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Report

The Legal Needs of Transgender Women Living with HIV

Evaluating access to justice in Los Angeles
November 2015
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Los Angeles County is home to the second-largest community of people living with HIV/AIDS in the U.S. This study analyzes responses from transgender participants in the Legal Needs Assessment Study, which surveyed almost 400 people living with HIV in the county.

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Highlights
Transgender women were more vulnerable to being harassed, attacked with violence, or subjected to other crimes than straight cisgender men.
Transgender women living with HIV in Los Angeles County face a variety of legal needs but most do not seek any legal assistance.
The minority of transgender women who did see assistance for their legal needs were able to find help.
Data Points
9%
of respondents to the Legal Needs Assessment Survey identified as transgender women
70%
of them identified as Hispanic, Latina, or of Spanish origin
44%
of transgender women reported being harassed, attacked with violence, or subjected to another crime in the past year.
41%
of respondents said they had come into contact with the criminal justice system in the previous five years
24%
of transgender women in the survey reported experiencing discrimination in the year before the survey
32%
of respondents reported experiencing it over a five-year period
94%
of respondents reported not having a testamentary will or health care directive
50%
of respondents reported needing help with legal immigration issues
Report

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.1 Epidemiological data confirms 558 transgender individuals are documented as living with HIV throughout Los Angeles County.2 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.3 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.4 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.5 Based on these assumptions, the estimated HIV prevalence among transgender women in LAC is 15.1%.6

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,7 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%).8 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.9 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.10 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%).

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The Legal Needs of Transgender Women Living with HIV
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Div. of HIV & STD Programs, L.A. Cnty. Dep’t of Pub. Health, 2013 Annual HIV Surveillance Report 2 (2014), available at http://publichealth. lacounty.gov/dhsp/Reports/HIV/2013AnnualHIVSurveillanceReport.pdf.

Id.

Div. of HIV & STD Programs, L.A. Cnty. Dep’t of Pub. Health, Los Angeles County Transgender Population Estimates 2012 (2012), available at http://publichealth.lacounty.gov/wwwfiles/ph/hae/hiv/Transgender%20Population%20Estimates%202-12-13%20pub.pdf.

2013 Annual HIV Surveillance, supra note 1, at 12.

Los Angeles County Transgender Population, supra note 3, at 4.

Id. at 5.

For this study, a “legal need” was defined as any issue or problem experienced by the respondent that legal services are known to cover, such as problems in housing, health care access, and employment. It is understood that these needs may not be conceptualized by respondents or others as inherently legal in nature. The list of issues with legal implications was developed by a team of attorneys and HIV/AIDS researchers within the Williams Institute.

Respondents were first asked whether they identified as Hispanic, Latino or of Spanish origin, and then were asked a second question about their race that allowed them to select all racial categories that they identified with. All figures above include any respondent who selected that racial/ethnic option, regardless of whether they also identified as other races/ethnicity. White, as defined in the figure above, only includes respondents who identified as non-Hispanic monoracial White. Thirty-two percent of respondents identified as monoracial non-Hispanic Black or African American, 1% of respondents identified as monoracial non-Hispanic American Indian/Alaskan Native, and .3% of respondents identified as only non-Hispanic Asian/Pacific Islander. Thirty-nine percent of respondents identified as White, regardless of whether they identified as other racial/ethnic identities.

Zero respondents identified as transgender men.

This figure indicates that the majority of respondents have a household income that falls under the median household income for Los Angeles County. See United States Census Bureau, Los Angeles County, California, State and County QuickFacts, http://quickfacts.census.gov/qfd/states/06/06037. html (last updated Dec. 4, 2014) (stating median household income at $55, 909, 3.01 persons per household, thus averaging approximately $18,636 per person).