Who is trans?

At birth, people are systematically assigned a binary gender based on their genitalia. Over the course of a lifetime, each person discovers their gender identity. Trans and non-binary* people are assigned at birth to a sex that does not correspond, or only partially corresponds, to their gender identity. People whose gender identity corresponds to the sex they were assigned at birth are cis(gender). Some trans people are women, some men and some non-binary. Their gender identity does not fall exclusively into the male/female binary categories. Some, but not all, trans people undergo a transition. For example, they change their first name, their sex on their civil status register, take hormones or undergo operations. Each transition is highly individual. Discrimination increases the risks Trans people live with HIV disproportionately because of a multitude of factors. At a societal level, stigma, discrimination and marginalisation contribute to modifying and limiting participation in society. Exclusion in the workplace, within the family or in the wider social environment is not uncommon. The lack of awareness of the existence of trans people and the realities of their lives, particularly in the medical and preventive fields, means that it is particularly difficult for trans people to acquire the knowledge they need to protect themselves effectively against HIV. Added to this is the fact that many, but not all, trans people feel a strong sense of unease about their bodies, which can limit self-care, including protection against HIV. Combined with the weight of social discrimination and its impact on the psyche, this can have a negative impact on the way trans people protect and care for their health. In addition to individual factors, lack of information and prevention, poor mental health, internalised discriminatory principles and an increased risk of sexualised violence all contribute to eventual HIV infection.

Intersectionality

Trans people living with HIV experience particular intersectionality. Intersectionality means that trans people living with HIV experience discrimination not only because of their trans identity, but also because of their HIV status. It is therefore particularly perfidious that trans people also have negative experiences within trans communities because of their HIV status and vice versa. Even in spaces marked by people living with HIV, trans people living with HIV experience discrimination because of their gender identity.

Trans people in the health sector

People who consult a health service want to be advised and listened to. For trans people living with HIV, the reality is often different. They spend a substantial part of their appointment explaining and informing their interlocutor, without being able to devote the necessary time to the consultation itself. They provide free, unsolicited information. In the best of cases, they meet with attentive and interested ears, but all too often these attempts at information are marked by inappropriate and medically irrelevant questions, which undermines confidence in the health services. Prejudice clouds consultation and leads to mistrust, which often results in trans people developing little or no relationship with health services and seeking treatment for health problems late or not at all. Meanwhile, health professionals often feel overwhelmed by the situation. They lack the language to be able to proactively formulate relevant medical questions and the basic knowledge to be able to determine for themselves when and how a person's trans identity might be relevant for consultation. This task is made even more difficult by the paucity of data and the lack of preparation on the subject for day-to-day work. Indeed, little knowledge of the physical effects of transition and its medical consequences is readily available. This requires an even better relationship and understanding between medical staff and trans people.

Reaching out to communities

It is particularly difficult for trans people unfamiliar with the medical system to find an appropriate point of contact. The lack of links between medical institutions and organisations for people living with HIV and trans communities creates an unnecessary barrier to access.

Visibility and networking

In addition to barrier-free access to the healthcare system and favourable medical care for trans people, the visibility of other trans people affected by HIV is proving to be a decisive success factor for trans people living with HIV. It is precisely within trans communities that being surrounded by other people who share the same realities of life can bring great relief. This can be an additional burden in the context of HIV. Conversely, people assigned to the female sex at birth are often taken less seriously and find it harder to make their voices heard. In addition, trans people often feel that the pathologisation of their gender identity contributes to their (medical) concerns being taken less seriously.

Gender and expectations

There is little discussion of the link between a person's gender identity and their approach to health and illness. People who are perceived as male are often expected not to talk about their health and needs and to be hard-working.

Tips for everyday life

Changes in society as a whole and political will are needed to improve the quality of life of trans people. But in direct contact with trans people, everyone can make a contribution. Here is some important advice, especially for health professionals, but not only:

- Use the proper forms of address, first names and pronouns and write them down if possible.
- Get information from specialist organisations run by the community. 
- Only ask questions that are medically relevant, and explain why they are relevant. 
- Be open about your uncertainties. 
- Focus on what the person wants to discuss.