The state of Georgia has recently taken tiny steps toward extending HIV prevention and treatment resources to transgender individuals, a group at high risk of contracting the disease. These steps include the Georgia HIV Community Planning Group identifying trans people as a priority population in its five-year prevention plan, and the Department of Human Resources offering a first-ever grant specifically for that community in 2009.

However, the inclusion of trans men and women in the state’s anti-HIV/AIDS efforts continues to feel like an afterthought, with “transgenders” tied with Asian/Pacific Islanders as the last priority population in Georgia’s comprehensive HIV prevention plan for 2009-2013. The DHR-funded grant paid for individual safer sex counseling and the distribution of condom kits, as well as a DVD on how to negotiate safer sex in romantic or passionate situations.

“What happened was that the DVD was set up for gay men, and the transgender community had a hard time trying to adapt to that,” said Alicia Newson, program director of the transgender outreach program R.E.A.L./T at Someone Cares, an AIDS organization in Marietta.

“We had to adapt it. We used the DVD in those settings, but then we had to go back and have a conversation about how these situations look specifically to the transgender community,” she said.

R.E.A.L./T showed the DVD to about 480 transgender individuals, and Newson is encouraged that the state finally devoted financial resources to help transgender individuals fight HIV. However, HIV prevention among transgender individuals is influenced by many greater factors than sex, and the more comprehensive initiatives receive no state assistance, Newson said.

“The most challenging part is the lack of education, employment and housing — it’s just not having the means to live,” Newson said. For that reason, Newson said she is most proud of the GED classes, job training and housing assistance that Someone Cares provides.

The Urban Coalition for HIV/AIDS Prevention Services issued a “best practices” report to public health agencies this month encouraging sensitivity and greater inclusion of transgender populations. The report discouraged a cookie-cutter approach to transgender HIV-prevention given the diversity of ethnicity, gender and sexual orientation among transgender individuals, and noted that there is no national surveillance data tracking the number of trans people with HIV.

Georgia also does not track transgender HIV cases, but the Community Planning Group estimated that trans people make up less than one percent of the state’s HIV-positive population. Of the more than 3,000 people receiving medications from the state’s AIDS Drug Assistance Program, none are classified as transgender.

“The issue with Georgia is that a lot of facilities don’t track that information, it’s either listed as male or female,” said Lamont Scales, prevention programs manager at AID Atlanta. “It really doesn’t give us an accurate picture of how many trans individuals are getting tested and the incident rate, so it does make it very difficult.”

Someone Cares has partnered with other non-profit organizations and even prisons to try to get more accurate numbers on the HIV epidemic in transgender Georgians, which Newson considers essential to getting further resources.

“Let’s be real, the only way we’re going to be able to get funding is being counted and letting it be known that we exist,” she said.

AID Atlanta recently hired a transgender HIV counselor to enhance its outreach.

“My job is take [transgender individuals] out of the closet, out of the alleys and out of the dark, and let them know that they’re also loved and being thought of,” said Erica Christian, who leads the My Sister’s Purpose for transgender individuals at AID Atlanta. “We need to know our status and take control of our lives for a change, and watch over each other.”

Newson from R.E.A.L./T believes that having a peer or “someone who looks like me” deliver prevention education and testing is the most effective form of outreach, and said this is especially lacking for female-to-male trans people.

“A lot of people think of trans people as transsexual women, but of course there are trans men, and we also have to make sure we are reaching out to those people with support groups, and connecting them with different agencies and providers,” Newson said.