WATCH NOW: SisterLove's HIV-Positive Peer Counselor on the importance of intersectionality in treating HIV in Atlanta's Trans Community.
An Epidemic of Bias
A report from the Centers for Disease Control (CDC) shows that nearly six out of ten transwomen in metro Atlanta have HIV.
This is the highest rate of any of the major cities in the report.
In seven major cities, 42% of transwomen reported living with HIV. When it comes to Black transwomen, the study's results are even more shocking. About 62% of Black transwomen live with HIV, while only 35% of Hispanic transwomen and 17% of white transwomen do.
Queen Hatcher-Johnson, the gender-inclusive program manager at Positive Impact Health Centers states, “We don’t have gender-affirming facilities and processes for folks trying to receive services.”
“There is transphobia in the healthcare system, there is misgendering – a whole lot of things that keep people out of care."
The struggle that HIV-positive transwomen face is further compounded by intersectional challenges.
63% of those surveyed lived at or below the poverty level.
42% had been homeless in the past year, and almost 54% had been verbally abused or harassed in the past year.
Intersectional Barriers. Intersectional Solutions
In a prepared statement, Demetre Daskalakis, director of the CDC's Division of HIV/AIDS Prevention, said, "These data provide a clear and compelling picture of the severe toll of HIV among transwomen and the social and economic factors—including systemic racism and transphobia—that are contributing to this unacceptable burden."
Daskalakis added, "Reducing HIV in these communities will require that public health and other providers of social and prevention services design innovative and comprehensive status-neutral solutions to overcome barriers to whole person prevention and care"
Few Trans Women in Atlanta use PrEP.
Georgia already has one of the highest HIV infection rates in the United States. The problem is even worse for transwomen in metro Atlanta, according to a recent CDC report:
Out of the seven cities, Transwomen in Atlanta had the second-lowest rate of HIV testing (78%), behind only Seattle (61%). Overall, 82% of transwomen had an HIV test.
More transwomen living without HIV know about PrEP in Atlanta than in most other big cities. About 92% of Atlanta transwomen know that taking a pill once a day can help prevent HIV.
While 92% of transwomen in Atlanta reported knowing about HIV-prevention drugs like PrEP, they were the least likely to use them at 23%, after Seattle (17 %). San Francisco has the most people who use PrEP (46 %).
About 67 % of the trans women in the study who do not have HIV take hormones to confirm their gender. The CDC says that the use of PrEP could be affected by worries about drug interactions between the hormones and PrEP.
“It’s very important to integrate PrEP care into some kind of gender-affirming care or clinic because that seems to increase people staying in PrEP care,” says Emory University Researcher Amalia Aldredge, M.D.
Joel Rosenstock, medical director of AbsoluteCare Atlanta, believes "the low use of PrEP is caused by a lack of access to care, the fact that Medicaid isn't being expanded, and social factors that affect health.”
“The lack of low-cost PrEP clinics in the Atlanta area is a factor in these numbers."
Intersectional Barriers to Access
The CDC report shows that high rates of poverty and homelessness among transwomen contribute to the high HIV rates in Atlanta.
Many transwomen move to Atlanta in search of a better life due to the city’s reputation as LGBTQIA+-friendly. Some are fleeing conservative cultures in small towns or families that don't accept and support them.
But when they arrive, they find a deficit of gender-affirming health care, stable housing, or jobs that will hire them.
Justine Ingram, an Atlanta transwoman who works as a Project Director for the LeadersTrust, states, "How can we worry about our health if we don't have a safe place to sleep at night, keep our things, or store our food?”
“If this community is always worried about their safety, you don't want to go to your doctor's appointments, take care of your health, and be proactive."
While many healthcare outreach programs for transwomen are focused on those living with HIV, the report's findings suggest a more holistic approach that includes gender-affirming care, mental health services, housing assistance, and employment opportunities could lead to lower rates of transmission and improved health outcomes.
