By JoAnne Keatley, MSW, Director and Co-Principal Investigator, Center of Excellence for Transgender Health at the University of California San Francisco
November has been designated as the National Transgender Awareness Month in order to raise awareness of issues that affect the transgender (trans) community. November 20th is the National Transgender Remembrance Day, an opportunity for the trans community and its allies to stand up against the lack of legal and workplace protection from discrimination and the transphobic violence that threatens daily life. For example, trans youth are harassed and bullied in schools or worse. In Oakland, my own backyard, a 16 year old was set on fire on a municipal bus traveling home from school merely for being their authentic self, because they were assigned a male sex at birth and had dared to wear a skirt and use gender neutral pronouns. This is terrible, heart breaking, and tragic.
This lack of legal protections and incredible violence significantly contributes to the health disparities within the trans community, such as high rates of HIV incidence. A recent meta-analysis found that a trans woman in the United States was 34 times as likely to be HIV positive than other adults.
Yet, there is resilience in our community. We are no longer standing in the shadows. We are taking a stand and demanding equal protection under the law. Joining forces with our allies, we are hopeful that the Employment Non Discrimination Act (ENDA), will be brought to a vote in the House of Representatives, as it has successfully been passed by the Senate earlier this month. We have fought and won important legal battles in California such as, bill AB 1266 that allow our youth access to safe bathroom and facilities use while in schools. This year Kaiser Permanente announced that all employer plans in California no longer exclude services for trans health. There is a paradigm shift occurring and I am thrilled to see it happen.
Still, we have an important element still evading us. There has yet to be a population based study among trans people in this country. The denominator is blurry because we have yet to put in motion a system to account for how many of us there are. Numbers are important. When you are not counted, you don’t count. In 2011 the U.S. Centers for Disease Control and Prevention (CDC) began including variables in their electronic HIV/AIDS recording system (EHARS) and the Adult Care Report Form that ask for two data points to help capture trans identities and other gender variance. In February 2013, The President’s Advisory Council on HIV/AIDS (PACHA) approved recommendations requiring all federal programs to systemically capture trans identities and other gender variance. Namely, by asking the questions: what is your current gender identity AND what was the sex assigned to you at birth, the CDC was able to demonstrate significant increases in being able to identify those with a gender identity other than that assigned to them at birth.
The Center of Excellence for Transgender Health has been advocating for the use of such a method since 2007. We believe that this method enables us to distinguish trans men, trans women, as well as those who are not trans, but may be erroneously labeled as such. The remaining problem is that the gender identity field is optional and not all states are compelling their health departments to report the data. I believe that NASTAD is in a unique position to support and encourage members to fully utilize these fields in order to accurately reflect the number of trans people in each state. In doing so, the data will be able to tell us the true extent of the syndemic affecting trans people. Only then will our nation be able to adequately respond to all of the critical health related needs of this community.
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