Trans Women with HIV Face Violence, Homelessness, and Discrimination. These Orgs Are Fighting Back.

Tiommi Luckett is full of joy, and she looks it: Her purple lipstick matches her dress, and marble cat eye glasses frame her eyes, which light up whenever she sees someone she recognizes. This happens several times as the Arkansan sits in the lobby of a hotel in Atlanta, where she’s attending an advocacy summit; every few minutes, a mentee, mentor, or friend approaches her for a hug. Today a Senior National Organizer for the Transgender Law Center’s Positively Trans program, she’s a far cry from the isolated and fearful person who was formally diagnosed with HIV in 2012. Two years before that, an oral swab indicated she had antibodies, but she wasn’t emotionally ready to deal with the possibility of a diagnosis at the time. It took until 2014 for her to be able to speak publicly about her status, and from there her role as an advocate for the trans and HIV-positive communities flourished. 

Even as Luckett’s life began to change, she encountered many of the challenges that commonly face trans women living with HIV. At one point, an abusive partner attempted to manipulate her with threats related to her diagnosis. “They try to hold your HIV status over you as a means of control because the burden of proof falls on me,” she says, referring to Arkansas’ criminalization statute, which makes exposing someone to HIV a felony (regardless of the individual’s viral load or ability to transmit the virus). The negative messages she had received about being HIV-positive and trans made her especially vulnerable to her partner’s manipulation. “You're really holding on to the idea that someone does love you when society shows or tells you that you're not deserving of love,” she told VICE News.

Violence—perpetrated by intimate partners, family members, acquaintances, and strangers—plays an active role in how HIV is continuing to affect trans women, in large part because the United States’ housing crisis makes trans women particularly vulnerable to harm. There’s a critical lack of safe emergency housing options for trans women, a result of the current political landscape, and it threatens to stymie progress toward ending the HIV epidemic. At the intersection of anti-trans stigma and policy, violence flourishes. Despite this, trans and HIV-positive communities are mobilized and thriving.  

One of the most robust datasets for understanding how violence and HIV are affecting trans people is the U.S. Transgender Survey (USTS); the last iteration, from 2015, had over 27,000 respondents. In 2015, 3.4% of transgender women reported that they were living with HIV—more than eleven times that of the general U.S. population. In a much smaller study of trans women in seven cities, the Centers for Disease Control found that 42% of participants were HIV-positive. Other studies have estimated the rate of HIV prevalence to be around 22% among trans women in the U.S.

But until recently, transgender people were largely left out of national HIV statistics; the CDC’s HIV surveillance programs did not publish data for transgender diagnoses before 2020. According to Andrea Wirtz, Assistant Professor in the Department of Epidemiology at Johns Hopkins Bloomberg School of Public Health, trans women have historically been lumped into other groups, such as gay and bisexual men, and undercounted. Wirtz’s research team found that systemic barriers have shut trans women out of HIV research for years. 

Wirtz is the joint principal investigator on the first cohort study of trans women in the U.S., known as the LITE Study, which has been following over 1,000 participants for more than five years and focuses on HIV and related health and social issues. While the research team did not set out to study violence, it came up as more and more participants were lost to follow-up. When Wirtz and her team talked to their community partners, they found that early mortality due to a variety of preventable causes was behind the trend. Mortality rates and HIV infection rates were almost comparable in the cohort, and a common predictor of both was sexual partnerships with cisgender men. However, transgender people who have experienced intimate partner violence may be overlooked when screening questions are not sensitive to the unique ways they experience abuse, such as a partner controlling their gender expression, or restricting their access to hormone medications. 

But according to Wirtz, intimate partner violence is just one of several risk factors for negative HIV health outcomes. Much more so than for cisgender people, violence perpetrated by strangers in public spaces is a major health barrier for trans women. “There’s a lot of focus on getting trans women on PrEP,” which may mean in-person appointments and consistently adhering to a daily pill, says Wirtz. “But then not only is that person weighing—like most people are weighing—cost, time burden, are they going to a place where they like the provider; but for trans people, it's like, ‘am I going to be assaulted on the way there? I’m now not just weighing in inconvenience, I’m weighing my actual physical safety.’” According to the CDC, transgender people living with HIV are 55% more likely to have missed a medical appointment in the past year compared to the broader HIV-positive population. 

“Violence does not just happen with guns and fists,” Tori Cooper, Director of the Trans Justice Initiative at the Human Rights Campaign, said in a statement. “Violence is also with policy and practices and anti-trans rhetoric that leads to discrimination. That is no different as it pertains to HIV.” 

Housing—or lack thereof—is an especially important factor in the future of the HIV epidemic. “We know that housing is prevention. Housing is also treatment,” Luckett told VICE News. “When people don’t have a place to live, then they’re not worried about what medicine they have. They’re not worried about what medicine they have to take.” There is a wealth of epidemiological evidence demonstrating the connection between stable housing and a person’s ability to access and adhere to PrEP, antiretroviral therapy, and other medical care. In the 2015 USTS, the rate of HIV was nearly twice as high for respondents who had experienced homelessness. 

In 2020, 8% of all people living with HIV reported experiencing homelessness in the past year; for transgender people living with HIV, this number was 29%. Housing instability or homelessness can be both a consequence and cause of violence among trans women. Violence perpetrated by a partner, parent, or family member may push an individual out of their home, or they may tolerate more abuse for longer for fear of becoming unhoused. 

Despite its importance, emergency housing remains a fraught space. “There are rules in many shelters across the country that place trans women in spaces that align with their assignments at birth based on an outdated I.D.,” says Cooper. “That is violent, unsafe and unethical.” 

Although the Family Violence Prevention and Services Act and the U.S. Department of Housing and Urban Development prohibit discrimination on the basis of gender identity in shelters, it is a common experience among trans women. Renee Lau, Director of Senior and Disabled Housing at the trans-led wellness center Baltimore Safe Haven, has seen many community members with negative experiences in emergency housing. “[Shelters] may not discriminate,” she says, “but that does not stop the other population within that center to stop discriminating against [trans women].” 

One in eight respondents to the 2015 USTS reported being unhoused during the past year; for those who had stayed in a shelter at some point in that period, 70% reported mistreatment on the basis of their gender identity, ranging from verbal harassment, physical or sexual assaults, being thrown out, or being pressured or forced to dress as the wrong gender. It’s hardly surprising, then, that the USTS found that more than a quarter of transgender people who experience homelessness avoid staying in a shelter. “You take the chance when you go as a trans woman to be on the men’s side and be raped,” says Luckett. “That’s why trans women of color are on the street. Because they say they’re not allowed to be on the women’s side, if they identify as a trans woman. And they don’t see us as valid. And so, when you’re on the street, of course, that [violence] happens. Because that's when you’re vulnerable and alone, you’re an easy target.”

Yet conservative lawmakers have sought to further entrench the inaccessibility of shelters for trans women through bills that would legalize anti-transgender discrimination in these settings, among others. Generically labeled as “Women’s Bills of Rights,” or with more obscure euphemisms, such laws have been passed in Florida, and implemented by executive order in Nebraska, Oklahoma, and Arkansas. When Maryland became a sanctuary state for transgender people in June, the number of requests for services at Baltimore Safe Haven tripled. According to Lau, the organization is serving an unprecedented number of people from other states, and finding a way to house all those in need remains their biggest challenge. 

But as with much other proposed anti-trans legislation, these bills are unpopular; similar bills have stalled or died in committee in Mississippi, Texas, South Carolina, and Iowa, as well as in the U.S. Senate and House. Poll after poll has demonstrated that Americans are overwhelmingly against the recent barrage of bills targeting transgender people. In 2022, this translated into a 91% failure rate for proposed anti-trans legislation. Luckett stays hopeful. “We are victorious,” she says. “We’re winning, even though some of my community is still suffering. We are fighting, me, our allies, our accomplices, we’re fighting together.”

While politicians continue the battle over the legal rights of an estimated 1.6 million trans people in the U.S., some of the biggest sources of change and protection for trans women living with HIV are coming from within the trans community. Baltimore Safe Haven is just one of several trans-led organizations prioritizing housing, along with Indiana’s Trans Solutions Research & Resource Center, which provides wraparound services, or the Louisiana trans-led land trust House of Tulip. 

According to Lau, before Baltimore Safe Haven there was no trans-focused senior housing option in the city, because trans people were not expected to live past forty. The commonly quoted statistic of trans women’s life expectancy being only thirty-five years has been debunked, but such a devastating number has led to a sense of hopelessness that is now being lifted for advocates like Luckett. “I refuse to believe that when I’m looking [at] and have access to Queen Mother Major Griffin herself,” she says, referring to Miss Major Griffin-Gracy, the legendary elder trans activist who has turned her Little Rock home into a retreat center for trans people. “This is who we are. We’re not dropping dead, regardless of circumstance and violence that is impacted upon us from structural levels, institutional levels, personal levels.”

“Joy, it should be free,” says Luckett. “It should be free.”

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