In November I was annoyed with a couple of statements by Sel Hwahng, but after re-reading this article he co-authored with Larry Nuttbrock, I’ve decided that it’s really solid research and should be read by anyone who’s interested in public health – or trans politics in general.
As I discussed in my earlier post, several years ago I participated in a study where I went to a storefront every month or so, gave a blood sample, and talked with a researcher for a while. Usually it was a fairly repetitive series of short-answer or Likert questions, but there were a few discussions that were more open-ended. Larry Nuttbrock was the principal investigator on the study, and I’m one of the “White cross-dressers” that he and Hwahng are talking about.
Re-reading the article, I see that it was really only two lines that bothered me:
These cross-dressers explained that because of their desire to maintain a traditional masculine gender role and hide their transgender status, they often did not undergo transition, hormonal supplementation, or surgery until well into their 40s or 50s. Transition often occurred after a domestic breakup, when they could be more out as transgender.
It was definitely true that some of us really wanted to transition but felt trapped by commitments to work and family, but not all of us by any means. I personally decided that I didn’t want to transition years before I got married and had a child, and I haven’t changed my mind about it. Most of the other people I met in that scene showed no interest in transitioning. But this is relatively minor.
Judging from media reports and health research, you might think that the trans population is either all HIV-infected prostitutes or all sexy young transitioners. I schlepped down to Avenue A every month and got pricked with a needle so that people could see another way to be trans. Hwahng and Nuttbrock show that here in New York there are at least three ways to be trans. They found that life was very different for us White cross-dressers than for Asian sex workers and members of the House Ball community.
According to Hwahng and Nuttbrock, House Ball members, almost all from Black and Latin American backgrounds, were more likely to engage in survival sex work and to have little power to refuse sex or to insist on condoms. Members of my White cross-dresser community were largely able to avoid sex work if we chose, so “when White cross-dressers did engage in sex work, it was almost always for recreational purposes.” The Asian sex workers in the study had an intermediate level of power, often being able to insist on condoms and working in hotels and apartments instead of on the street.
Given these different circumstances, it’s sadly not surprising that our risks of HIV infection are vastly different. In another paper co-authored by the entire study team, they didn’t have enough data about the Asian sex workers, but they reported that “HIV was 3.5% among Caucasian Americans compared to 49.6% and 48.1% among the Hispanics and African Americans.”
It’s important to note here the limitations of the study. Nuttbrock and his colleagues were able to investigate these three trans communities, but they were aware of others:
The study also identified additional groups, including the following: low-income, immigrant Latina(o) sex workers of Central and South American origin who solicited in Queens; low income, immigrant Latina(o) sex workers who solicited in Manhattan; and low-income, immigrant South Asian transvestites in Manhattan, Queens, and New Jersey. Not enough data had been gathered at this writing, however, for detailed analyses of these other populations. Some study participants did not fit any of these ethnocultural contexts but did not constitute large numbers and were thus considered outlier data.
This is really key. We don’t know what we don’t know. There could be some population of wealthy South Asian transvestites that completely swamps all three of the other groups numerically, but that was invisible to Hwahng and Nuttbrock because they meet in secret in luxury condo towers. Not that likely, but nobody really knows. I’ll close with a great quote from the report:
To understand the complex, interlocking behavioral and sociostructural determinants of health that often remain hidden within the geographic location of the New York City metropolitan area, it is thus imperative to examine as many divergent ethnocultural transgender communities as possible.