Trans Women and HIV: Social Psychological Perspectives

160 Pages·2020·2.153 MB·English

by  Rusi Jaspal

Trans Women and HIV
Social Psychological
Perspectives
Trans Women and HIV
“In the face of high levels of stigmatisation and prejudice against trans people,
thisbookoffersanimportantcontributiontoknowledge.Ittakesanuancedand
insightfulapproachtoaneglectedarea—transwomenandHIV—anditwillbeof
interesttopractitioners,policymakers,andthosewhoareconcernedwithhealth,
sexuality, and gender.”
—Prof. Surya Monro, University of Huddersfield, UK
“As a psychological practitioner providing clinical education and training to the
next generation of mental health workers, I believe that this timely and relevant
bookhighlightstheimportanceofunderstandingthephenomenologicalperspec-
tive of sexual and ethnic diversity in the medical and psychiatric models. The
case studies bring to life the people behind the labels, integrating the context
and theoretical foundations to provide an empathic, resilience-based model to
promote psycho-medical well-being interventions. This book also offers a way
forward with recommendations for policy makers and programme developers
managing health risks and health promotion.”
—Dr. Joann Griffith, De Montfort University, Leicester, UK
“Trans women living with HIV may be uncounted in datasets. This book
details exquisitely the complex intersectional aspects of stigma faced by this
group, exposing its structurally violent and disempowering nature. Jaspal notes
the struggle to construct an identity characterised by “self-esteem, continuity,
belongingandauthenticity”,compoundedbyHIVstatus,andthecopingmech-
anisms that may be adopted to deal with transphobia, sexism and racism. It is a
powerful and essential work, and for clinicians offers important, practical recom-
mendations that we must strive better to embed into HIV care and prevention
services. We are left with a key question needing urgent attention—how can
we all discourage concealment and self-isolation among trans women living with
HIV, to reduce stigma, and improve health overall?”
—Dr. Tristan J. Barber, Royal Free Hospital, London, UK
Rusi Jaspal
Trans Women
and HIV
Social Psychological Perspectives
Rusi Jaspal
School of Social Sciences
Nottingham Trent University
Nottingham, UK
ISBN 978-3-030-57544-1 ISBN 978-3-030-57545-8 (eBook)
https://doi.org/10.1007/978-3-030-57545-8
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Acknowledgements
My research career has seen me explore aspects of identity, relation-
ships and psychological wellbeing in many minority groups in society.
Throughout all of these research projects, I have always been motivated
by the same things: my deep appreciation of diversity, which enriches
our society; my fascination with the functioning of social groups; and
my conviction that diversity must be supported so that minority groups
can thrive and flourish. Outgroups have a crucial role to play in enabling
minority groups to experience social and psychological wellbeing. It has
felt very rewarding to write this book about transgender women living
withHIVintheUK.Thebookbeginstofillagapthatmanyofusinthe
field of HIV have long lamented. I am immensely grateful to the eleven
trans women who generously shared their experiences with me. I thank
my Ph.D. students over the years whose ideas have inspired me. I would
like to express my deepest gratitude to Aedan J Wolton without whose
supportthisprojectwouldsimplynothavecometofruition.Iamgrateful
toLaurenKennedywhowasmyresearchassistantontheEXTRA(Experi-
encesofTransWomenLivingWithHIV)StudyandtoSueHaywardwho
provided excellent administrative support. I thank my beloved family—
Ramesh, Asha, Babak and Jaya—for their unwavering support during the
writing of this and other books.
v
Contents
Part I Trans Women in Context
1 Understanding Trans Women and HIV 3
2 The Construction of Trans Identity 25
3 HIV Stressors and Risk Factors 43
Part II Trans Women Living with HIV in the UK
4 Researching HIV and Trans Women 67
5 Multi-Layered Stigma 89
6 Self-Isolation and Identity Concealment 109
vii
viii CONTENTS
7 Sex Work and HIV 127
Part III Conclusion
8 Supporting Trans Women Living with HIV 147
Index 155
List of Figures
Fig. 1.1 Number of HIV diagnoses by year in the United Kingdom
(2004–2018) 19
Fig. 2.1 Identity process theory (from Jaspal, 2018) 31
Fig. 3.1 The Health Adversity Risk Model (from Jaspal et al., 2018) 55
ix
PART I
Trans Women in Context
CHAPTER 1
Understanding Trans Women and HIV
Abstract In this introductory chapter, the social psychological focus of
the volume on the experiences, identities and psychological well-being of
trans women living with HIV in the UK is discussed. The key questions
addressed in this volume are described: (1) How do trans women living
with HIV experience their diagnosis and the ‘stressors’ associated with
thecondition?(2)HowdotheyperceiveandmanageHIVdisclosure?(3)
How does the experience of living with HIV shape identity and psycho-
logical well-being among trans women? Two case studies are provided
to illustrate the psychological challenges among trans women living with
HIV in the UK. Key terms that are used in the volume are defined. A
brief history of trans women and a brief overview of key statistics on the
trans population and of HIV incidence in the UK are provided.
Keywords HIV · Trans women · Trans history · HIV epidemiology ·
Social psychology
Thefieldofhumanimmunodeficiencyvirus(HIV)hasundergonesignifi-
cantdevelopmentsincethefirstclinicalobservationsofacquiredimmune
deficiencysyndrome(AIDS)in1981.HIVhasgonefrombeinganalmost
invariablylife-limitingdiseasetoalife-changingchroniccondition.Effec-
tive treatments have been developed, ensuring a very good prognosis for
those diagnosed and treated early. Both the efficacy and tolerability of
© The Author(s) 2020 3
R. Jaspal, Trans Women and HIV,
https://doi.org/10.1007/978-3-030-57545-8_1