As a HIV-positive transgender youth, 22-year-old *Tory belongs to the at-risk group that is considered to be most in need of intervention if Jamaica has any hope of seeing further reductions in the number of persons living with HIV/AIDS.
According to a study that was released last week by the Jamaica AIDS Support for Life (JASL), transgender persons who are HIV-positive are more likely to experience homelessness, stigma, forced sex and physical violence. Of the 71 transgender participants polled, more than 52 per cent were involved in sex work for accommodation and food, among other things.
"Now we are seeing where they are at increased risk more than gay men, and more than sex workers, of course, and so it's really just about how we are going to ensure that our programmes are attending to the needs of these persons," said executive director of JASL, Kandasi Levermore.
A UNAIDS report ahead of the commemoration of World AIDS Day on December 1 warned that 15-24 years is a dangerous time for women. It noted that an estimated 45 per cent of all new HIV infections globally in 2014 were among members of key populations and their sexual partners, and warned that new HIV infections are continuing to increase among people who inject drugs and men who have sex with men. The report went on to say that HIV was not declining in sex workers and transgender people.
Tory, a male who identifies as a female, has found himself in several of these categories. He became homeless at 16 years old and became a sex worker shortly after to provide for himself. His clients were mostly professional men, and at 18, he decided to go and live with a police officer who he said was a "regular buyer". He said he contracted HIV from the lawman.
"Being 16 and a sex worker, you get more clients because you are young, because you are new, because they like young people because they think you are not very smart. But I was very smart. Why I was homeless is because I was kicked out of high school because of my sexual orientation," he told The Sunday Gleaner.
MISTREATMENT AT CLINIC
He said due to the mistreatment he received at the first clinic he visited after his diagnosis, he did not take any medication for the first year. He, however, went to a different clinic where the attitude of health professionals was better, and he has since seen vast improvement in his health. He said he is now focused on becoming stable because his greatest desire now is to have a child, although he admitted that he had never had sexual intercourse with a woman.
"I am gay because I won't be in a long-term relationship with a woman," said Tory, before explaining that he is open to having sex with a woman for the sake of having a child.
"I want a child with my genes. Adoption is so hard in Jamaica at this point. She can be a lesbian or she can also be positive and virally suppressed, like myself. So there is a lot of hope to get a child if I want a child when I am ready," he said.
According to a report released recently by JASL, which was funded by the Canadian Institute of Health Research, there is very little knowledge about the HIV prevalence among transgender women in Jamaica.
However, the National HIV/STI programme noted that, "In contrast with the estimated HIV prevalence of 0.4 and 0.5 per cent reported in adolescent girls and boys aged 15-19 at the national level through the UNAIDS 2014 estimates, the HIV prevalence among gay and bisexual adolescent boys is estimated to be 14 per cent, while HIV prevalence in transgender adolescents is estimated to be 27 per cent."
Renae*, who came out as a transgender at 21 years old, said he is concerned that HIV is highest among transgender youths, and blamed this on the fact that those who adopt this lifestyle were often stigmatised or forced to engage in transactional sex.
"Being gay is a taboo, but being transgender is a greater taboo, and because of that, you have a lot of parents who actually do put out their children for these type of things, and you are out on the streets, you have no formal education, you have no way to really provide for yourself," he said.
"So you have to come up with means and ways to provide for yourself, and one of those methods is to become prey to sexual predators out there, or to offer yourself up as collateral, and oftentimes it is to persons who maybe know that they have the virus, but they don't care."
Although Renae was born male, he identifies as a female and is now an advocate for those living in the transgender community. He believes that while there have been improvements in access to treatment for those who are HIV-positive, stigma and discrimination are still forcing some to go underground instead of seeking help.
"That's why I work so hard within the health sector to make things better for trans people on a whole," he said.
[* Names changed to protect identity]