Photo by Sarit Z Rogers @SaritPhotography
It takes a lot to come out — whether you're LGBQ or HIV-positive — but it can be a particularly difficult decision for those who've undergone a gender transition, because it undermines the very thing you've worked so hard to acheive: being seen as the man or woman you identify as.
Teo Drake chose to embrace the stigma that comes with being trans and HIV-positive, because he knows people need to see things to believe they exist — and too many people act like HIV-positive trans guys don't.
“The dual stigma of being a trans man and having HIV — particularly trans men who identify as gay and/or have sex with men — means that it’s easier to allow people to make assumptions than to have to also disclose being trans," says Drake, who sits on the board of Positively Trans, and is a long-term survivor who's been positive for over two decades.
“One of the major factors for me in deciding to become more visible was that I fear that trans men make up a growing demographic of HIV-positive people... because there’s virtually no targeted HIV-prevention information for this demographic. And that deeply worries me.”
A recent study from University of California Los Angeles’s Williams Institute suggests that transgender people represent a much larger portion of the American population than previously thought. According to the new data, 0.6 percent, or 1.4 million Americans identify as transgender. Transgender women have been hard hit by HIV with nearly a third of trans women in the U.S. living with the virus (over half for African-American trans women).
Trans men are often forgotten about, but a survey of HIV-positive trans people by Transgender Law Center’s Positively Trans program indicated that 12 percent of respondents were men living with HIV.
Choosing to disclose his HIV status and embrace the trans label held particular challenges for Drake, because “I’ve never seen ‘trans’ as central to my identity and I’ve previously not been very public about my gender history. I identify as a queer man with a history of gender transition.”
Drake says he was willing to come out in part because “as a white person who is disabled, my race affords me a level of protection compared to many other folks. I also didn’t have to worry about losing my job, as many people do. But mostly [I joined Positively Trans] because I know that people need to put a face to an experience for it to be understood as real.”
But he’s also clear that his experience isn’t universal. “I don’t speak for other HIV-positive trans guys,” he says.
Although California’s Office of AIDS recently presented data indicating that transgender men have the lowest levels of viral suppression among all HIV-positive residents, Drake cautions against extrapolating that data to mean trans men have worse health outcomes than trans women.
“Social determinants of health like housing, policing, incarceration, and interpersonal violence,” put HIV-positive trans women, particularly women of color, at greater risks,” he says. “That said, I can certainly hazard a guess that stigma and disparities in access to health insurance, as well as feeling unwelcomed by HIV-related support services, contribute to negative health outcomes among HIV-positive trans men. I can [personally] attest to the number of agencies that weren’t prepared for me to walk through the doors, leaving me feeling unwelcomed and unseen, at best.”
Many trans people report outright discrimination, harassment, and ignorance are barriers to health care. “Add being HIV-positive,” Drake says, “and that increases the risk of having a negative experience in a health care setting.” As “someone who lives in a rural area, I learned the hard way that I can’t show up at my local hospital and disclose that I’m trans and expect that interaction to go well.”
Drake would like more service providers to understand, “you can’t look at my HIV disease without understanding my life history and current context. You can’t treat my HIV without also understanding what pressures I live under, what impacts my ability to stay in care, and what is most important for me that helps me stay alive. I’m very clear that if I had to choose between testosterone and my HIV meds I would choose testosterone every time.”
That’s because Drake credits his gender transition with keeping him alive. “The whole reason I began to get well 14 years ago, after years of living with AIDS and having a T-cell count of 33, is because I finally started to like who I was and I finally wanted to live.”
Although his T-cells have long since rebounded, Drake says, “When people say we shouldn’t use the word AIDS anymore, that we’re all just HIV-positive, it invisiblizes so much of the resilience and the honoring of where I’ve come from. AIDS isn’t a place of shame or a historical artifact for me, it’s a symbol of my defiance and my resilience.”
A Buddhist co-founder of Transforming Hearts Collective, Drake also believes becoming a Buddhist and yoga practitioner played a significant role in his recovery. “I wouldn’t be alive today if I hadn’t found a spiritual practice that taught me how to come home to my body in loving ways, that supported me in navigating discomfort, and that helped me to center compassion for myself and for others at the core of who I am.”
His experiences living with the disease for over two decades, Drake says are “definitely woven into the work that I do to support movement building around anti-oppression and anti-racism…. It particularly informs the work I do with queer and trans folks, drawing on the skills that my spiritual practices have taught me around self-care and communal care as being keys to our collective survival.”
Drake writes on these subjects in the anthology, Yoga and Body Image and at the blog RootsGrowTheTree.com. He serves on the board of Phallacies, which employs innovative educational theater in leadership development, health education, and violence prevention for men. Drake’s also on the faculty and board of Off the Mat, Into the World, an organization that sees yoga as a tool for change. “It’s a practice that helps a person cultivate self-awareness and learn to move through discomfort and pain. And in the face of injustice, it can sustain us in our efforts for personal, cultural, and global transformation.”