Transgender Issues and HIV Prevention
XI International AIDS Conference, Vancouver, July 8, 1996

Sandra: My name is Sandra Laframboise, and I'm a proud transgendered person who co-founded a transgender organization for sex workers and IV drug users in Vancouver. We're one of the first transgender organizations in Canada to receive public health funds. It is my honour to introduce our panel here, discussing their own programs for transgendered people around the world.

I've met one of the members personally, so I'll start with introducing Kartini Slemeh, from Malaysia. She has a sex worker program in Malaysia. The second speaker will be Barbara Warren. She's with the Lesbian and Gay Community Centre, Gender Identity Support Services, and she'll be speaking about her little project. I understand, Barbara, that your colleagues will be coming up and presenting [?]. And our third and last speaker is Luis Mott. He's from [?] Federale de Bahia, in Brazil. He does work with sex workers who are transvestites in Brazil.

Thank you.

Kartini: Good evening, ladies and gentlemen, friends and sisters.

Sandra: We're having a little trouble with the equipment. Any of you work with transgendered people? Wow, look at that! Three! Four! Cool!

This was the first Canadian project sponsored by the federal government and the Ministry of Health of the provincial government on transgender HIV/AIDS issues. So, just to tell you how this came about, a year and half ago, when we started our HIV/AIDS outreach, and started looking at the literature on transgender and HIV and AIDS, there was practically nothing. On the databank in Canada, of about 34,000 published articles, there were only four articles on transgender and HIV/AIDS. Three of them were from outside this country, and the fourth was a makeshift pamphlet I and my partner here, Deborah Brady, wrote. So, we've applied for funding, and this has been in the making for the last seven months, and it's fresh off the press. And we'll make it available for people starting tomorrow.

Kartini: Malaysia is located in the Asia pacific region. It has a population of 19 million. It's a multiracial country, consisting of Malay, Chinese, Christians, Indians, Sikhs and others. The main religion of Malaysia is Islam.

In 1985, AIDS made headlines in the media, and the cause of AIDS was immoral behaviour. Advertisements included images of transgendered as immoral. No information was provided on how transgendered could protect themselves.

I'm Kartini Slemeh, project manager for the Transgender Support Program, with four years' involvement in HIV/AIDS work. I'm a transgender and a sex worker. In Malaysia, there are estimated to be around 10,000 transgendered, 70% working as sex workers, and 20% working in entertainment clubs, hair salons, beauticians' shops, and boutiques. 2% [?], and 3% work in private firms. They are a very unique community, because transgendered come from various religions, traditions and cultures. Their ages range from 13 to 65 years old. They portray themselves very beautifully and elegantly, and they work very hard at being [?] at any time. For example, in beauty contests, they are just as beautiful and talented as many other women. And the unity among the transgendered is stronger.

The reason that transgendered are involved in the sex industries is that they are not accepted working in the government sectors or in private firms. Not because they don't have qualifications, but because of who they choose to be. Transgendered feel most comfortable dressing as women while working, but this is not accepted. And they are always blamed for the failure of business. They don't have a choice -- in order to survive, they have to become sex workers.

Transgendered are often humiliated because of their sexual preference, both by the society and by their families. Large numbers of transgendered move to big cities or towns to meet other transgendered, where they feel much safer and have moral support from their friends. Other reasons include avoiding humiliation and prejudice against their families by the society, because they have a son who is transgender.

Often transgendered are labeled as a [?] on the society, because of the way they appear. They are seen as a sex object, for desperate men to satisfy their lust. However, many transgendered do try to get out of the sex trade, and some are actually in legal and reputable positions.

In terms of harassment by the authorities, the transgender community [?] is always abuse. Section 21 of the Minor Offences Act states that a person can be arrested for indecent behaviour. The police of course interpret this to include cross-dressing, although this is not listed in the act. Often when transgendered sex workers who are arrested plead not guilty, they are given heavy bail, of 500 to 1,000 Malaysian [?], when a maximum sentence under the Minor Offences act is only 25 Malaysian [?]. If they are sent to jail, their hair is cut short, which is very disgraceful to all transgendered. There are also cases of transgendered who are caught in their rooms while they are asleep, and charged with immoral behaviour or soliciting.

Looking at the religious aspects, transsexuality is not accepted, and dressing as a women is considered a sin. This leads to a lot of confusion and personal agony for transgendered who are themselves Muslims. It is difficult for changes to be made in policies regarding transgendered, because policy is often based on religion.

In 1985, transgendered were still naive about HIV and AIDS. They had no access to HIV/AIDS information, and nothing was being done to ensure that they received such information. The attitudes made them think that they are not at risk, because they are the receiving party, not the giver. And also because of the way the media -- and especially international media coverage -- is focusing more on the gay community. Even though they know about HIV/AIDS, they don't feel at risk, because HIV/AIDS is only spread by foreigners. So why worry?

In May 1982, a needs assessment study was done with the transgender sex workers' committees. The assessment was based on knowledge, attitude, practices, and beliefs. On HIV/AIDS and the needs. Of the 27 people interviewed, 7% mentioned that they'd never heard of HIV. 30% responded positively to the question "Can someone get HIV from being bitten by a mosquito?"

The knowledge, attitude, practices, and belief [?] also identified confusion among respondents with regard to safe and unsafe sexual practice. For example, when asked, "Can someone get HIV from oral sex with another man who has HIV or AIDS," 29.6% answered "no" or "don't know." 55.6% of transgendered agreed with the statement, "I can't get HIV as long as I don't fuck with male foreigners."

With respect to sexual behaviours, it was clear that the transgender subgroup was particularly vulnerable to engaging frequently in high-risk sexual behaviour. This is determined through inquiries about the number of partners with whom they have engaged in unprotected intercourse. When asked if they would allow customers to fuck them with {A -- does she mean "without"?] a condom, 51.8% said yes. The most common reason stated was the need of money.

On condom use, our data shows 13.3% of the total number of respondents never use condoms while engaging in active sexual intercourse with their regular sexual partners. Another 24.1% use condoms only "some" or "most" of the time with their regular partners, while 7% always use condoms. 44% of the respondents felt that using condoms proved that you did not trust your regular partner.

When asked what type of lubricant was used during intercourse, 62.9% of the transgendered responded, "KY jelly." However, when asked "Which of the following would prevent condoms from tearing?" and given the examples of saliva, KY or Vaseline, the result indicated a general lack of understanding of the utility of using a water-based lubricant, as opposed to an oil-based lubricant. 55% of the transgendered believed that Vaseline would prevent a condom from tearing.

In the focus group discussion, it was mentioned that the transgendered community needs a safe place to drop in to discuss problems such as sex reassignment, hormones, breast implants, face and nose surgery, legal advice, and problems they face while at work, as well as the need for more accurate information on HIV/AIDS and being HIV-positive, as the information, counselling, and clinic.

The results of the needs assessment study gave us important information that we could use to design programs for the transgendered community. This was important, because the problems were based on the needs and issues of the local transgendered community. In August 1993, Pink Triangle Malaysia opened [?] drop-in centre, which was specifically for sex workers, and especially for transgendered.

An outreach program was implemented. Outreach was carried out twice a week, [?] given to the community, and a leaflet was designed with specific information for the community. A retreat workshop was also organized. The object of the retreat workshop was to bring the transgendered sex workers out of their working place, to a beach resort. This is mainly to allow the transgendered sex workers to be more focused on the issues discussed, and partly a holiday bonus for them.

Topics discussed at the workshop were HIV/AIDS, STDs, legal advice, negotiating of condom use, empowerment, money management, sexuality, and health issues. In-house sessions cater to transgendered sex workers who are unable to attend the retreat workshop. Sessions are held once a month at the drop-in centre. From the retreat and in-house sessions, peer educators will be identified.

A peer educator workshop was also organized. The objective of the peer educator workshop was to train and provide peer educators with more in-depth information. With this information, peers will play an effective role in disseminating information to the community.

One of the results achieved by the transgender support program was a marked increase in awareness of condom usage, due to the fact that more transgendered sex workers had access to HIV, STD and sexual health information. Being in the know, transgendered sex workers felt more empowered about their sexuality. This enabled them to take more control of their personal health, as well as becoming more confident in negotiating condom use with clients.

The [?] support program has a strong objective in building up the community. An indication of this objective being met was the increase in participation of transgendered sex workers at the workshop. The workshop led to many new developments.

The main development was the setting up of transgender fund by the community itself. The intention of this project was to provide financial support for hospitalization, as a result of high medical expenses. Funding was also necessary for court bail, due to instances where transgendered sex workers are arbitrarily harassed by the judicial system for immoral behaviours. The fund also covers funeral costs for those in need of such services.

In developing a transgender fund, the community was being empowered in dealing with a society that was discriminatory, by providing services, and welfare for the committee itself. Being a committee-based approach, the program allows maximum input from transgendered sex workers' committee in structuring the program itself. The representation of the transgendered committee on the board of directors as the organization level also enabled the transgendered committee more power in decision making while the changing needs and issues of the committee are met. {Andrew: in the above, I'm not sure whether she is sometimes saying "community" rather than "committee}

In conclusion, prosecuting transgendered sex workers will not abolish the sex industries. Consequences of the police raids push the sex industries underground, which make them more vulnerable. They also make it harder to reach the transgendered sex workers' community to disseminate essential information.

I would like to propose to every government ministry, NGOs and individuals to be more open and sensitive to transgender issues, and to give them more opportunities in terms of providing jobs, medical attention, insurance, housing, and being treated equally with other people in the society. Talk to the transgendered in your community. Don't laugh at them or beat them up. Make an effort to understand the transgendered community. Make an effort to respect them.

Thank you.

Sandra: Thank you. There is about one minute left for questions, but I know at the end of the session there will be a lot more time for questions, because one speaker has not come. So would you prefer to wait till the end for questions? Great.

One of the things I just want to reiterate from Kartini's conclusion: even here in Canada, transgendered persons do face discrimination and human rights violations and abuses systemically, on a daily basis. And High Risk Project, with other community organizations, just finished writing a legal brief called Transgender Law Reform Project. It's finally in place, and it's available for reading in public libraries. It details all these human rights violations. Okay -- Barbara?

Barbara: I just have to say that I'm very moved and inspired by Kartini's presentation and, in fact, she could have left a couple of her slides up there, since I don't have any. Because our experience in New York is very, very similar, in terms of developing community-based approaches, and the kind of impact that a community-based approach has. As to what she has presented from halfway around the world, from Kuala Lumpur, I also think that it is phenomenal.

I have been working with and for and on behalf of transgendered and transsexual people now for about eight years. Eight years ago, just using the word transsexual was a curiosity for most people, even in the lesbian and gay communities, and using the word transgender was unheard of. It's a relatively new term. It's a term that actually came from the community. And it's a term that embraces and affirms the diversity of the gender community, and the diversity of people within the gender community. And it's just phenomenal to me that folks are using it in Brazil, in Kuala Lampur, in New York City, in San Francisco, in Vancouver.

I think what we're really seeing is the emergence of an identity amongst transgendered people as a community. Again, just like lesbian and gay people, and bisexuals, and all people, there's a tremendous diversity in the transgender community. But the visibility of transgendered people from all walks of life -- sex workers, doctors, housewives, guys -- yes, there are men who identify as transgender across the spectrum. People who are bi-gendered, and female-to-male, and even female to gay males. Unfortunately, they're not really represented in our presentations here today, but hopefully next time, at the next conference, we will have the men in the community being able to present some of the innovative HIV prevention and intervention strategies that they've developed to reach transgendered men from all walks of life.

So, I could sit down now. I'm happy. But I won't. I will tell you a little bit about the project that we have in New York. I will apologize for the absence of visual aids. I did bring with me our fabulous new video; here's the proof. Unfortunately, I was much chagrined when I got here to find out that, for some reason, with all the technology available at this conference, they were not able to provide us with a video projector, so I'm not able to show you the fabulous three-minute excerpt that I wanted to show you. But I will tell you a little bit about it, and we certainly will make this video available to all of you who want to use it in your working doing HIV prevention and intervention, education and affirmation for transgendered and transsexual people. And I certainly will make sure that my esteemed colleagues up here all get a copy of it, because I think it will be useful for them and will engender solidarity among transgendered people around the world.

I don't want to spend too much time talking about the risk factors. I just want to acknowledge that trans people are at extremely high risk for HIV and AIDS, for a number of reasons: unprotected sex, and also the sharing of needles, not just for drugs but also for hormones. And that's something that most of you are probably familiar with.

Also, transgendered people are at high risk because, as Kartini pointed out, discrimination and oppression of transgendered people around the world create isolation, create lack of self-esteem and create inability to access health prevention and health promotion resources, in much the same way that the lesbian and gay community was unable to access (and in some parts of the world, are still unable to access) such resources years ago.

So there is extremely high risk and there is a real necessity to create spaces and to help empower and bring together transgendered people, who, once they are brought together, know how to work with each other and know how to reach out to their own community, and know the kinds of things that they need, and the kinds of mechanisms that would be effective.

I also wanted to just talk for a minute about who we're talking about. Oftentimes in these presentations -- and, again, with great respect for my colleagues up here -- when people talk to uninformed people about transgendered people, immediately that's synonymous with people who are in the sex industry, or and with people who may be of male-to-female experience. I just want to reiterate that when we talk about transgender today, we are talking about a very, very wide community.

If we're going to create HIV prevention and health promotion materials, we need to bear in mind that we're talking about a community that cuts across all other communities and, in fact, is a multigendered community. We're not just talking about people of male to female experience. We're talking about -- and this also includes -- gay identified men who live a drag lifestyle; cross-dressers, who may be heterosexually inclined, married men who in fact cross-dress, have unprotected, anal-receptive sex with other men but, because their identities are not integrated, don't see themselves as necessarily being at any kind of risk, and go back to their straight male lives and don't necessarily see themselves as being at risk.

We're also talking about people who have been taught to be ashamed of their genitals, because their genitals may not conform to their presentation of themselves. And we all know that, in order to practise safer sex, it's really, really important to be able to protect yourself and to protect your genitals, and not to feel like you have to ignore them or hide them from your partner in order to pass, in order not to be beaten up, in order to be acceptable.

We're talking about bi-gendered people. We're talking about transvestites. We're talking about people of transsexual experience. We're talking about females to males, males to females, bi-genders, cross-genders, transgenders, new women, new men -- it's an incredibly large community. What we've been lucky in terms of, in New York, is that we've had a lot of people who've been willing to come out of the closet, been willing to become visible, been willing to talk about their own experiences, and been willing to come out and reach out to other people in their own communities.

Transgender visibility, and supporting our transgender colleagues, is absolutely essential in order to create and implement effective HIV prevention programs. And I just want to say again that I'm very impressed by the courage of the openly transgendered people who are here today, talking about who they are and talking about the work they're doing.

The other point I want to make, briefly, is that, as Kartini also pointed out, lack of funding is a major barrier. We are funded -- and now I'm going to come out of the closet a little -- we are funded in New York State. Our gender identity project has a substantial -- actually, it's not a big amount of funding., but it's substantial to us, 'cause we had no money for a long time -- amount of money from the State of New York, through our AIDS Institute in New York State. However, we sort of have to keep that low-key. Because we are afraid in the current political scene in New York, that if it really became apparent to the current governor of New York and the folks in New York, 'cause they're running the show, that they were in fact funding a transgender HIV prevention project, we might lose that funding. So our funding is very precarious.

And I think that also explains why there's -- I'd love to get up and present research -- but there's very little research. Part of that has to do with funding, and part of that has to do with lack of interest, or even just ignorance on the part of folks about who transgendered people are, why they're at high risk and why we really need to know more about what's going on in those communities, and how those communities can implement effective HIV prevention, and many other issues that transgendered people face. The social needs, the civic needs, the psychological needs, the health care needs -- there are multiple needs of transgendered people.

And we know that just knowledge -- just teaching people how to use condoms or latex barriers, or about safer sex, or about risk, is insufficient. People really need to generate a community norm. People really need to be able to come together. And that's why we created a peer-based initiative in New York, through the Lesbian and Gay Community Services Centre -- which probably, one of these days soon, will be called the Lesbian, Gay, Bisexual and Transgender Community Services Centre.

But I'm proud of the Centre in New York, because the Centre board of directors, and the lesbian and gay communities of New York, and some of my colleagues -- who are going to present today, just very briefly, about there programs -- have all, in the lesbian and gay community, embraced the transgender community, and have advocated and created a space for transgender -- for all queer people to come together.

So, collaboration is the other issue. Health care needs, psychological needs, social service needs, peer education needs -- one program can't do it all. We have a number of projects in New York -- my colleagues are in the audience today -- that have come together and selflessly shared all of their resources. I don't think we have time for everybody to talk, but I just want them to stand up, and I do want to introduced them to you.

Dr. Birgit Pols is director of the Community Health Project in New York City, and it really has been under her leadership that the clinic -- the Transgender Health and Education Clinic, which is a primary care clinic -- very important for transgender people to access relevant, sensitive and affirmative primary health care services. Not just those services that are for HIV intervention or prevention, but the whole range of primary health care services. Dr. Pols has instituted this program at the community health centres. It's a collaborative program, and we have transgender physicians, nurses, peer educators and people staffing that project, and it's really a very powerful and much needed program, and we're going to work with her to expand it.

We have Barbara Otto, a physician who specializes in adolescent medicine, who runs the first adolescent transgender primary care and AIDS intervention clinic in New York City, called the Kayak Program. Again, it's a very, very important project, because it really reaches out to high-risk street and homeless transgendered adolescents, many of whom are either HIV positive or at high risk for HIV, in a very empowering and affirmative way, and offers a whole range of services.

I also have with me Dr. Don Cappazucca, who has founded the Gender Support Services. He's a psychologist. He's also -- if I may out you, John, with your permission -- a drag queen. A member of the Imperial Court of New York. As a gay-identified men who is also a trans-identified gay man, he's done some very powerful work with gay men -- who are really involved in drag community and live a drag lifestyle -- around the special issues of HIV prevention and intervention. The Imperial Court of New York was our first source of funding for our transgender project, when nobody else in the gay community or the straight community wanted to give us money.

In my last minute, I will say that I have a whole bunch of materials that were created by our core of dedicated and fabulous peer counsellors. They would have been with us today if I'd shown the video. I have some copies; I will make them available to folks. We have comp cards[?]. My colleagues have been passing out this stuff. I have tons of it. I'll pass it out to you. We have brochures. We actually even have a condom guide that uses pictures of what the community in New York calls a phallic woman. A shapely, womanly-looking woman with a penis, putting on a condom. And we're using this for outreach to folks who may be non-op or pre-op, but are female in their identity, and have breasts, and consider themselves female but still have a penis, and need to learn, in an unashamed way, to put a condom on that penis, or to be able to put a condom on any penis that comes near them in a sexual act.

Last but not least, the fabulous safer sex kit. And it's growing more fabulous every day. (We're trying to raise more money.) We decided that transgendered people -- or all people -- shouldn't just have a plastic baggy with a couple of condoms thrown in. So we've got a lipstick donated by the body shop in here. We've got all our transgender materials. We have a keychain. We have the whole range of latex barriers in here, not just condoms. We have dental dams. We have passionfruit lubricant. We have nonoxynol-9 lubricant. And we put in a fabulous little make-up case that, when you're done with all the stuff inside, you can keep your make-up in, or your goodies in. We're using this as part of our street outreach project.

We also work with a program called Positive Health. It is the first hormone needle exchange program in New York. Jason Farrell, who's the director of that project, wasn't able to be with us today, but he is also one of our collaborators. There's a team of transgender outreach workers who pass out clean needles -- larger-gauge needles. They're the first program in New York to get a waiver for larger-gauge needles, so that people who are sharing needles to inject either silicone or hormones can at least have access to a clean needle.

Recommendations: We need more research. We need more involvement. We really, really need all of you working in the field as both researchers and practitioners to support transgender and transsexual people, many of whom are also working in the field, to come out. To feel safe in coming out. To be able to do research and intervention and education in the transgender community, and to ensure that we have access to funding to continue this much needed effort.

I thank you.

Sandra: Thank you. Again, we're out of time for questions to Barb. Barb, is it okay to wait till the last speaker speaks?

Barbara: Yes.

Sandra: Also, just to emphasize the high risk in the stats: In Vancouver, it was estimated that 70% of transgendered sex workers were HIV positive. We've conducted a little questionnaire, on an informal basis, just meeting people, and 35% out of 133 members disclosed that they were HIV positive. So there needs to be research. So you people advocate for research on our behalf, please. We need it.

?: Our final speaker this afternoon is Luis Mott from Brazil. He will be speaking on Risk of HIV Infection for {A: I know he said "by" but I think he meant "for"} Transvestite Sex Workers in Brazil: Prostitution, Silicone, and Drugs.

Luis: I thank you very much, everybody who is here. Especially people from Brazil, and friends of Brazil. Brazil has a very old tradition of transvestitism -- of transvestites. I found in Portuguese archives documents about the presence of Brazilian Indian transvestites, black slaves from Nigeria and from Angola -- even in Portuguese estates, in Portugal -- since the 16th century.

So we have all these historical reasons for exporting transvestites, first to France and now to Rome. A lot of Brazilian transvestites are sex workers in Rome at present. But this tradition doesn't mean that Brazilians accept transvestites and homosexuals, as people do in other countries, where human rights are respected. In the last 15 years, 1,400 homosexuals were killed in Brazil -- victims of homophobia. And if homosexuals represent about 10% of the Brazilian population -- Brazil has 160 million inhabitants. 10% of this -- homosexuals represent about 16 million inhabitants. There are about 8,000 transvestites. And 30% of the homosexuals killed are transvestites. So the majority of the victims of homophobia in Brazil are transvestites.

Two years ago, the Brazilian gay movement finally founded a national organization that included transvestites. The official name of the Brazilian homosexual movement is The Brazilian Association of Gays, Lesbians and Transvestites. I think ours is the only country in the world where the homosexual movement included transvestites in the name of their association.

I will talk about the risk of HIV infection for transvestite sex workers in Brazil. The research had its inspiration in work carried out by the gay group of Bahia -- GGB[?] -- and the Bahian anti-AIDS centre, which had as its purpose the prevention of STDs and AIDS among transvestite prostitutes in the City of Salvador, Bahia, Brazil. Salvador is the capital of Bahia. It is the most black African area of Brazil. It has about 2 million inhabitants.

When I talk about transvestites, you must translate for transgender, because this is the word that is used by transgendered people in Brazil.

From our initial contact with the target population in 1990, we have developed the hypothesis that transvestites sex workers represent one of the social groups most at risk for infection by HIV and other STDs, as a result of their practice of homosexual prostitution, aggravated by the use of IV drugs and the injection of silicone and hormones by means of re-used needles.

According to a survey conducted by the Association of Transvestites of Salvador, there are supposed to be approximately 8,000 transvestites in Brazil -- about 200 in Salvador, Bahia. Our interest in studying such a small population is linked to the predominance of two high-risk factors for the transmission of HIV. 95% of Brazilian transvestites make a living by rendering homoerotic services, thereby exposing themselves to risk of infection through the practice of anal sex and prostitution.

Another characteristic of this population which makes it particularly important in epidemiological terms is the fact that each transvestite serves an average of four clients a day, and 48% of these clients say that they prefer to practise anal sex without condoms. If we multiply -- it's a funny statistic but, lacking others, please accept this -- if we multiply four daily sex acts by 25 days a month, these 8,000 transvestites in Brazil will have carried out a total of 10 million sex acts per year -- a considerable total in a country with a population of 160 million inhabitants, where the minimum monthly salary is $112 US, and a condom costs 50 cents US.

Since there are no official statistics concerning the homosexual population of Brazil, the methods of investigation consisted of a questionnaire with 70 closed questions, and an interview schedule. A survey was carried out in an area of residential concentration of the target population, which led to the conclusion that Salvador has a population of approximately 200 transvestites, of whom 179 were formally interviewed between 1994 and 1996. This represents about 240 sex acts per year in Salvador. {A: this stat makes no sense whatsoever}

This is the first anthropological research project to construct a sociodemographic profile of the transvestites in Brazil, hence the importance given here to ethnographic data. The target population is predominantly black or mixed -- 70% -- with whites representing 30%. This coincides with the ethnic configuration of the state of Bahia, which contrasts with the general population of Brazil, where white are 60% of the inhabitants.

Only 29% of the transvestites are natives of Salvador. 52% are not Bahians. This is a peculiar situation in comparison with other social and professional groups in Salvador, which consist predominantly of natives of the state of Bahia. The target population is strongly marked by mobility and spatial instability. 25% of the interviewees had arrived in Salvador less than a week earlier, and 34% less than a month.

Also, above the national average is the educational level of transvestites resident in Salvador. Only 6% of them are illiterate, compared with 16% of the general population of Brazil. This peculiarity makes the use of printed material concerning the prevention of AIDS accessible to almost the whole of the targeted population.

Although public opinion imagines that transvestites service dozens of clients a day, the extremes varied between one and 14 clients daily, with an average of 4.1 per day. 86% service between one and five clients. According to the informants, the great majority of these clients are married, middle-aged, middle-class men who, on their way home from work at night, secretly search out the services of these sex professionals.

42% of these acts take place in hotels or motels, 20% in the client's own vehicle, and the rest in [?] rooms or beaches, in deserted streets, or in cinemas specializing in erotic films. 90% of the transvestites stated that they use condoms regularly. Every week

{Side one of tape ends here}

20 condoms free, that they received from either the Ministry of Health or different foundations. 90% of the transvestites stated that they used condoms regularly, 4% for less than a year, 33% from one to two years, and 43% for more than three years. To the question, "Do you prefer to have sex with a condom?" 93% of the transvestites replied yes, while 48% of the clients preferred to have sex without condoms, some of them offering double the fee if the prostitute allows unprotected sex.

As for their age, the youngest transvestite was only 14, and the oldest 41. However, only 13% were above the age of 31. The loss of youthful freshness is a disincentive to clients, hence the early age at which initiation into prostitution occurs among homosexuals originating in the lowest strata of Brazilian society, and the tendency among prostitutes above the age of 30 to give up prostitution. 13% of the transvestites interviewed were under 18, which is the legal age of consent in Brazil for homosexual and heterosexual acts. However, 99% had their first homosexual experience before age 18

The lowest age for the first homosexual experience was three years -- probably an act of sexual violence. But a lot of gays interviewed by us in the gay group of Bahia said they started at nine or ten. They said that they took the initiative in the contact; they seduced the adult men without physical or psychological violence. Because now in Brazil there is paranoia about sex tourism and child prostitution. It's a human right, of course, to protect all those children, both boys and girls. But, in most respects, the sexuality of gay adolescents -- they want to have sex before 18, which is the age of consent in Brazil.

So, the lowest age for a first homosexual experience was three years, and by the age of 15, 49% of the interviewees had already had their first homosexual experience. Nine years was the lowest age for initiation into transvestitism. The most common age for taking up transvestitism was between 14 and 15. The lowest age at which an informant began to receive money for sex work was seven. The age of 17 or 18 was when the majority began to prostitute themselves. It is worth noting that there was a predominant pattern of two years' interval between the adoption of the clothing of the opposite sex, and the rendering of sexual services.

The choice of transvestitism implies not only the use of feminine clothing and accoutrements, but also the adoption of certain feminizing practices. 85% of the transvestites used female hormones, predominantly [?], [?] and [?]. Some of them had begun self-medication with these hormones at the age of ten. And 37% by the age of 15. This is a very important problem to be researched, because we don't exactly know the effects of this use.

32% of the transvestites resident in Salvador have between a cup and 12 litres of silicone in their bodies. Industrial silicone is distributed between their face, breasts, buttocks and legs. 75% have less than 2 litres. The age range for the first application of silicone goes from 13 to 34 years.

In conclusion, the results of this preliminary research have revealed that it is necessary to continue the distribution of free condoms to the transvestites of Salvador and, as an extension, to all the prostitutes of Brazil, since the 90% who have admitted to using condoms regularly may stop using them if they can't get them freely, because of their low social condition and poor wages. By treating transvestites clients and their permanent lovers -- an anonymous population, and very difficult to reach through STD/HIV prevention campaigns -- it is necessary to turn sex professionals into agents of sexual education for their clients, producing specific educational materials for such a population.

Thank you very much.

MC: For those of you who came in late, our last speaker actually went first, because the first speaker was not here. But we have approximately ten minutes for exploring further and asking questions of our presenters. A very wide variety of stories were told, and I think that they have shown us some of the complexity of this issue.

Aud: My name is Rick Lyons. I'm from the Prisoners HIV/AIDS Support Action Network in Toronto. We do quite a lot of work with transgendered prisoners in Ontario. Actually, within the last four or five weeks we've set up a weekly support group for HIV-positive transgendered prisoners in the Don Jail, which is one of the main jails in downtown Toronto, which is [?] successful.

I guess my question is directed to Barbara, but I'd be interested in any answers around any programs specifically working with transgendered prisoners or ex-prisoners, as well as some of the human rights issues for transgendered prisoners involved with the police or in the prison system in some of the other countries as well.

Barbara: Just in terms of what's going on in the United States -- not much, in terms of supporting transgendered people who are incarcerated. It's interesting you should raise that, because there's a lawyer in New York -- a gay man -- who is an activist, who is just now putting together an article for the Harvard Law Review on human rights violations of incarcerated persons who have transgender identity. And we get a tremendous volume of mail from folks who are in jail who identify as transgendered, and folks who are in jail who are interested in exploring their gender, and some folks who are in jail who are partnered with transgendered people. So I know that that is a huge issue.

The only advantage, I think, right now, to being incarcerated if you're transgendered is that, for some strange reason, at least in New York State, in many jails transgendered people have access to free hormones, which is not the case for transgendered people who are not incarcerated. However, I don't know if that's much compensation for what transgendered people who are incarcerated suffer.

Aud: I work at New York Hospital; I run a support group for HIV-positive transgendered women. This question is directed to Kartini and Sandra: I know that the women from the group have asked me to ask this question on their behalf, and I know they're going to be very excited to hear that there are two people on the panel who are transgendered. Their question is, because of their HIV diagnosis, many would like to achieve certain life goals that would enhance their female identity. Most significantly, sexual reassignment surgery. And they are unable to obtain this surgery in the States presently, because of their HIV status. And I'm wondering, in your countries -- in Canada and Malaysia -- is there any similarity? And how do people cope in your countries? And what hope can I bring to these women?

Sandra: Yes, there is, actually -- in Canada, so far as we know here at the High Risk Project in Vancouver, there is not one doctor that will operate on you if you're diagnosed HIV positive. As well, most of the transgendered people we deal with at our centre have told us anecdotal evidences that, when they've been diagnosed HIV positive, the doctor will discontinue their hormonal therapy

We find that that's a human rights abuse. The premise the doctor uses is that hormonal treatment can contribute to heart problems if you already have an immune deficiency. But my premise is that it's life and death for us. Hormonal therapy -- transition into the other gender -- is what will alleviate our mental suffering. It's like saying to a heart patient, "Because you continue using alcohol and eating fat, I will not perform bypass surgery on you." I see it that way.

However, just as recently as last week, I've heard that there is the possibility of one doctor that will willingly operate on people who are diagnosed HIV positive in Montreal. But I'm not sure yet. We're following that up. Kartini?

Kartini: Talking about sex reassignment in Malaysia -- actually, sex reassignment was banned in Malaysia in 1987, due to the fact that it's a Muslim country. Talking about sex reassignment has not been done for Muslims, and even for other races. So mostly if transgendered want to go for sex reassignment, they go overseas to Thailand or Singapore. But still, it's quite expensive. There was a case of one transgendered who was tested positive by one doctor, but still got a breast implant. That was in Thailand. But if you test positive in Malaysia, they don't allow you to have a sex operation.

Aud: Thank you, and if that doctor does do it in Montreal --

Sandra: We will publish it, believe me!

Aud: I'm Dr. Mireda from the University of Illinois in Chicago. I'd like to ask Luis Mott a question. I'd like to know if there's any special program in Brazil to prevent transmission of HIV infection among gay people and bisexuals.

Luis: Yes -- homosexual men in Brazil represent about 1/4 of the cases of AIDS notification in Brazil. Unfortunately, there are no specific statistics about the number of gay men and bisexuals in Brazil. And, unfortunately, bisexual men in Brazil are much more concerned with heterosexist society than homosexual liberation. So it's very difficult for us to include bisexuals in the gay and lesbian and transvestite movement. Because they have an identity much more concerned with heterosexuality than with homosexuality, even if they practise more homoerotic acts.

But, about transvestites, I think there is very important progress, because they had, two weeks ago, the fourth national conference of transvestites in Brazil, funded by the health ministry. I think we can criticize a lot of the politics of the government in Brazil, but we can't deny that, if there was not this financial support from the government, transvestites would have still more problems in preventing HIV and STDs.

Sandra: Thank you. We'll have to cut down the number of questions for people as we're going along. And I just want to remind everybody that -- I'm a little bit selfish here, so I hope I don't offend anybody -- this is the transgender component, so please raise your questions around transgender issues. It's our first opportunity on the world level, so I feel really proud and honoured to be here. And it's really hard for us as well to be open like this, here. So thank you.

Aud: I had a question for Mr. Mott. I work in an agency that has been serving transgenders for many years. When we do outreach on the street we give out mega-bags and all kinds of stuff, but -- in terms of the survey that you conducted in Brazil, did people who filled it out receive an incentive for filling it out, and what was that?

Luis: No. Because you have a weekly condom distribution program. The first time a new transvestite arrives, a transvestite leader will apply a questionnaire of 60 or 70 different questions. Our pay is defending them when they are arrested by police, and defending their human rights. And giving condoms.

Aud: Luis and Barbara -- is your project for transgendered people, or are you working with transgendered people? And if, in your project, you include transgendered people? If you've got transgendered people working as well.

Sandra: If I may, I'll clarify. I'm not sure if you're asking if the project employs transgendered people?

Aud: Yes.

Luis: The project was organized by the gay group of Bahia. We promoted the foundation of the Bahian association for transvestites, and the development of their local leadership. And the president of the association is a transvestite -- Kayla Simpson. So we work for them, with them.

Aud: And what about you, Barbara?

Barbara: I thought I made that clear in the presentation -- that the director of the gender identity project in New York is Rosalind Blumenstein, who is a woman of transsexual experience. We have 15 peer counsellors, who are paid, who also identify as transgendered, both male and female and bi-gendered people. And we are now at the Centre recruiting someone to our board of directors who is a person of openly transsexual/transgendered experience.

Sandra: Thank you.

MC: I'd just like to thank all of our speakers for enlightening us on transgendered people and their issues. And I also would like to recommend the reading of this document, which Sandra and her group have produced. And she may want to have the last word about this.

Sandra: Thank you very much. All I can say is that we at High Risk Project believe in transgendered people for transgendered people, from the very grassroots to the very highest level of executive officer on the board, we try to provide spaces for the sex trade workers and IV drug users who are transgendered. We believe in empowerment. And, as gruesome and as hard as it is, we allow that to happen.

Thank you.