Imagine being identified by the wrong gender in the lobby of your own doctor’s office, or having trouble finding a job, or being rejected by your own family, because you are a transgender person.
These situations complicate an already difficult daily experience for trans people, and they increase the risk of HIV among an already vulnerable population in South Florida, according to a new study by Human Rights Watch. The research focused on transgender women living with HIV, who face discrimination and lack of access to proper healthcare in Miami-Dade and Broward counties — despite significant government funding for medication and services.
The findings reveal troubling shortcomings in the healthcare systems that are meant to serve marginalized communities — insufficient cultural sensitivity training for medical employees, inadequate data collection to measure HIV’s impact on the transgender community and barriers that make it harder for people to get their medications.
At an event in South Beach to announce the release of the report Tuesday, researcher Megan McLemore said a yearlong study examined what federal, state and local governments and healthcare agencies are doing to provide adequate healthcare to transgender women.
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“We found a lot of talk, a lot of plans, a lot of strategy documents, a lot of proposals, a lot of hand-wringing, a lot of expressions of concern,” McLemore said to an audience gathered at the Betsy Hotel. “But we asked, ‘Is this translating into policy and services on the ground? Are trans women getting the healthcare and help that they need?’ And the answer was no.”
The Human Rights Watch report is based on questionnaires from 125 transgender women and more than 100 interviews with advocates, healthcare providers and government officials in Miami-Dade and Broward counties. The research pointed to widespread issues with transgender women feeling uncomfortable or harassed at their healthcare providers. In some cases, patients were not identified by the correct gender at their own doctor’s office, causing people embarrassment that deterred them from returning.
The report, titled “Living at Risk: Transgender Women, HIV, and Human Rights in South Florida,” opens with a telling anecdote from one of the survey respondents. (Respondents were kept anonymous.)
“This woman shouted for ‘Kevin’ to come to the desk. I shrunk in my seat, hoping she would see the note on the chart about my gender change. But she just kept yelling for Kevin. I finally had to get up and cross the room in a walk of shame,” said a 31-year-old Miami resident. “Will I ever go back there? No way.”
McLemore concluded that too few clinics in South Florida provide an acceptable standard of care for trans women in an environment where the patients truly feel welcome and respected.
“I used to go to Jackson hospital, but I haven’t been there in over a year,” said one 65-year-old survey respondent. “They are terrible. Not knowledgeable about trans health. They misgendered me. I don’t feel comfortable or trust them.”
Of those trans women surveyed, 45 percent had no health insurance. Of those who had health insurance, 39 percent had Medicaid and 23 percent reported having private insurance. More than 63 percent reported income of less than $10,000 a year, and more than half were unemployed.
Survey respondents’ stories and statistics underscore an overall hostile environment for transgender women who face discrimination in the workplace and in healthcare settings, the report states. Other trends compound the issue, including a high rate of incarceration among trans women — a result of many turning to sex work as a means to make ends meet. Factoring in efforts from President Donald Trump’s administration to eliminate protections for transgender people, McLemore concluded that the plight facing transgender women in South Florida is a public health crisis compounding the HIV crisis.
“This is an environment of risk for HIV that endangers their lives and their health every day,” she said.
The South Florida report comes at a sensitive time. Nationwide, transgender people fear the repercussions of a White House that wants to eliminate recognition of people who identify as a gender other than the one they were assigned at birth. The Trump administration has launched an effort to define gender as a biological, unchangeable condition determined by genitalia, an initiative reported by The New York Times in October.
The Human Rights Watch report was also timed to a day of significance for the transgender community. It marked the International Day of Transgender Remembrance, a day to honor the memory of people who have been murdered as a result of transphobia. On Monday, Human Rights Watch released a separate report on violence against transgender people, examining the circumstances around the killing of 22 transgender people in the U.S. since the beginning of 2018.
McLemore’s report identified a key problem with far-reaching consequences: the lack of quality data on HIV infections in the transgender community. Sound data is crucial not only for understanding the breadth of the issue but also for securing government funding that relies on hard numbers. The Centers for Disease Control has issued guidelines to the states for how to collect such data, but the states are not closely monitored.
“There’s no enforcement. It’s not a legal requirement. So states are implementing that at their own pace. And Florida has partially implemented it,” McLemore said. “It has gotten better. There is more transgender data than there used to be, but in doing this report HIV officials in Florida acknowledged that their data is incomplete and inaccurate still.”
June Romero, a community advocate and trans actress who attended Tuesday’s event, said she was not surprised by the report’s findings, but has hope that the report will spark action.
“I’m incredibly relieved and I’m hopeful that the Human Rights Watch is dedicating their resources to such a report, and I hope that it’s a catalyst for a really important and necessary change,” she said.
McLemore and her team worked with community organizations to connect with people who would participate in the survey. Members of those groups formed a panel convened Tuesday to discuss the findings of the report.
For Arianna Lint, a trans woman and CEO of a community-based organization, Arianna’s Center, the survey data can serve as a basis for grant applications to aid her group’s mission to connect people with social and medical services. Her group specializes in helping members of the LatinX transgender community. The term “LatinX” is a gender-neutral pronoun that replaces the male and female Spanish pronouns. It is meant to be more inclusive.
Other panel members highlighted the importance of training for all workplaces to make transgender people feel comfortable and accepted. Morgan Mayfaire, co-founder and CEO of TransSOCIAL, said his group specializes in cultural sensitivity training. A transgender man, Mayfaire said the training is fun, based on respect, and necessary to avoid situations where people refer to others by the wrong gender. Being misgendered, particularly in a medical office, can discourage someone from coming back.
“It’s a slap in the face. It takes away your dignity, and it takes away who you are,” Mayfaire said.
McLemore outlined several steps that all levels of government can take to protect the rights of transgender people and members of the broader LGBTQ community. Apart from federal policy changes that increase access to healthcare, she suggested state and local authorities follow federal guidelines for collecting HIV data from transgender patients.
Another major recommendation: ensuring coverage of hormone replacement therapy in the AIDS Drug Assistance Program and making sure people are aware of its availability. Under a model for care accepted by experts, providers who prescribe HIV medication are encouraged to also offer hormone replacement therapy to transgender patients. Studies show hormone replacement therapy, a common treatment used by transgender people who are transitioning, has positive physical and psychological effects that help people align their bodies more closely to their gender identities.
McLemore said more clinics who offer HIV treatment should be prepared to offer hormone replacement therapy for the ease and convenience of their patients.
Some already do. Sheryl Zayas, a doctor at Care Resource Community Health Center in Fort Lauderdale, is noted in the report as a proponent for bundling the services, arguing that offering hormone replacement therapy is “essential” for keeping people in care.
“HIV doctors can do this, and it’s extremely important they do,” McLemore said. “If they don’t, they’re not effectively treating trans women who are living with HIV.”
Read the full report below: