressing gaps in education and understanding of the trans community for those providing services to our community. When the question “Why hasn’t the HIV epidemic ended yet?” was posed to the group of community members and HIV-related service providers, participants collectively agreed that there was a lack of investment and trans representation in service providers and decision-makers. This only confirmed our mission of furthering gender justice in Texas. In reality, the HIV epidemic continues today due to the systemic homophobia, transphobia, and racism that affects how community members are able to combat stigma, misinformation, isolation, and barriers to a self-determined healthy life.
In comparison to their cisgender counterparts, transgender adults in the United States disproportionately receive new HIV diagnoses. While, in 2019, there was a decline in overall new HIV transmissions, cases increased among trans people: 46 percent of those new transmissions were among Black trans community members and 35 percent were among Latine community members. In Texas, it wasn’t until 2017 that Texas HIV Surveillance started to collect gender identity in their reports. As a result, allocation and investment into community interventions surrounding MSM (Men who have Sex with Men) communities were glossing over the wider transgender community. In 2019 the Texas HIV Surveillance report revealed that nearly 2 percent of new transmissions were among transgender people, 40 percent being Black and 46 percent Latine. Within the latter report, the “MSM” category continues to inaccurately identify modes of transmission that transgender women experience.
Ongoing barriers to accessing competent healthcare directly contribute to the increasing HIV transmission rates within the trans community. According to the National Center for Transgender Equality, one in three trans people report being refused medical care or harassed by medical professionals simply because they are trans, and one in four trans people have postponed or avoided medical care due to discrimination. This stigma and transphobia only increase the likelihood that trans people will avoid getting tested, and that trans people living with HIV will not stay in care. We must address this problem—which is not a problem of medical compliance, as it is often framed, but one of systemic transphobia.
Gin Nguyên Pham, the co-author of this article, witnessed this stigma in action during their time as a former Health Promotions Specialist at AIDS Services of Austin and The Q, an Mpowerment Project of Vivent Health. While conducting HIV testing in Austin, Texas, Pham noticed that the overwhelming majority of trans and gender-diverse community members coming to get tested—fearful of discrimination from other providers—would often sign up for PrEP just to obtain eligibility to receive gender-affirming care from the AIDS service organization.
As a state, we must address the wide-ranging factors that contribute to the holistic wellbeing of our transgender and gender-diverse community members. Transgender people in Texas often still do not have protection from discrimination in employment, education, and housing discrimination. This combination of risk factors makes it more likely that trans Texans will engage in unsafe practices, such as survival sex work, increasing their risks of being exposed to HIV and other sexually transmitted infections.
Throughout the last 650 days of this global pandemic, and throughout the cruel 10-month legislative session in Texas, healthcare access continues to play a vital role in the gatekeeping of the wellbeing of all Texans. When supporting transgender lives, we must understand the importance of having representation for all the identities we hold, so that soon we will instead be asking how we ended the HIV epidemic.
Emmett Schelling is the Executive Director for the Transgender Education Network of Texas (TENT). He previously served as the president of the San Antonio Gender Association (SAGA) from 2016–17. During college, he studied business management and marketing, and, at one point, did an internship as an associate youth pastor and ministry outreach fellow. He transitioned from management in the private sector to non-profit work, where he applies many of the same skills. He’s been featured in numerous media outlets throughout Texas, nationally, and worldwide, including Newsweek, Refinery29, The Hill, Slate, and HuffPost. He is often invited to speak with political leaders and their staff, medical professionals, legal professionals, social workers, college students, parents, and trans-identified students on trans and gender-noncomforming (TGNC) issues, as well as issues that intersect with the TGNC community.
Gin Nguyên Pham is the Community Engagement Specialist for the Transgender Education Network of Texas (TENT). They formerly served as a Health Promotions Specialist at AIDS Services of Austin and The Q (2018–19). They have provided and helped build various community spaces for queer and trans individuals in Austin, Texas, through the Gender and Sexuality Center at the University of Texas at Austin and as the co-founder of AQuA (Austin Queer Asians).
