XVII Harry Benjamin International Gender Dysphoria Association Symposium
31 October - 4 November 2001, Galveston, Texas, U.S.A.

A Needs Assessment of Transgendered People of Color in the District of Columbia

XAVIER, JESSICA U.S.A.

Objective: The objective of the Washington DC, Transgender Needs Assessment Survey (WTNAS) is to conduct one of the largest needs analyses of African American and Latino Gender Variant (GV) people in the US. The study focuses on barriers and access to regular, transgender-related and HIV-related health care, HIV/STD risk behaviors, housing, employment, and crime and violence victimization. Preliminary and ongoing analysis of the data will allow the District of Columbia Health Department, community-based health care and social service organizations, and AIDS service organizations to specifically target and thus better allocate intervention services for transgendered people of color in need.

Methods: After the initial development and pilot testing of the data collection instruments, the survey was conducted from September 1999 through January 2000. A total of 252 transgender-identified and other GV persons were surveyed, using a snowball sampling technique. Key members of transgender sub-populations were identified and trained as survey administrators. Eligibility was open to a broad definition and/or overt evidence of visible gender variance, rather than just transgender self-identification, plus a willingness to sign informed consent. The questionnaire was available in both English and Spanish language versions.

Results: Ninety-five percent of the sample were GV people of color, with 69% African-American and 22% Hispanic-Latino/a. Seventy-five percent were born male, 24% were born female and 1% intersexed. Eighty percent were between the ages of 13 and 36, and 20% were 37 to 61. Forty-three percent were victims of crime or violence, 34% reported problems with alcohol, and 36% problems with drugs. Thirty-five percent reported suicidal ideation, with 16% attempting suicide. Nearly 40% lacked a high school diploma, and 42% were unemployed. The self-reported overall HIV seroprevalence rate was 25%, with 32% in Male-to-Females (MFTs). With regard to sexual risk behaviors on a life-time basis, 67% of the sample reported unprotected genital-genital contact, 42% reported unprotected anal-genital contact and 43% reported unprotected oral-anal contact. Commonly identified barriers to access of routine, transgender and HIV-related health care included lack of employment, lack of insurance, prover insensitivity and hostility, and fear of transgender status being revealed. Respondents ranked housing, employment and HIV-related care as their three most important needs.

Conclusions: The WTNAS results suggest such significant differences between Gender Variant people and MSMs in per capita rates of employment, housing and educational discrimination; medical needs and priorities; fear of disclosure; the unconsidered risks and needs of Female-to-Male (FTM) and female-bodied transgendered people; and gender variant physiology and psychology, to warrant a paradigm shift in HIV prevention efforts – specifically, the official recognition by the Centers for Disease Control and Prevention (CDC) of a GV category for specifically targeted intervention strategies and surveillance. The results further indicate 1) more education is needed for transgendered people themselves regarding transgender-related care options; 2) the need for transgender sensitivity and awareness programs for health care and social service staff; 3) the need for in-service educational programs for medical and mental health providers regarding transgender-related care; 4) the provision of readily accessible and affordable transgender-related care by local community-based organizations; and 5) the development of transgender-specific HIV/AIDS education and prevention materials.