Transgender community organizations in the Seattle area are marking Trans Awareness Week by highlighting the critical need for improved health care and access to resources.
While Washington has made significant strides to curb the HIV epidemic, advocates emphasize this is no time for complacency, and that there is still more work to be done, with a focus on addressing disparities, if Washington is to ever truly end the epidemic.
A final assessment of the 2020 End AIDS Washington initiative shows Public Health – Seattle and King County and the state Department of Health met three of its 20 goals set in 2014 to diagnose, treat and prevent the HIV epidemic by 2020, according to the 2021 HIV/AIDS Epidemiology Report and Community Profile.
The state is on track to meet another eight goals, including four that already meet the national standard but fall short of the bar set by the state and county health departments.
The pandemic led to disruptions in testing and access to care for some people living with HIV. Washington state saw a slight worsening for many indicators in 2021, although the changes were not drastic, DOH said.
More than half the people diagnosed with HIV in Washington last year were men who have sex with men, with the disease burden more acute among queer and trans people of color. But these estimates are riddled with problems: The state does not have an accurate estimate of the number of trans people living here, and the last national survey of transgender people was in 2015.
Epidemiologist Stephaun E. Wallace of the Fred Hutchinson Cancer Center and the University of Washington also says there is no uniform way to delineate transgender men from cisgender men, or to know if the data includes transgender women.
The state is well aware of these disparities. Similar to national projections, it roughly estimates about 20% of trans women are HIV positive and 10 to 20 times more likely to have other sexually transmitted diseases than other women with HIV, according to the 2022 Office of Infectious Disease Disparities Report.
“If we’re not collecting that data, there’s no way to report it. And if the systems that are set up to collect the data on the trans experience are missing the mark, then we’re not capturing information about a whole segment of the population,” Wallace said.
“We won’t be able to end HIV really if we leave anybody behind.”
Organizers say currently most resources to address health care crises disproportionately impacting the queer community are concentrated in Seattle, despite a significant proportion of the trans community being priced out of the city limits.
“A lot of us have been displaced and now live further south in King County or Pierce County, and unfortunately for some of us who are still here in South King County we get what we have called the ‘leftovers’ from Seattle,” said Taffy Johnson, executive director of UTOPIA, a community organization focused on helping trans people of color.
UTOPIA sets up a wellness clinic called Mapu Maia to offer trans people outside of the Seattle area a safe space to access health care. But limited resources prevents them from offering services more frequently, Johnson said.
To overcome this, UTOPIA partners with local community clinics but often hits bureaucratic roadblocks. “It feels like those are ways how the system was set up to gatekeeper resources within bigger organizations,” Johnson said.
Compared with other states, Washington has many initiatives for people to access, but many don’t know these options exist, said Ariyah Albert, of People of Color Against AIDS Network, an organization serving Seattle’s marginalized communities.
“If they can’t see you, if they can’t know you, then they can’t access you … You have to meet people where they are,” said Albert.
One way to address the disparities in HIV test distribution would be to introduce or expand the option to mail testing kits, eliminating a barrier of seeking a center by allowing people to test at home.
These initiatives are already underway in San Francisco and Los Angeles. People can reach out for support and connect with a provider after sending in their kits, Wallace said.
To implement such a solution and find other ways to meet the community where they’re at, he said health departments have to change their current top-down approach and meaningfully engage grassroots organizations already doing the work.
Less community advisory boards and rubber stamping, and more intentional involvement and “sharing power and resources” with the communities, Wallace said.
Advocates say it would mean acknowledging the resiliency and the work that many have been doing for years to maintain a level of health, irrespective of the failure of systems to adequately provide services and support.
Prejudice against trans people, and accompanying socio-economic barriers, have led many into sex work and subsequent incarceration, increasing their vulnerability to disease, Johnson said.
Ultimately, all of these efforts are geared toward rebuilding trust between trans people and health care systems that have long marginalized them.
“We have been taught that if you’re not gay or trans, so-and-so disease won’t affect you when that’s not true. There are no gay diseases, there are only human diseases and we have to make sure that we don’t isolate people or treat them like lepers,” Johnson said. “No one deserves to feel like they are less than, or shamed for who we are.”
Breaking down stigma and creating safer health care spaces with competent providers can lead to better outcomes for ending the HIV epidemic or any other disease that disproportionately impacts the queer community.
“If we don’t stop the stigma then people are going to continue to not get tested or attend to the telltale signs and we’re going to keep seeing spikes — because when we walk out of spaces where we have been misgendered, dead named — it is a haunting feeling,” Albert said
UTOPIA is hosting a Transgender Day of Remembrance event with a vigil on Nov. 20 at the Auburn Riverside Theatre at 6 p.m. POCAAN’s vigil with the Seattle LGBTQ Center will be held Nov. 22 at 400 E Pine St. in Seattle at 4 p.m.