Introduction
Los Angeles County (“LAC”) is home to the second-largest community of people living with HIV/AIDS (“PLWH”) in the U.S. Currently, an estimated 58,000 PLWH reside in the county, a figure that has steadily increased over time. Epidemiological data confirms 558 transgender individuals are documented as living with HIV throughout Los Angeles County. Because gender identity data was not collected by the state in the HIV/AIDS Case Report Form prior to 2002, LAC estimates the number of transgender individuals living with HIV to be closer to double that figure. Prevalence rates of HIV among transgender individuals cannot be calculated due to a lack of data regarding the total size of the transgender population in LAC. Using population estimates from four previous studies, however, the County estimates there to be 14,428 transgender persons living in LAC, half of whom, or 7,214, are presumed to identify as transgender women. Based on these assumptions, the estimated HIV prevalence among transgender women in LAC is 15.1%.
In 2013, the Williams Institute designed the Legal Assessment of Needs Study (“LeAN Study”) to examine the legal needs of PLWH in LAC. The study focused on particularly vulnerable members of the HIV-positive community, including low-income and unemployed individuals. Almost all respondents were accessing community-based social services and safety net programs at the time of the study. Research studies focused on legal services for PLWH are limited, and to date, little research has been done to assess the unmet legal needs of transgender women living with HIV.
Legal Assessment of Needs (“LeAN”) Survey
This report summarizes findings of the LeAN Study for transgender women living with HIV in Los Angeles County. We describe respondents’ legal needs, respondents’ experiences getting assistance for identified legal needs from both legal and non-legal sources, and barriers respondents faced in accessing assistance from both legal and non-legal sources. We describe differences and similarities between transgender women and all other respondents. Finally, we discuss how these legal needs may relate to health access and health status.
The LeAN Study survey included 387 respondents who identified as PLWH. Overall, respondents identified as cisgender men (69%), cisgender women (21%), and transgender women (9%) with a mean age of 49 years (SD = 10.6, age range 20-77 years). Almost half of the respondents (48%) reported living with AIDS. Respondents identified their race/ethnicity as Hispanic, Latino or of Spanish origin (44%), Black or African American (37%), White (17%), American Indian/Alaskan Native (6%), and Asian/Pacific Islander (1.6%). Respondents resided in 111 unique zip codes spread across LAC, including the Metro (43%), South L.A. (20%), South Bay (16%) and San Fernando (11%) areas.
Thirty-four of the total respondents, or 9%, identified as transgender women. This cohort represents approximately 6% of the total population of confirmed HIV-positive transgender individuals living with HIV in LAC. Of these women, 79% identified as being Hispanic, Latino or of Spanish origin, and over 70% indicated being foreign-born. Their mean age was 46 (SD= 10.4, range 21-73 years). Transgender women respondents reported residing in 24 unique zip codes spread across the following areas: the Metro (44%), South L.A. (21%), South Bay (15%), San Fernando (9%), East L.A. (6%), San Gabriel (3%) and West L.A. (3%) areas. These areas were generally the same areas where other respondents reported residing.
More than 90% of transgender women indicated not having children, and household size for transgender women was smaller on average than for other respondents. As compared to all other respondents, transgender women reported a lower level of formal education (74% received a high school education or below compared to 55% of non-transgender identified respondents). Transgender women were less likely to report being disabled and living on disability benefits than non-transgender respondents (18% vs. 51%, respectively) and more likely to have worked sometime in the past five years than non-transgender respondents (56% vs. 37%, respectively).
No significant differences were observed between transgender and non-transgender respondents with regard to self-reported income. Fifty percent of respondents reported household incomes of less than $10,000 per year, and 78% of respondents reported household incomes under $20,000 per year. For transgender women, 64% reported household incomes of less than $10,000 per year, and 79% of respondents reported household incomes under $20,000 per year. Encouragingly, similar to the survey respondents as a whole, transgender women also reported high rates of being linked to care (100%), retained in care (97%), being prescribed anti-retroviral medication in the last year (97%) and being informed as having an undetectable viral load in the past year (85%).