The 2011 Injustice at Every Turn: A Look at Black Respondents in the National Transgender Discrimination Survey exposed the high levels of discrimination Black transgender people face everywhere from education or to the workforce. When it came to healthcare, reported experiences were equally dismal. While 21% of Black transgender people reported being refused medical care due to bias, 34% reported postponing care due to fear of discrimination. It is no wonder why Black transgender people are affected by HIV in devastating numbers.
Healer, orator, and founder of the Trans Women of Color Collective Lourdes Ashley Hunter once said:
"Solidarity with the trans community is not a retweet, 'like,' or Facebook share. Solidarity is informed, intentional, reoccurring, sustainable acts of service."
This call for accountability among trans allies could not be more clear. This National Black HIV/AIDS Awareness Day, we must ask ourselves: what does a shift in accountability in social justice movements and public health spaces look like?
Good, accurate information is a basic requirement in high-quality decision-making processes. As informants of health care systems, public health professionals have the power to set the stage for improved transgender care. Elitism in the healthcare industry must be eliminated: the Black transgender community must be able to set their own priorities and be supported by those of us in positions of influence and power. Our privilege as healthcare specialists with a mission to end the HIV epidemic demands we make decisions based upon a clear appreciation and understanding of the facts, implications, and future consequences of an action. Spaces such as the Philadelphia Trans Health Conference and Center of Excellence for Transgender Health provide direct access to countless transgender activists and wealth of knowledge about the transgender community. The World Professional Association for Transgender Health is a leading international association devoted to the understanding and treatment of individuals with gender identity disorders. It is our task as workers within healthcare systems to utilize the resources available to educate ourselves about the needs of Black transgender people.
- Move from diversity to inclusion. Whereas "diversity" describes the extent to which a space has people from differing backgrounds and communities, "inclusivity" involves creating an atmosphere in which all people feel valued, respected, and safe. Moving from diversity to inclusion is key in the survival of Black transgender people. It is not enough to simply have Black transgender people present in clinics or offices. These spaces must be made safe and competent in order to ensure adequate care and protection. Identify potential barriers to inclusivity for Black transgender people--such as trans-exclusive health insurance or a lack of Black transgender people in positions of leadership--and begin tearing those walls down.
- Develop trans-specific portfolios of work or incorporate Black transgender people into already-existing programs. Integration is key as we work to end the HIV epidemic, which disproportionately impacts marginalized communities. Include transgender women in projects and initiatives geared toward women, and transgender men in ones targeted at men, all while remaining aware of and addressing the unique challenges Black trans people face.
- Ensure an equal distribution of funding, research, and general information gathering efforts. Research related to HIV among transgender people has almost exclusively focused on male-to-female transgender people. This research has produced data demonstrating the disproportionate impact of HIV on Black transgender women. It has not, however, accounted for the also-vulnerable Black female-to-male transgender community, despite preliminary evidence that some trans men are at high risk for infection (particularly those who have sex with transgender women and non-trans men).
- Support transgender people's efforts to develop their own solutions and strategies. As public health professionals it is our role to follow the leadership of the transgender community and offer a helping hand. Organizations such as Casa Ruby, resources such as RAD Remedy, and studies such as Positively Trans need funding in order to continue being successful. Partnering with national organizations as such as the Sylvia Rivera Law Project, National Center for Transgender Equality, and the Trans Women of Color Collective also helps ensure that people and spaces already serving the Black transgender community can continue to thrive.
Deliberate efforts to aid the Black transgender community must last beyond the initial honeymoon phase. Informed decision-making processes require an ongoing dialogue between public health professionals and the Black transgender community. Intentionality requires a conscious decision-making cycle, a willingness to regularly evaluate those decisions as time progresses, and an ability to receive and process criticism. Solidarity with the Black transgender community cannot be a one-time fleeting thought or temporary outrage.
Accountability is key in public health spaces. Many of the tools and resources necessary to integrate the Black transgender community into our programs in a conscious, meaningful way already exist. It is up to us as leaders in the healthcare industry to take advantage of them and do the right thing, not the easy or safe thing. Resources may be limited, but no part of the Black community can afford to continue being decimated by HIV. We must find ways to work together and include all members of the community in our prevention and care methods.
Shaan is a professional writer and photographer and Associate, Communications/Health Equity at the National Alliance of State & Territorial AIDS Directors (NASTAD). NASTAD is a national nonprofit association that works to strengthen state, territory and global-based public health leadership, expertise and advocacy and bring them to bear in reducing the incidence of HIV and hepatitis infections and on providing care and support to all who live with HIV and hepatitis.