Trans women need better HIV services, and they also need good jobs

Transgender people—particularly trans women—are disproportionately affected by HIV. In the U.S., nearly a quarter of trans women are living with HIV.

Stigma, discrimination and exclusion can stand in the way of housing, education, healthcare and employment, which in turn can affect the health and well-being of trans people and increase their HIV risk. Many trans women also turn to sex work in order to survive, which can also place them at higher risk for HIV.

Andrea Horne

Andrea Horne

“Many trans women, because nobody will hire them, turn to survival sex work,” said Andrea Horne, the TransLife program coordinator for San Francisco AIDS Foundation. “This ultimately leads to violence, losing your possessions. You might turn to drugs, or get HIV. You get arrested. You go to jail, and when you get out, you don’t have any money. Still, nobody will hire you. So you start the same thing over again. Some women never get out of that cycle.”

To interrupt this cycle, the California HIV Alliance, a coalition of HIV organizations from across California, is proposing demonstration projects across the state that would work with trans people to assess needs and barriers to employment, provide client-centered training, give referrals to inclusive employers, and link them to HIV care and prevention services. This spring, the California HIV Alliance will ask the state for $2 million, delivered over three years, to fund these economic empowerment demonstration projects.

“The demonstration projects are designed to offer a wide array of economic empowerment support to trans people—and in particular trans women,” said Courtney Mulhern-Pearson, senior director of policy and strategy at San Francisco AIDS Foundation. “The barriers to better health for trans women aren’t limited to HIV risk and access to treatment—the main issues folks are facing are economic.”

“Trans women need more sustainable incomes,” said Janetta Johnson, executive director of TGI Justice, a San Francisco organization dedicated to improving the lives and health of transgender, gender-variant and intersex people. “Having a paycheck makes a big difference, especially if you’re talking about people who were formerly incarcerated or who have substance use or abuse history. These people need to be supported and invested in so that they can grow. When you think about the trans community, this is a community that hasn’t been invested in.”

Mulhern-Pearson said the inspiration for the budget request came out of a think tank organized last spring. A statewide group of experts from the trans community, convened by the California HIV/AIDS Policy Research Center, gathered for a day-long session to develop a list of best practices for HIV prevention and care in trans communities. At the meeting, attendees spent time discussing challenges to delivering tailored services to trans population, opportunities to improve the health of trans people in California, and examples of already-existing programs that have been successful.

The Los Angeles LGBT Center’s Transgender Economic Empowerment Project is one example of a program that combines employment empowerment and HIV testing, prevention, and linkage to care. In addition to providing career and health services to trans people, the program works with employers to make workplaces trans-welcoming and hire trans employees.

Johnson said that many trans women she knows have done well in work environments that are supportive, that recognize the skills and abilities trans women bring to the table, and that provide mentorship and learning opportunities on the job.

“We recently had a conversation with a shelter, who was looking to hire someone. A lot of trans women might not have a lot to put on paper, but they do have relevant job skills. They have experience being inside the criminal justice system. They know how to negotiate situations with other trans women. They know how to organize in a way that creates peace and safety. These are transferable skills.”


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