The TRT will accomplish this work by focusing on efforts that:
The TRT was convened by the Infectious Disease and Environmental Health Administration (IDEHA -previously called the Maryland AIDS Administration) in response to input received at the Transgender Health Forums held during the summer of 2007. The forums revealed a common desire among transgender consumers, health and human services providers, and other stakeholders for the creation of a stable venue to engage in activities to tackle the many barriers transgender Marylanders face to full and equal inclusion in society, which collectively contribute to heightened risk for HIV for transgender people.
Membership in the Transgender Response Team is open to local members of transgender communities, their allies, service providers, and others interested in improving the health of transgender Marylanders.
The Transgender Response Team is asked to:
HIV risk behavior—including injection drug and other substance use, and sex—occurs in a context of multiple, sometimes competing, influences. One major genre of tools in the HIV prevention toolkit is behavioral interventions. Behavioral HIV prevention interventions focus on individuals’ behavioral factors such as knowledge, risk perception, and skills (such as communication skills and mechanical skills.) Members of communities at risk of acquiring HIV need a solid foundation of knowledge, risk perception, and skills to avoid infection. However, HIV risk does not occur in isolation. Rather, HIV risk behavior occurs in a larger social and environmental context that wields a significant role in decision making, sometimes trumping the individuals’ own intentions and better judgment. Therefore, HIV prevention efforts must also consider the context in which HIV risk behavior occurs.
Environmental influences on behavior include socioeconomic status—which impacts the quality and stability of one’s housing/shelter, access to medical care, food, education, and employment—and the overall structure of privilege and oppression in our society. Environmental influences can raise HIV transmission risks in external and obvious ways, such as when a commercial sex worker can earn a higher wage for offering barrier-free sex than for protected sex, or when oppression prevents a member of an oppressed group from completing their education and becoming competitive in a credentialed workforce.
Environmental influences such as oppression may raise HIV transmission risks in more subtle ways, such as when a member of an oppressed group believes the negative message given to them from the dominant culture that they are worth less than members of the privileged group. Prevailing norms of ignorance and hostility to oppressed groups can produce significant trauma, isolation, and poor mental health outcomes among members of oppressed communities. They may lack the resources to acquire mental health services that—if culturally competent and not further stigmatizing—might assist them in overcoming trauma. In the absence of these resources, members of oppressed groups may use substances to “cope” with anxiety and depression. For those predisposed to addiction, this coping response may produce a disastrous new set of problems. Like mental health services, substance abuse treatment may be cost prohibitive and/or culturally incompetent. Under the influence, people are less likely to follow through with HIV risk reduction commitments they may have for themselves. By recruiting members of oppressed groups to the belief that they have less value, environmental oppression leads to HIV risk behavior.
Structural interventions seek to reduce HIV risk behavior by changing the environment in which it occurs. If individuals are stably housed, they are less vulnerable and less likely to need to engage in illegal activity to meet their basic needs. In this way, working to expand the availability of low-income housing is an HIV prevention intervention. If communities are given access to education, they gain opportunity to access employment. Therefore, efforts to ensure safe schools legislation is passed, operationalized, and enforced, can be described as an HIV prevention intervention.
(See the document posted below: HIV Prevention at the Structural Level: Defining Structural Change, from the Children's Hospital of Los Angeles, Center for Strengthening Youth Prevention Paradigms, 2013.)
In 1994, the Maryland General Assembly exempted Baltimore City from components of the statewide paraphernalia law which prohibits the possession of drug injection equipment. The AIDS Administration funds the Baltimore City Health Department’s syringe exchange project, which changed the environment for injection drug users. The project makes clean needles accessible to IDU as well as removes the legal risk to them of carrying them. The number of new cases of HIV in Baltimore City attributed to the sharing of dirty injection drug needles has fallen consistently since the needle exchange van project began.
Source: The Maryland 2005 HIV/AIDS Annual Report, pg. 44.