This article is the first of two, written by Amy Cunningham. Amy is doing an internship with AlterHeros for her HIV/AIDS class. Don’t miss the conclusion!
Gender-based discrimination seems to have existed as long as human beings have been designating male and female identities to certain individuals, based on physical characteristics. Additionally, as new definitions of gender emerge, so to do new ways to discriminate. This is undeniably the case in relation to transgender individuals who attempt to live their day-to-day life as the sex other than the one they were born in.
Though this discrimination is often associated with the psychological damage that it can cause (i.e. issues of identity, self-esteem, etc.), it is important not to overlook the way discrimination manifests itself on the individual body, inflicting harm through the vulnerability to abuse and infection to which it can expose the individuals. More specifically, this article intends to discuss how the neglect and alienation of this particular group results in their vulnerability to HIV infection.
Viviane K. Namaste bases her book Invisible Lives: The Erasure of Transsexual and Transgendered People on the thesis that transsexuals are exposed to such severe forms of discrimination in the everyday social world, that their identities are essentially erased from society. As she describes the various ways in which this erasure occurs, she additionally demonstrates the detrimental effects of this discrimination.
The first part of this article will focus primarily on her text as it provides a thorough yet varied approach to the issue of transgendered identity in the society. However, as the book itself was published eight years ago (and the information in it is obviously even older), a second part to this article will focus on more current research.
Although other research has been done on TS/TG people, Namaste notes the unfortunate trend that “few investigations examine the politics of health care and social services as they are experienced by transsexuals and transgenderists” (157). It is from this perspective that the research demonstrates how transgender discrimination is institutionalized through legal and social systems that “impede and sometimes prevent [transsexuals] from living in [their] bodies as [they] choose” (158).
Transsexuality, sex work and healthcare
One of the major hindrances in the prevention of HIV and STI (sexually transmitted diseases) is the exclusion of transsexuals from health care systems. First off, it is important to note that this exclusion is not strictly the result of doctors, nurses, and clinicians refusing to treat transsexuals, though this is often the case, and for varied reasons; but it is not uncommon for the individuals themselves to refuse treatment.
This is because treatment can often come with certain strings attached, mainly that the patient be acknowledged by the sex and the name that they were given at birth, and not the one that they chose for themselves. This has obvious implications on the individual’s sense of identity and also promotes intolerance on the part of the health care providers.
Of all the alienation to which TS/TG people are subject, their treatment by the police might be the most disturbing. Here, it is most often the transsexual sex workers that are subject to inhumane treatment; however, for this group of individuals, the abuse is consistently present.
|Viviane K. Namaste bases her book on the thesis that transsexuals are exposed to such severe forms of discrimination in the everyday social world.|
Namaste states that “all the prostitutes I spoke with recounted stories of police harassment, intimidation, and verbal abuse” (170). Transgendered prostitutes “choose not to report the violence directed against them to the police, whether the violence is perpetrated by the police themselves, a client, a lover or a stranger” (173).
In her book, Namaste provides many individual accounts of police violence or neglect, which characterize the relationship between transsexual sex workers and the police. Additionally, she discusses the negative consequences that can come from reporting an assaulting officer such as increased police surveillance while attempting to attract clients.
As is often the case, ignorance and discrimination can occur in well-intentioned individuals. For instance, many individuals who advocate rights for transsexual lifestyles employ an emphasis on the many TS/TG individuals who have been successful in procuring and maintaining highly respected and well-paying jobs (i.e. surgeons, lawyers, etc) and use this detail to indicate the ability for TS/TG people to properly integrate into society’s mainstream, professional careers.
However, Namaste states that this focus on the “professional transsexual,” establishes “the legitimacy of transsexuality through an appeal to professional occupations” and in turn “discriminates against prostitutes, since it does not consider prostitution to be a valid form of work” (209). In Namaste’s research, transsexual sex workers were even subject to discrimination in Gender Identity Clinics (GIC, institutions specifically developed to aid TS/TG individuals), where they were denied access to programs, hormones, and SRS because of their line of work. Thus it is clear that the erasure of transsexual identity from social institutions that Namaste premises her study on, is only further emphasized in regard to TS/TG sex workers.
It is additionally relevant to point out the legal context of this issue of prostitution. Her studies being done in Canada, Namaste notes that prostitution itself is not illegal, and so the policies of these GICs are not based on legal issues but instead reflect moral judgements of the people who work in them.
What are the risks?
Namaste states that, “research on MTF (male-to-female) transsexuals and transvestites who are prostitutes reveals an HIV seroprevalence rate that is, without exaggeration, astronomical” (237).
Additionally, this research reflects a significant link between transsexual sex workers and intravenous drug use. Perhaps the revelation that is most indicative of the harmful effects of discrimination is that transsexual prostitutes have a higher seroprevalence rate than sex workers who are not transgendered.
Namaste notes the four factors which put FTM (female-to-male) transsexuals at an increased risk of infection: “(1) self-esteem and a stigma of AIDS; (2) unsafe sexual relations with clients or lovers; (3) alcohol and drug use, which can prevent the adoption of safe sexual practices; and (4) the injection of intravenous drugs with a shared need of syringe” (237). These factors, however, are not exclusive to transsexual sex workers, but can apply to all sex workers.
There are however, some factors that are unique to FTM transsexuals: they involve the use of needles to inject hormones (often illegally obtained) or silicone (for the formation of more feminine features). Since access to these needles can be limited, some individuals might share used syringes, which puts them at a higher risk of infection. Additionally the alienation that TS/TG individuals face from health care institutions and police, as previously discussed, compound these factors by restricting their access to sterile equipment, condoms, and a safe environment in which they can work.
Evidently, the ‘erasure’ to which Namaste so frequently refers, is an extremely harmful process to these neglected communities in society. Unfortunately, it is reflected once again, in more current research where findings are scarce and can be of questionable reliability.
Namaste, Viviane, K. Invisible Lives: The Erasure of Transsexual and Transgendered People. Chicago Press: University of Chicago and London, 2000.