Letters to the Editor

South Florida transgender women need HIV healthcare

Nationally, rates of HIV infection are declining, but among transgender women, rates of new HIV infection have remained at crisis levels for more than a decade.

Some of the highest rates are in southern states such as Florida, where the rate is the third-highest in the nation.

In 2017, Miami-Dade and Broward counties had the highest HIV rates in the country, increasing the urgency for transgender women to get the care they need.

According to the federal Centers for Disease Control and Prevention, one of four transgender women, and as many as half of transgender women of color are living with HIV — a public health emergency driven largely by poverty, lack of stable housing, and lack of access to health insurance. But the state of Florida, and the federal government are failing to deliver the needed services.

Over the past year and a half, we have interviewed hundreds of transgender women in Miami-Dade and Broward as well as their advocates, medical providers, federal and state officials, and law enforcement. Florida and federal HIV officials talk a lot about how important it is to reach “high risk” populations like trans women. We investigated whether the reality on the ground is matching the rhetoric. It isn’t.

We found that many transgender women in Miami and Fort Lauderdale live in extreme poverty.

Florida receives millions of dollars in federal funding for HIV services, and state officials told us that their HIV budget had increased more than 15 percent in the last three years. But the federal Ryan White Program, the primary vehicle for government funding of HIV services and medications, contains no requirements or standards for transgender-related care. In Miami and Fort Lauderdale, several dozen Ryan White clinics offer HIV services, but only a handful are considered safe and accessible to the women we interviewed and the advocates who help them find treatment.

The stark reality is that 30 years into the epidemic, neither the state nor the federal government knows how many transgender women are living with HIV, how many are struggling to get care, or how this impacts the health of the community as a whole.

Until policymakers ensure that transgender women have access to affordable health care that respects their identity and rights, HIV will continue to endanger the lives of some of the most vulnerable members of our community.

Megan McLemore

Senior U.S. researcher at Human Rights Watch