



Trans People with Mental Illness—Like transgender prisoners, these are trans people who face restrictions on their credibility and autonomy by virtue of living with moderate to severe mental health issues, which are exacerbated by people’s transphobia and gender expectations. They may be denied hormone therapy (whether they’d already begun it or not), have a higher rate of turning to the gray market for transition-related care, which is unregulated and often dangerous, and they may have higher rates of suicidal ideation and attempts. Telling someone who already has challenges with their mental health that they will not be supported as a trans person can certainly make their health issues worse, and it is well documented that individuals with mental health instability often fail to find effective advocates to help them meet their health needs. Advocates like the National Alliance on Mental Illness work to separate a person’s mental health from the idea that being transgender is itself a mental illness, but much more work among therapists, the health care system, and the courts needs to be done.

Trans Drug Users—With relatively few paths toward adequate health care, a culture that adds stress to trans lives, limited work prospects, and a general lack of access to mental health support, many transgender people self-medicate to handle their trauma or conditions. If this approach leads to worsening or more frequent drug use, an individual may find themselves in the criminal justice system (see above), in unstable housing, and their health outcomes worsen significantly. Not only do we need to alleviate the drivers of unhealthy drug use (I am not getting into an argument about recreational drug use), but we need to ensure that the support system around drug user health is culturally competent to work with transgender people, so that transphobia is not a barrier for them as they interact with drug counselors, doctors, trauma care personnel, first responders, and peer programs. Syringe exchange has a 25-year history of lowering HIV and hepatitis C incidence among drug users  but many programs do not have specific training on working with trans users.

Trans Sex Workers—When I talked with transgender sex workers in Washington, DC, several people told me that they started out in sex work because they had been bullied out of high school and never earned their degree. Often they were also estranged from their immediate family, so there were few avenues to earn money and be able to support themselves. Many people I knew began sex work in their mid-teens and while they knew it was dangerous, it also allowed them flexibility and was, for them, less humiliating than working for minimum wage at a business that wouldn’t respect their gender identity. Culturally we treat sex workers with great disdain and in places like DC, trans sex workers have been harassed by police, disproportionately arrested and imprisoned, and then humiliated in prison. Transgender sex workers face a higher rate of HIV and hepatitis C in part due to poor police practices around their arrests and convictions. Organizations like HIPS actively perform outreach to provide sex workers with education and condoms with very little funding, at least compared to HRC.

Transgender people live on the margins. We are often unemployed or underemployed. We face open hostility and harassment from passersby and when we defend ourselves we may face imprisonment instead of our attackers. We have more trouble than average getting housing, have higher rates of suicide and drug use, and alcoholism. All of that said, we’re community leaders, live in stable relationships, raise children, donate to causes, we vote, we have successful careers, and we are loved. When a transgender person’s experience intersects with another condition of vulnerability, we must provide support to them because that could be any of us, given the right circumstances. What keeping to an agenda of a new omnibus ENDA-type bill forgets is that too many trans people face conditions more dire than that potential law would ameliorate. Until we lift all of us up, our movement is incomplete. And if HRC truly wants to apologize to “the trans community,” it needs to define an agenda that includes all of that community.

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Categories: LGBT Civil Rights, ponderings


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