Bad stats, advocacy and HIV in trans communities

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In April I posted about a study by Stefan Baral and his colleagues at Johns Hopkins that purported to show that “Transgender Women 49 Times More Likely to Have HIV.” Baral acknowledged in a comment (I have no reason to doubt that it’s really him) that “these are pretty bad stats!” but went on to say that he felt his publication would help trans communities in the long run, and pasted the limitations section that he had ignored in his statements to the Huffington Post.

Claudia says that the police in Jackson Heights are much more respectful than in Hunts Point, focusing on keeping the overall area safe. “The men get rowdy, get drunk, and behave awfully. I don’t care if these women are men, nobody has a right to treat them like garbage.” See more photos by Chris Arnade, and read some of the sex workers' own stories.
Claudia says that the police in Jackson Heights are much more respectful than in Hunts Point, focusing on keeping the overall area safe. “The men get rowdy, get drunk, and behave awfully. I don’t care if these women are men, nobody has a right to treat them like garbage.” See more photos by Chris Arnade in his Flickr set, and read some of the sex workers’ own stories.

In theory I agree that it’s worth disseminating potentially inaccurate information if you believe that it’s going to help people regardless. In practice it’s never easy to predict what effect your actions will have. In this particular case, I think that reports like these do more harm than good for a very specific reason: they obscure important differences.

Baral’s study was actually a “meta-study” that combined studies done in cities all over the world. All of these studies investigated non-random samples of transgender people, usually focusing on subgroups that are at particular risk for violence or disease. They all include disclaimers saying “NON-REPRESENTATIVE SAMPLE NO NO DO NOT GENERALIZE RESULTS!!!”

One of the source studies turned out to be the study that I participated in here in New York, led by Larry Nuttbrock of the National Development and Research Institutes (NDRI). In November I criticized the study for overgeneralizing, but as I mentioned in May, the study does reveal some important things, which may very well be found in other communities.

In particular, the NDRI study reveals the deep divide here in New York between the lives of middle-class white trans people and lower-class black and Hispanic trans people. The difference in HIV infection rates (3.5% vs. 48-50%) between the two groups of participants in the study is huge. In another paper, the NDRI researchers indicate that HIV infection tends to correlate with unprotected anal sex, which in turn tends to correlate with gender abuse and symptoms of depression, as well as with attraction to men and nonwhite ethnicity.

What that means, in turn, is that middle-class white trans people like me are not at significant risk for HIV infection, or gender abuse, or depression. To use a fancy social science term, it’s intersectional: if you’re black or Latina, if you’re feminine, if you’re attracted to men, if you’re poor, if you’re a prostitute, it all adds to your risk. And as Hwahng and Nuttbrock observed, it’s all about power: the power to say no to unprotected anal sex.

That’s why you won’t see me using this study to get anything for myself. These high HIV rates don’t apply to me. I don’t deserve any of the money that governments and donors want to spend on it. I don’t know which donors Baral is trying to convince, or what he wants them to spend the money on, but it shouldn’t be middle-class white people.

This is not a problem of “trans women” or even of transgender people in general. It is a problem of disempowered black and Latina transvestites, and it can only be solved by re-empowering them. As Erica so eloquently put it, nihil de nobis sine nobis.

Of course I’m concerned about these high HIV rates, because I care about my fellow transvestites, and my neighbors. That’s why I’m prepared to act in support and solidarity, and I hope you are too. But don’t talk to mainstream transgender organizations that aren’t doing anything about this issue. Talk to organizations that empower sex workers of all genders, like the Red Umbrella Project.

Were you looking at the woman in the red dress?

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Film director Lana Wachowski, whom I associate most with the Matrix, has now declared her gender transition. I didn’t feel comfortable speculating when her transgender feelings were just a rumor, but now I can say that I see the Matrix as a deeply transgender movie. Blogger Hannah DuVoix finds a number of trans themes in the movie, but dissociation and glamour are the two that make the biggest impression on me. (There will be some spoilers here for those who haven’t yet seen it.)

The Matrix is dissociative. Dissociation is a psychological term for a particular kind of disconnect from reality, at least as others experience that reality. Dissociation can range from plain old field-independence to a deeply held belief that “my” body is not my own. One of its most extreme expressions is the dissociative fugue, where a person runs away and assumes a new identity, sometimes forgetting who they “really” are.

I refuse to speak for all trans people, but my own trans feelings have always contained an element of dissociation, and I’ve seen and heard it from others. A lot of my trans fantasies have involved some disconnection from my body. When I was younger I used to fantasize about moving to a different city and taking on a completely new identity for myself. Many trans people have done this, including the story of Holly Woodlawn as Lou Reed tells it in “Take a Walk on the Wild Side.”

In the Matrix, these dissociative fantasies are reality. When Neo takes the red pill, his entire reality is revealed to be an illusion, and he discovers his real body and the sensations that go with it. He is not just a programmer, “Mr. Anderson,” in a dreary world. He is something more, something where his “unreal” online identity is foregrounded.

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The Matrix deals with glamour, and specifically the desire to own and control feminine glamour. After Neo first disconnects from the Matrix, Morpheus takes him into a training program, a sandbox where he can demonstrate how the constructed world works. He is distracted by “the woman in the red dress” (played by Fiona Johnson), who walks by, smirking flirtatiously, and then turns into an evil Agent pointing a gun at Neo.

When Neo leaves the training program, his new shipmate Mouse slyly confides that he created the woman in the red dress, and that she’s available for other encounters. It’s not exactly a secret that many trans people obsess over the glamour of their target gender, trying to discover and replicate its secrets.

In her speech to the Human Rights Campaign, Wachowski talks about spending hours trying on dresses in the wardrobe closet of her high school drama club. I have similar memories, and when I saw the Matrix I had spent the previous year and a half working on my own animated virtual women, one of whom was sort of blonde (and neither of whom turned out anywhere near as sexy as the Woman in the Red Dress). Like Mouse – and Wachowski – I had very good reasons for doing it, but those reasons don’t preclude others.

Again, I’m not saying that all trans people are dissociative or obsessed with the glamour of their target gender, but these are themes we hear from lots of trans people. I wasn’t entirely surprised with the rumors and later revelations about Wachowski, because I had recognized a kindred spirit.

“Trans women” and the erasure of transvestites

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Transgender politics is notoriously full of terminological arguments. It’s an age-old expression of power: the right to decide which categories people get put in, who belongs and who doesn’t, who is condemned and who is spared, who is mocked and who is praised.

These arguments are compounded by the problems that we humans have in categorizing anything in a way that we can agree on. Last week I had a chance to talk with George Lakoff, who has done a lot to raise awareness of the problems with traditional definitions of categories, and he agreed that these problems have a greater impact when it comes to categorizing people.

Because of this, I generally try to avoid talking about transgender people, and instead focus on trans feelings, beliefs and actions. Unfortunately, the rest of the trans world hasn’t seen the value in this, and keeps arguing about how to categorize people. One of the worst things people do is to apply their categories uncritically to people from other cultures at other times, without their approval or consent.

This came up a few days ago when someone called Nat tweeted this:


As Nat explained to me, the target of this tweet was the organization Stonewall UK, which is apparently run by a bunch of rich white dudes in suits. I agree that it’s problematic for an organization called Stonewall to be run by people who don’t look anything like the people who started the Stonewall Riots, but I objected to Nat’s use of “trans women” to describe the actual rioters.

The people who started the Stonewall Riots did not call themselves “trans women of color.” “Trans women” is a recent coinage, from the past ten years, and “of color” is only slightly older. If they wanted to categorize themselves by race they were “black” (maybe “Negro”) and “Puerto Rican,” and if they categorized themselves by gender expression they were “transvestites” and “queens.” After the riots, the organization that Sylvia Rivera founded was called the Street Transvestites Action Network. (She later changed it to Street Transgender Action Network, but never to anything containing the term “trans women.”)

Rioters at the Stonewall Inn, 1969.
Rioters at the Stonewall Inn, 1969.
The problem with referring to the Stonewall activists as “trans women” is that that category is reserved for transitioners. Some of the Stonewall veterans had partly transitioned, and some transitioned later (including Rivera), but many lived part time and never transitioned. Would they transition if they were in their teens and twenties today? Maybe, maybe not.

Nat tweeted to me, “I was under the impression that trans* included -vestite?” Yes, trans* includes -vestite. “Trans woman” does not – except when they’re co-opting us to get money or political support.

When have you ever heard “trans woman” used to describe someone who’s not transitioning? RuPaul has been explicitly excluded from the category – and apart from being wealthy she probably bears the greatest resemblance to the Stonewall rioters of any celebrity today. If you can find a non-transitioner in any list of contemporary “trans women,” I’d love to see it. I’ve never seen Eddie Izzard or Rye Silverman in one. And in the few tweets I’ve read from @theNatFantastic, I’ve never seen a contemporary non-transitioner as a trans woman.

So no, you don’t get to go around talking about “trans women” never mentioning a non-transitioner, and then turn around and claim non-transitioning heroes as “trans women.” The Stonewall rioters were not trans women. They were transvestites. They’re my heroes, not yours.

Here’s the kicker, which prompted Nat to tell me to “chill the fuck out”: there is a systematic exclusion of non-transitioners from the “trans community,” and “trans women” leaders are actively involved in this exclusion. “Trans women” are doing exactly the same thing as Nat’s “rich white dudes in suits.” Nat’s tweet was part of this exclusion.

Maybe it’s because I sometimes look like a white dude in a suit, but I’ve found a lot more acceptance and support from rich white dudes in suits than I ever have from “trans women,” many of whom are rich and white and wear suits.

Let’s all remember that the Stonewall Riots were started by Black and Puerto Rican transvestites. Their legacy belongs to the world, but more to Black people, Puerto Ricans and transvestites than to the rest of us. And most of all to Black and Puerto Rican transvestites, who still flock to Greenwich Village to this day. Maybe we should let them decide what to do with it.

Segregated bathrooms are a kludge

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Bathrooms are an important issue to me. When I present as a woman I use women’s bathrooms, and I want every trans person to have the right to choose their bathroom. But I realize that the desire some people have to exclude us from bathrooms is based on a legitimate concern. I heard this recently in a story from Afghanistan, where some people have made gender-segregated bathrooms a priority.

Graduates of the Women’s Afghan National Police training course in Kandahar province, Afghanistan smile after receiving their ANP graduation certificates Aug. 5 at Camp Nathan Smith. Photo by Spc. Tracy R. Weeden / Isafmedia.

In Afghanistan, crimes against women often go unpunished. The Afghan government recognized that a major factor was the absence of female officers, and hired a number of new recruits. Now, many of those police officers are leaving, because they are being regularly attacked and raped.

The most common locations for these assaults are the police station bathrooms, which are open to all genders. The female officers are most vulnerable when half-naked, performing involuntary bodily functions. The proposed solution, advocated by Human Rights Watch, is to institute women-only spaces, where a man would be automatically suspect.

It’s too often overlooked that the shared bathrooms in no way cause the attacks. These attacks are deliberate acts of violence chosen by individuals, encouraged by a culture that dehumanizes women, and perpetuated by a legal system uninterested in bringing the perpetrators to justice.

This story helps some of us understand why gender-segregated bathrooms exist in the first place. They are a kludge, a short cut to stop the worst abuses. And like all kludges, bathroom segregation doesn’t work one hundred percent. There are false positives – trans people who are denied access to the bathrooms that fit our presentation and marked when we use the others. Significantly, there are plenty of false negatives – men who walk right into segregated bathrooms and attack women without any claim to transgender status.

A kludge may be necessary to break through a logjam. Think of the US Marshals who accompanied Ruby Bridges when she became the first Black student to attend William Frantz Elementary School. Segregated bathrooms may similarly be warranted in the case of the Afghan police. But just as integrated schools no longer require guards for every Black student, in some places segregated bathrooms may no longer be necessary.

Twice when I was in college here in the US I lived on dormitory floors where the bathrooms were nominally reserved for a single gender, but the residents had voted unanimously to open them to all genders. When I was studying in Paris, the public bathrooms in the classroom buildings were similarly integrated, with all gender markings removed.

Of course rape and voyeurism still exist in both the US and France, and in some places it may still be necessary to segregate bathrooms by gender. But the two experiences I mentioned suggest that in some situations respect for women’s rights and the rule of law is so secure that we no longer need the kludge of segregated bathrooms to protect women.

Even in places where gender-segregated bathrooms are still deemed necessary, it is clear that people who want to rape, ogle or video women in bathrooms will do so if they think they can get away with it. A small minority of them claim to be trans, probably because they actually are trans. In the end, what really protects women in bathrooms is not ineffective attempts to keep trans people out of them, but strong enforcement of the laws against assault and voyeurism.

Living in the highlight reel

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Steven Furtick, a Christian cleric who has publicly condemned homosexuality, has nevertheless come up with a great metaphor to help us understand insecurity.

Building on Furtick’s metaphor, it occurred to me recently that glamour, as described by Virginia Postrel, is the desire to escape from our behind-the-scenes into someone else’s highlight reel.

Headshot

After taking this picture of myself last week, I’m thinking that narcissism is the desire to escape from our behind-the-scenes into our own highlight reel.

Visibility fatigue

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There’s a concept that I want to introduce here: visibility fatigue. It’s something I’ve been noticing in relation to trans issues, and I’ll make those connections in future blog posts.

I have a T-shirt that says, “MIND THE GAP” with the logo of the London Underground. I bought it on a trip to London in 2001, when a recording of that phrase was played every fifteen seconds or so in stations that had a particularly large gap. Back home in New York, one day I was out walking and a guy gave me a knowing look, smiled and said, “Nice shirt.”

It seemed like he wanted to talk more, like we shared some great secret, but I was on my way somewhere else and didn’t really want to chat about it. I realized at that moment that there’s probably thousands and thousands of people here in New York who’ve been to London, ridden the Underground and heard that phrase. Did we really share that much that separated us from other New Yorkers? At that moment I realized that I didn’t really want everyone I ran into on the street knowing I’d been to London.

I have another T-shirt that’s one of my prized possessions. I got it at the 1996 Pride Rally, one of the first times I ever went out in public presenting as a woman. One day I wore it to the gym around the block, and on the way there I happened to be walking alongside my neighbor Jim. Jim asked me why I was wearing a big pink triangle if I’m married to a woman and we have a kid together. I explained that I was a transvestite and answered a few more questions, and everything was cool.

Most of the time, though, the shirt just sits on the shelf. It’s not that I don’t want to be out, proud and visible. It’s that I want some measure of control over it. It was work explaining this stuff to Jim, and there was no guarantee that he would be as understanding as he was about it. Sometimes I’m not up for that.

At the Lavender Languages conference this year I attended a talk by the Moroccan-French-Canadian artist 2fik who does amazing and very provocative things with gender and identity. He described some very hostile reactions he’s gotten – including death threats in at least one instance. But as I remarked to him, at the end of the day he can take off his clothes. He can have a break from being provocative.

I’ve always wanted to keep that ability to have a break. I grew up a long-haired boy in the seventies, and I remember that visibility fatigue – just wanting to blend in once in a while. It figured into my decision not to transition: I had succeeded in being seen as a pretty young woman, and enjoyed that visibility in small doses, but understood why so many women find it frustrating. I had also had the experience of not passing, and attracting attention that way. I knew that most people have times during a transition when they don’t pass, and some never pass. I didn’t want to be that visible all the time, with no rest in anonymity.

My tolerance for visibility has also varied over the course of my life. When I was younger I often felt a desire to be provocative. Now I favor more subtle approaches. I think that’s natural and good. But I’m glad that I didn’t make choices when I was young that don’t work for me now.

Some people have a lower tolerance for visibility and attention than I do. Others, like my neighbor “La Loca,” have a greater tolerance. If they want to use that visibility to teach people or just express their gender in a way that feels more comfortable, more power to them. Especially if they don’t wind up committing to a level of visibility that they can’t sustain with comfort later on.

In future posts I’ll show why I think visibility fatigue is important when talking about transgender lives.

Good research: Three trans communities in New York City

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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.

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The Silver Swan, a popular hangout for “White cross-dressers” in the mid-00s.

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.

The kind of coming out we need

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Last month I highlighted some good research done by Lal Zimman at the University of Colorado, where he found two conceptions of coming out among trans people that were very different from the way the term is used by lesbians and gay men. In the comments, my friend Caprice Bellefleur hit on the next point that I was going to make: that there’s a fourth way that coming out is used.

There is a further complication about the use of the term “coming out” among trans people. Many, especially those who identify as crossdressers, use it to mean the first time they appeared in public in their alternate gender. They may not have disclosed anything to anyone.

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In keeping with Zimman’s use of the letter “d,” with declaring a gender transition and disclosing a transgender history, I’ll talk about non-transitioning trans people displaying non-normative gender expression.

Zimman explicitly excluded crossdressers from his definition of “transgender,” acknowledging its use as a euphemism for “transsexual,” but when I met him in February I was there to advocate rejecting that sense of the word, based in part on the fact that there’s so much overlap. Many of his “transgender people,” particularly on the feminine spectrum, identify for years as crossdressers, and in fact the “declaration” he described is a performative speech act that, in the eyes of many trans people, is enough to allow someone to pass from “umbrella trans” (or even “just a cross-dresser” or “just a lesbian”) into “really trans.”

(I honestly don’t know much about coming out for queens and butch lesbians. I do know that for some gay men, coming out allows some feminine self-expression, and similarly allows some masculine expression for lesbians, but I’ve heard that that is still stigmatized by many people, gay and straight.)

As I said before, I’m not really happy with these three uses of “coming out.” To put this in perspective, there are several advantages that the “gay” kind of being out confers on the individual and the community:

  1. The dishonesty and self-denial necessary to be closeted tend to be habit-forming and have a corrosive effect on character
  2. The same habits of dishonesty and self-denial have a corrosive effect on the tenor of group interactions.
  3. Large numbers of gay men, lesbians and bisexuals being out contribute to safety in numbers.
  4. It’s easy to dehumanize people when you can pretend they’re not there, but it’s a lot harder when you know someone.
  5. It’s easy to hate people when they feel ashamed of themselves, but it’s harder when they have self-respect.

The two forms of “coming out” that Zimman describes (declaring and disclosing) fulfill all these characteristics, but they are only available to people who choose to transition and genderqueer or genderfluid people. Someone who has the exact same thoughts, beliefs and feelings but decides not to transition or change their primary gender expression has only the display form of coming out available to them. When people display they are visible in public as trans people, but in clothing and accessories that they normally don’t wear, and with makeup that changes their appearance. They may not be recognized by people who know them in their primary identity. Most importantly, they don’t use the same name. How is anyone supposed to know that the Tiffany Sparkle that they met at the dance club last Friday is the same person as Bob from Accounting?

This means that displaying has only one of the four advantages of coming out, the “safety in numbers” advantage, and that only when people are actively cross-dressing. There may be some feeling of liberation in this, but it is fleeting, and at all other times they still have to hide and to deny their true feelings. And while they hide, others are unaware that people they know are “one of those” and know that all these people are so ashamed of themselves they don’t want their true names known.

I seem to be the exception here. I decided not to transition in 1995, and I decided to come out in 1996. I came out “gay style,” by putting up a website and telling my co-workers. I didn’t start wearing dresses to work; I just told people. And when a trans-related topic came up, I came out again as necessary.

I’ve reaped three of the four benefits of coming out. I’ve felt hugely better being able to talk about this important part of my life, and knowing that all these people know and are still treating me with respect. I’ve used it to build bridges in my community and break down walls of hatred and mistrust. But I don’t get the benefit of strength in numbers.

I don’t know any other non-transitioning trans people who’ve come out the way I did, and that’s a shame. Because there are a lot of closeted trans people out there who don’t seem to know that it’s possible to come out this way. The only way they see out of the closet is to disclose a gender transition. That’s not right.

Who owns “transvestite”?

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Courtney O’Donnell blogs about media representation of trans people, and serves a useful watchdog role. It’s possible to go overboard with that, and normally she recognizes it. Last September she wrote, “As for ‘transvestite’, some have made it know they find this word offensive, too, however, I’m also aware that it’s usage as an umbrella term is rather widespread — particularly in the United Kingdom. I’d be curious to hear what trans people from the other side of the pond feel about the term.” Last week in a post about Rosalinda Rebolledo, she asked whether Rebolledo’s story counted as “transgender news.”

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In a post today, O’Donnell goes overboard. The actress Gwyneth Paltrow, who’s actually less silly than a lot of Hollywood people, was asked by USA Today, “But seriously, how can she look so fresh the day after partying until near-sunrise for the Met Gala?” Paltrow replied, “Are you crazy? I’m like RuPaul! I have so much makeup on. Foundation! Last night, I was literally a transvestite.”

(Don’t even start on the “literally.” That battle is lost, people. We’ve got plenty of words that mean “in the real world, not metaphorically or metonymically.” Use them, and forget this one.)

O’Donnell created an image saying that Paltrow “Ridicules Trans People,” and writes, “Trans people are not objects to ridicule. While it may appear to be a thoughtless comment by an ignorant person, however, a celebrity of her stature yields quite a bit of influence among her fans, so she’s going to have to own up to committing this very public blunder. I wouldn’t go so far to say Paltrow is transphobic, but she in dire need of education. If we can get her to apologize, she can redeem herself and send a bit of good PR our way.”

A lot of O’Donnell’s commenters said she was making too big a deal of it, to which O’Donnell replied, “Remember, those that do violence against trans people do not check for labels — crossdressers, transvestites, transsexuals — trans people are all one and the same to them. Being mocked in the media by a celebrity, no matter how slight, normalizes this behavior. While readers are free to give Paltrow a pass, I’d like to think I’m helping ensure that mocking trans people isn’t so easily blurted out during interviews anymore.”

I’m not really sure what ignorance Paltrow is exhibiting, let alone mockery, and what kind of “education” O’Donnell has in mind for her. Beyond that, though, where does O’Donnell get off policing the word “transvestite”? It’s clear from her September post that she doesn’t identify as one, and doesn’t understand the nuances of the word. Why not leave it to someone who does?
IMG_0535When I was a cute young thing I didn’t need to wear any makeup at all. But at 41, I’m not just a transvestite but an aging transvestite. I have to spend an hour slathering the stuff on just so that I don’t see my beard shadow in the mirror. It’s a pain in the ass, and it’s kind of nice to know that People‘s “Most Beautiful Woman” has to put up with it much more often than I do.

I don’t feel at all ridiculed by the comparison. I don’t feel mocked by someone who wears a lot of makeup pointing out that we do too. I don’t see how it could encourage people to violently attack us. In fact, I feel sympathy and validation from Paltrow.

I’d appreciate it if O’Donnell and (any other non-transvestite activists) could back off from the term “transvestite” and focus on whatever flavor of trans she identifies with. If we want her help, we can ask for it. And actually, if she wants to give a signal boost to this effort, that’d be nice.

(P.S. See also Jeremy Feist’s take.)

Bad Stat of the Month: HIV infection

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AIDS is a horrible disease. My family has lost at least one dear friend to it, and the world has lost millions of loving, creative people. It also affects a significant number of transgender people around the world. AIDS needs to stop, and I’m heartened by recent news of medical advances that help people to live full lives with HIV infections, and even suggest the possibility of a cure.

In order to stop the spread of AIDS and help save the lives of people infected with HIV, we need to know what’s going on. We need the best information possible, and we need to avoid overreaching and making unjustified assumptions. That’s why I’m frustrated by April’s Bad Stat of the Month: Worldwide burden of HIV in transgender women by Stefan Baral, Tonia Poteat, Susanne Strömdahl, Andrea Wirtz, Thomas Guadamuz and Chris Beyrer at Johns Hopkins, the Karolinksa Institutet and the University of Pittsburgh.

As I said with the inaugural Bad Stat of the Month, I’m not happy to be doing this. I’m sure that Baral and his associates are all caring professionals who really want to make a difference in the fight against AIDS. I believe that they also want to help transgender people, and they think they’re doing that by spreading these figures. I hope that this post will convince them that this strategy does more harm than good, and that they should concentrate their efforts elsewhere.

So here’s the headline that came blazing across my feed reader earlier this month: Transgender Women 49 Times More Likely To Have HIV, Study Says. “It doesn’t seem like it’s been a priority for global funding entities to care about the needs of transgender communities,” Baral told the Huffington Post’s Meredith Bennett-Smith. Bennett-Smith continues, “Going forward, Baral said he hopes health care providers and advocates will improve the way they target transgender populations and tailor treatment systems and support networks.”

Fair enough. I want global funding entities to improve the way they target transgender populations, because much as I want them to care about my needs, as a middle-class HIV-negative white American I don’t need their funding. What I’m afraid of is that the research of Baral and his associates will obscure that fact and other important patterns in the data, making it more difficult for them to target populations, exactly the opposite of their intentions.

How does this study obscure these patterns in the data? There are multiple ways, and I could probably write a post a day for a month. Tonight I’m going to focus on one specific weakness in the methdology, that I’ve discussed many times before. Baral and his colleagues pooled data from 39 studies across fifteen countries. I’ve looked at a few of these studies, and they all use non-representative samples. It is well known that a non-representative sample cannot be reliably generalized to the population at large, and many of these studies warn against such overgeneralizations. Baral and his co-authors simply ignored these warnings, stating in their summary, “Our findings suggest that transgender women are a very high burden population for HIV and are in urgent need of prevention, treatment, and care services.”

For example, one of the studies that Baral et al. used was a study by Kristen Clements-Nolle, Rani Marx, Robert Guzman and Mitchell Katz of the San Francisco Department of Public Health, who write, “The primary limitation of our research was the use of non-probability sampling. Our findings may not generalize to other urban areas, and there may be threats to internal validity if certain sampling methods were more likely to recruit high-risk individuals. Most traditional random sampling approaches would not produce reliable samples, however, because the transgender population has strong privacy concerns and has never been counted, and because many transgender persons are marginally housed or homeless.”

Despite this warning, Baral et al. went right ahead and generalized Clements-Nolle et al’s results, not only to other urban areas, but to the entire United States, and with a certain weighting, to the world.

As I said, there are more problems with the meta-study, but I’ll have to save those for later posts. I’ll also talk about the implications of these problems for trans people and people at risk for HIV.