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Transcript: HIV/AIDS Prevention and Care Among Migrant and Immigrant Latino Transgenders

In May 2005 HIV InSite recorded the proceedings of several sessions at Equality and Parity: A Statewide Action for Transgender HIV Prevention and Care. Following is a partial bilingual transcript of presentations on HIV/AIDS prevention and care among migrant and immigrant Latino Transgenders.

JoAnne G. Keatley (Introductions)
Project Director, TRANS. UCSF Center for AIDS Prevention Studies.

Participants: Maria Hernández, Karina Luján, Sandra Ramirez. Translator: Maricarmen Arjona.


Introduction

JoAnne G. Keatley: Karina Luján is an HIV/AIDS community health outreach worker, and she has had three years of working with HIV/AIDS education and assisted with data collection with this study, so thanks, Karina, and please step out.

Karina Luján

First of all I'd like to give a little information about myself. I have lived in Fresno, California, all my life. Father is from Mexico originally; my mother's from Texas. I barely started my transition in January of this year. I've always known what I am, but as previously spoken before, especially in rural communities, there is a lot of ignorance, not a lot of information, so to me, when I was actually growing up, dressing up, the way I was involved is doing shows, a lot of shows. That was in the community, so to me when people spoke and asked me what I was it was real easy to say, "soy transvesti", I'm transvesti, that's what it was all the time. And it's a little bit - - it's even more categorized because the Latino is one culture and American is something totally different, which they would be categorized as the drag queens, so even in such a small rural community we're not even together as one - we're still separated.

As far as me being a health educator, I've been a health educator for three years, volunteered for one, and with this current job that I have currently it is difficult to transition because they don't understand. I'm not allowed to use my female name, I'm not allowed to dress while I'm at work, but they do allow me to dress when I go do outreach in the street at night to the clubs, so that's a little bit difficult there. I'll be getting to that right now.

(Question from audience)

Believe it or not, and honestly it took quite a bit of fighting just to get to where I am today with this organization that I've been with.

(Question from audience)

Which honestly is one of the reasons that I actually did come, and I'm so happy to be here because I have been receiving a lot of information, I've been lucky to meet some wonderful Latinas from Los Angeles that have actually taken a minute and spoke with me. Very happy to know that I'm not out there alone, because, believe it or not, I am the only transgender providing services in Fresno County as of today. The only one. Transgender woman. Thank you. If you'd like to push the slide.

I work for Westcare of California. We are a nonprofit organization. We're funded by the State Office of AIDS, subcontracted through Fresno County Health Department. What we do is we provide services to the MSM community, which is men who have sex with men. What we do is we provide street outreach. We currently have an interactive web site which I have also been trying to advocate to change, because even though it does have a little bit of information for transgenders, safetyforboys.com doesn't really apply to us. Far from it. When I do go out and do outreach we provide harm reduction materials. We give them information, literature, but then once again a lot of it does not cater to the transgender community whatsoever. I have established a peer education program currently with eleven peer educators. Six of them are transgender and providing them with information on HIV education and prevention, to be able to go out into the community and spread the word, to be able to talk with others that I normally probably would not be able to get in contact with, because believe it or not, coming from Fresno, rural community, we are not recognized at all, so that's another problem we're facing.

I also currently do outreach in other rural communities that are in and around Fresno County, Mendota, Madeira, Selma, anything that's in Fresno County, because there are a lot of other people, too, migrant workers that come. They may not specifically live in Fresno but they do live in these other smaller towns, the majority of them work in the fields, so lots of time they have to move to these smaller towns because that's where they have and find work.

Being transgender in the Central Valley, conservative, agricultural, hundreds of thousands of migrants, immigrants, the majority of them do not speak English. Their main language is Spanish, which is very difficult to provide information because, honestly, there is nothing out there for us in the rural community in Spanish. All the information is in English. So to be able to actually go out and speak with these people to let them know that there are other options, we'd actually have to go out and I have to speak with them one-on-one because there's no literature. Most of the information that I receive, I translate it and give them the information and hope that they will utilize it. Sorry, just gotta take a minute . . .

Like I was stating before, most of the resources that we do have available, because we do have an MSM contract, the only reason why the services are currently being provided to transgenders is because I'm employed there and I'm transgender myself so the services that I'm helping to provide, because I'm... is actually on the side, because we're not funded for this, so a lot of it is being done on my time to actually go speak with the women. Even though I've just barely recently been reemployed again with Westcare in January, I'm going out six, seven days a week, every night, to reach these women whether they're out in the bars, out on the street, in their homes, to provide these services to them, even though, like I stated before, our contract is specifically MSM, so that's another challenge that we have in the rural community.

In the Valley, as I stated before, the transgender community is hidden underground. Many choose not to stay in the area, which I know they have spoken about this yesterday and today all day. Seeing how we do not have any resources in the rural community most of them do come to San Francisco, most of them do go to LA, which I myself will be starting my first hormone treatment June 10 in LA because there are no services, no health care providers, no doctors that provide services for us in the rural community that would understand anybody coming from the transgender community, so most of the women that do live in Fresno County and receive hormone treatment, they receive any kind of hormone treatment mostly illegally, through other people. Transgenders in Fresno County, the majority of them are from Mexico, coming from different rural communities. Most of their families are still in Mexico. As Maria stated before, they do go back periodically, because when they actually did their survey they did come to Fresno. I happened to be at the club. Most of the women that she did interview, I know them personally. Most of them do return at least once a year to visit their family but the trend is changing because the majority of them, to be able to actually go over and to be able to have money to come back, it's difficult to find the money as it is, but then it's getting more and more difficult to actually go back and forth.

Okay, predominantly in Fresno County the people that I actually do come in contact with are male to female, age ranges from 16 to 30, and believe it or not, they're getting younger and younger. I'm actually seeing male to female transgenders out on the streets already at fifteen, fourteen years old, talking with them, they're in the bars, they also don't know what they are. The majority of them identify as gay because they don't know otherwise. They'll go out, they'll wear makeup, they'll wear blouses, and to be able to speak with them to know there are other alternatives, that there is something other than strictly being gay, lesbian, identifying as that. It is harder because they don't understand, and to give them this information is very difficult sometimes because they already have that mind set, no, I'm gay, I'm gay. No, you're not. There is another option for you. It's very hard. And like I said the majority of them, they do speak Spanish, they very - - their English is not that good and the little bit that they do know is probably coming from where they listen to the English radio stations, they listen, they watch TV, and they don't have any education whatsoever, not even coming from Mexico. No education. The little bit that they know, they learned here. And the majority of them that I have actually tried to help, we have a center in Fresno, Cesar Chavez, where they actually do provide classes on how to read, how to write, in English, that actually helps them out, and it is free for them. The majority of them, to even find employment, is so difficult. A lot of them actually - - fieldwork, seeing that we are an agricultural community, they work in the fields. You will see them all summer long working in the fields. They'll find restaurant work. If they're lucky they'll have friends that will actually lend them their social security card to work if the person is not using it at the time. They would literally almost do just about anything to actually find a job as compared to working out on the streets, but like I said, it is difficult out there for them.

A lot of the transgenders in the community that I currently work with and that I speak with, a lot of them are actually scared to get tested. A lot of them, they have prostituted, they do work in the street, a lot of them are actually scared to go and get tested and to find out that they are positive. They figure as long as they're living okay, they're healthy, they eat right, exercise, that's good enough to maintain how they're going to look. They don't want to go get tested and from there find out that they probably are positive and their health goes down from there, which is another really sad thing that I actually like to talk to them about, because they're not just putting themselves at risk because they're not taking medication when they could get treatment. A lot of them are scared because they don't have papers, they're not legal here, so they don't want to go to the doctor because they're scared that they could get reported, because that's how much they actually don't know, that there are people out there, services that can be provided to them that don't ask for your papers. They don't ask to see if you are actually a legal U.S. citizen.

The services that are mostly sought by the transgender community is what just about everybody else here is actually looking for, especially in the rural communities, to actually see physicians that actually know what their needs are, to be able to help them out, to access hormones through a doctor so they can actually be taken care of instead of buying them illegally, injecting themselves, injecting their friends, and not knowing exactly how much to take and how much not to and to where they're actually hurting themselves. Seeing psychologists for problems that they have, the majority of them, especially coming from Mexico, being molested at young ages. I know three of them that were actually molested at five years old, four years old, by family members. A lot of problems that they have already coming from Mexico over here, and they are not able to receive any kind of help or services here either.

Services that we provide, like I said, is very limited. It's strictly to the MSM community. Nothing is actually being provided for the transgender community as of yet. The only agency that actually does provide those services is the agency that I work for, and the only person that provides the services is myself, because I'm actually the only person employed doing outreach to the MSM and transgender community besides the peer educators that I currently have with me. The reason for this is actually, therefore, the need of money. We don't have any money, the money that we get from funding is very low. We don't even have any sort of literature or brochures that actually cater to the transgender community that they could feel that this is actually for them, and a lot of the transgenders are actually at risk, seeing how it is a conservative community. Two years ago one transgender female that I know, she was stabbed to death by a gentleman that she met. He, from what we know, he asked her what she was, she specifically she said she's female, she's straight - that's how she identified herself. When he found out otherwise, he stabbed her to death, left her for dead in her apartment, and believe it or not the police did catch him, awaiting sentence as of right now, and he is pleading not guilty.

Some of the risk factors that are involved: alcohol consumption, drug use, being in the clubs, the sharing of needles to inject hormones as well as home fat injections. Those of them that I know that do not have money to actually go see a doctor to receive treatment, they inject oil into their body to actually get the figure of a female. They get it from friends that are nurses that actually probably don't even know what they're doing, but just for the sake of wanting to be a female, to actually have that look, to finally be how they feel on the inside to look it on the outside, they're willing to do just about anything, and that is kind of sad as well. Trying to help them out and give them information and let them know that there are other options out there. A lot of the hormones that they do receive, they receive them illegally through other people that actually buy them and bring them to our town. They buy pertulab, cuerpo amarillo, a lot of the most popular hormones out there.

Prevention strategies. There are currently no prevention strategies that are catering to the transgender community as I stated before. The only prevention strategy that I could provide currently is just talking with them, trying to educate them as much as I can, as much as I know, because I am even limited, too, in the information that I currently have, giving them condoms, to be able to protect themselves, to actually have safe sex for those that are actually out there and have no other option but prostitution. Recommendations that I would have to help service the transgender community: low-cost healthcare, some assistance to where we could actually get some information to them, find our clinic, something that could help them with the cost of hormones, because a lot of them are not employed, they don't have money, they have to work out on the street just to be able to afford and pay their rent. We currently do not have, like I stated many times, literature, something to campaign to be able to help the transgender community, something that they could identify with. As of right now, even in our office, we only have one pamphlet that actually caters to the transgender community, and honestly I don't even find too much information in there not even for the Latino culture, and it's provided by the California AIDS Clearinghouse, and I'm sure you've seen it out there, the little orange one that has like the woman and her back's toward you. That's the only information, that's the only pamphlet that's out there for transgenders that we currently have that California AIDS Clearinghouse that is free because we do not have any money for any kind of information for the Latina transgenders as well as anybody else. Well I guess that is it. We had to cut it kind of short there, but thank you.

Sandra Ramirez

[Bilingual presentation done in Spanish with simultaneous translation into English]

Host Joanne Keatley: I'm going to introduce Sandra. This is Sandra Ramirez, and she is transgender group facilitator, a Latina transgender group facilitator. This is the first time that Sandra is going to be speaking about her personal story, and she is starting the transgender process, although I think that she's pretty much along the way. And so, one thing that she would like to ask of you today is to be patient with her because she may pause a few times when she is telling her story because some of it is painful, and so there will be pauses, and so if you could just be patient with her as she goes through her personal story.

Sandra Ramírez: Quiero darles las gracias a mis amigas transgénero que me están dando apoyo, ¡ gracias! [aplausos] A mis amigas de San Diego también gracias.

So, I want to thank you, my friends and my colleagues from San Diego, and I also want to thank my friends from LA.

Mi nombre es Sandra Ramírez y soy una transgénero mexicana. Mis orígenes: Nací en el estado de Guerrero, México, en un pueblo rural con 150 habitantes. Vengo de una familia humilde y trabajadora. A la edad de los 8 años mi mamá me trajo a vivir a Acapulco y a los 13 me trajo a La Paz, Baja California Sur, donde empecé poco a poco con mis cambios. Yo quería ser mujer pero me era muy difícil porque la sociedad me humillaba.

My name is Sandra Ramirez, and I am a transgender Mexican. I was born in Guerrero State in Mexico in a rural town with 150 inhabitants, and I'm coming from a humble and working class family. At the age of eight my mom brought me to Acapulco, Guerrero, and when I was 13 years old brought me to La Paz, Baja California Sur, where I started little by little with my changes. I wanted to be a woman, but it was a little difficult because society humiliated me.

Mi travesía a los Estados Unidos. A finales del [año] 89 unas amigas transgéneros me invitaron a venir a los Estados Unidos. Corrimos por el bordo, era fácil. Hoy es lo más difícil y peligroso; así comencé a vivir aquí de "ilegal". Iba a visitar a mi familia dos veces por año, pero las cosas empezaron a ponerse demasiado difíciles y peligrosas. En alguna de esas travesías fui asaltada y violada, y algunas otras compañeras, asesinadas.

At the end of 1989 my transgender friends invited me to come over to the States, and we used to run across the border and it was easy, but today it is very dangerous and difficult, and that's how I started my life here as illegal. I was going to visit my family twice a year but things started getting very dangerous and in some of these trips I was raped and robbed and other of my friends were killed.

Mi última travesía -y aquí empieza mi asilo político por orientación sexual.- En 1999 me detuvieron en la garita de San Ysidro, venía escondida en el compartimiento de una van. Me taparon con una tabla, luego una alfombra y finalmente una llanta. Tenía mucho miedo porque no había oxígeno. En ese momento, renuncié a mi país porque siempre fui humillada y encarcelada. Mi único delito era el andar vestida de mujer.

In 1999 I was stopped in San Ysidro and I was hiding in the back of a van and I was covered with a piece of wood, and with a carpet (a rug) and finally with a tire. I was very scared because there was not much oxygen. At that moment I renounced to my country, because I always was humiliated and I was put in jail, and my only crime was just being dressed as a woman. I should say that this is her last trip where she started the process of political asylum given her sexual orientation.

Asilo político por orientación sexual. En el 2001, después de ser rechazada mi petición en Anaheim, California, gané mi caso en corte ante un juez de migración. Sólo tuve que presentar una biografía de mi vida y pruebas de torturas de mi país.

After my petition being rejected in Anaheim, California [in 2001], I won my case in the court before an immigration judge. I only had to present my biography and proof of the torture I suffered in my country.

Trabajando con mi Comunidad. Después de haber ganado mi asilo político, empecé a trabajar para el Binational AIDS Advocacy Project que fue lo que fue "PROCABI" en el área de referencias, alcance en la comunidad (lo que es outreach) y empezamos con un grupo de apoyo transgénero y también tuve el honor de poder asistir al abogado de inmigración, el que ganó mi caso.

Working with my community after getting my asylum, I started working for PROCABI and I was providing referrals, doing outreach, support groups [for transgenders], and also I had the opportunity to support my lawyer, the lawyer that helped me out with the process. Sandra ask: Support or "asistir" (to assist)? "Lo asistía."

Interpreter: Yeah, she assited [him] [People laugh]

Sandra: Yo ocupaba el soporte [público ríe y aplaude] - I was the one "using the support" [people laugh and clap]

Como facilitadora de grupos de apoyo. Aquí están unas fotos de algunas actividades y quiero comentar que este año celebramos el quinto aniversario [aplausos]. Y quiero compartir que a partir de este año, no estamos bajo [la administración fiscal de] ninguna organización, anteriormente [el grupo de apoyo] estábamos bajo PROCABI, pero esta vez todo el grupo trabajó y logramos juntar cuatro mil cien dólares y con orgullo celebramos nuestro quinto aniversario. Este es un grupo abierto a familias y amigos de transgéneros. Aquí en la esquinita hay fotos de gente que yo creo que ustedes ya conocen. Son activistas de la comunidad y con orgullo yo he tomado entrenamientos con ellos. Mi admiración para María Román.

Here are some pictures of the work that she [Sandra] has been doing [as a support group facilitator], and they [the support group] already celebrated their fifth anniversary. The support group now is working independently and they were able to raise $4,100. This is an open group for family and friends of transgender women. And here are pictures of people that you may know already and she has taken training with them and of people helping out in the community. "My admiration to María Román."

[Pregunta de la audiencia que no se escucha.]

Respuesta: Hay transgéneros de hombre a mujer y de mujer a hombre. Este es un grupo abierto para GLBTQ [y familiares y amigos]. Siempre y cuando quieran aprender de nosotras y apoyarnos, son bienvenidos.

[Question from the audience not audible.]

Response: She is clarifying that this support group is a group that supports both male-to-female and female-to-male transgender and friends and family of the transgender community. As long as people want to learn from all [transgender people] they are welcome.

Prevención y educación. Muchos expertos invitados han visitado nuestro grupo de apoyo, tales como educadores de STDs [enfermedades de transmisión sexual] y HIV [VIH], abogados de inmigración, psicólogos, oficiales de la policía, oficiales de violencia doméstica, farmacias y muchos otros más.

Prevention and education. Several experts have been invited and have visited our support group, such as HIV/STD health educators, INS lawyers, psychologists, police officers, officials for domestic violence, pharmacists, and many others.

Propósito del grupo: Aprender para nosotras poder educar a nuestras familias y a las nuevas generaciones. ¿Quiénes vienen al grupo? Aquí contesto lo que usted me preguntaba [refiriéndose a una persona de la audiencia] Viene todo tipo de gente. Gay, lesbiana, bisexual, transgénero y nuestras familias y como lo dije, todo aquel que venga a apoyarnos y a aprender de nosotras.

The purpose of the group is to learn so we can educate our families, our friends, and the new generations to come. And who comes to the group? Responding to the gentleman's question, everybody: gay, lesbian, bisexual, transgender, and our families, and everybody who wants to learn from us.

Asilo Político: El 70% de los asistentes a este grupo, ya han podido ganar su asilo político por su orientación sexual gracias a la información de agencias, abogados y también compartiendo mi historia. [Aplausos]

Political asylum. 70% of the group participants have achieved political asylum given their sexual orientation. Thank you to the information provided by agencies, lawyers, and also by sharing our own history, by sharing my own life history. [Applause]

Quiero dar las gracias a toda esta gente que me ha apoyado personalmente, quiero dar las gracias al señor Víctor Pereda, Robin Slade, Tracy O'Brian, I love you... Terry Albitron. Y a todas las organizaciones que nos han apoyado (al Grupo Transgénero 2000) durante cinco años; gracias Bienestar, gracias Metropolitan Community Church, gracias The Center, gracias TCC y a todas nuestras familias. Fin.

I'd like to thank all the people who has helped me out personally, I'd like to thank to Mr. Victor Pereda, Robin Slade, Tracy O'Brian, I love you... Terry Albitron. To all the organizations that had supported us (Grupo Transgénero 2000) during five years, thank you Bienestar, thank you Metropolitan Community Church, thank you The Center thank you TCT and to our families as well. The end.

Preguntas y Respuestas: Questions and Answers

Pregunta: Oye Sandra, yo inicié mi proceso migratorio en 1985, tu te cruzaste en el 89. Yo emigré por petición familiar pero yo, como dos o tres veces me quise ir de mi casa porque ya no aguantaba... le aguanté 15 años a mi padre. Pero entonces si yo en el 85 me hubiera cruzado ¿estaría en la misma situación tuya? ¿Tu dices que todavía no había ningún grupo de apoyo?

Question: She's saying that she initiated her process in '85 and you [Sandra] immigrated in '89 and she left her house because she wasn't tolerating the situation at your home, and she didn't tolerate her dad anymore. And the question is, if she had immigrated earlier, would her case be settled down by now? ...Is that the question? [Sandra indicates what she understood, see below]

Respuesta: Lo que yo le entendí a su pregunta era que si en aquel entonces no había grupos de apoyo transgénero y le contesté que no. En San Diego no.

Answer: Another question was also if there was a transgender group back then, and Sandra has responded that back then there was no transgender group at that time. Not in San Diego.

Pregunta: [No se grabó bien pero se refiere a que si se solicita el asilo político por orientación sexual o por género.]

Respuesta de Sandra: [Se solicita por orientación sexual. De acuerdo con Sandra orientación sexual y género es lo mismo. Así fue en su caso.]

Question: The question was if political asylum was requested by sexual orientation and whether sexual orientation or gender was the same thing. Response: It was requested and given by sexual orientation and that in this case sexual orientation and gender is the same thing. Is that correct? "En mi caso así fue" It was in her case.

Comentario: Primero que nada chicas quiero felicitarlas a todas por su presentación, pero particularmente a ustedes dos [las presentadoras transgénero] quiero felicitarlas por su dedicación, esfuerzo y el valor que tienen para estar aquí representándonos y hacernos saber la necesidad que existe aún dentro de las comunidades rurales. Por eso yo les quiero agradecer personalmente. Pero también quiero hacerles saber que en esta conferencia, habemos muchas personas de las cuales ustedes se pueden beneficiar con respecto a información, con respecto a maneras, a estrategias de cómo implementar tal vez programas que ya existen para que los puedan llevar para donde ustedes están. Y lo que le quiero decir también a usted [refiriéndose a la epidemióloga María Teresa Hernández que presentó datos de un estudio que incluyó mujeres transgénero], yo sé que el estudio se hizo con 11 personas, ¿cuál sería la posibilidad de que un mismo estudio o algo similar se hiciera, para tener más conocimiento en sí, con una población más grande?

Commentary: Basically what I just said, very briefly, I was just thanking them for being up here and representing our community and expressing the necessities there are in their towns and also I advised them to ask many of us who are here in this conference to seek [for] probably current programs there are in place in other areas that they can probably implement in their towns. I also asked Maria Teresa would it be possible if the study that she conducted with the eleven participants, that if there is a possibility that it could be done on a broader scale.

Respuesta de María Teresa: Si existe una muy buena posibilidad de que podamos continuar el estudio, hacer como un subgrupo del muestreo para obtener un grupo más grande de muestreo de transgéneros. Lo haríamos con el apoyo de la Secretaría de Salud de México del Instituto Nacional de Salud Pública porque ellos también están interesados en tener un grupo de transgéneros con una representación entre migrantes más alta; ya que aún entre el grupo de alto riesgo de los migrantes, los transgénero tienen una prevalencia concentrada dentro de los migrantes de alto riesgo.

Response from María Teresa Hernández : It is possible. The methodology that get used - that we got the eleven participants - I think is not one that is geared towards specifically getting transgenders. We would have to change it, and I think we are definitely open to that. We definitely realize that the transgender population within the high risk migrant community it's even sort of higher, even higher risk, I mean, this is an HIV study. So it's definitely a priority population. We would, together with the Secretaría de Salud del Instituto Nacional de Salud Pública, basically the Mexican NIH, they're also interested in designing a subsection of the study that would focus specifically on transgender with a methodology that would be able to allow us to select out and recruit more transgenders.

Pregunta: ¿Cuáles son los siguientes pasos de este estudio y cómo se comparan los datos que éste estudio presenta sobre transgéneros con los otros inmigrantes que no son trangénero?

Question: The question is what would be the next steps in this study and how the data presented here on transgenders would compare to the data of the non-transgender migrants.

Respuesta de María Teresa: Es muy interesante, el grupo transgénero es casi como un microcosmo concentrado de lo que se ve en el grupo más grande. Con las personas transgénero vemos todos los mismos factores de riesgo pero solo que más concentrados. Por ejemplo, una migración constante a México todo es tiempo, que en cuanto a las dinámicas de transmisión es por eso muy importante colaborar con la Secretaría de Salud mexicana ya que no existen fronteras sino solo una sociedad continua, relaciones sexuales e interpersonales. En cuanto a en qué estamos ahora con lo del seguimiento, continuamos recolectando datos y analizando la otra mitad de la información la cual no hemos presentado, México está hacienda lo mismo. Allá lo hacen durante el invierno cuando es más probable que los mexicanos visiten a sus familias, aunque sabemos que no llegan a ir cada año. El pasado invierno se trabajo en las áreas rurales de Oaxaca, Jalisco, Michoacán, Zacatecas y otras que no recuerdo al momento. También estamos planeando en trabajar en Baja California, específicamente en Tijuana. Mientras que la encuesta se esté llevando acabo, queremos también continuar un enfoque con las personas transgénero. Parece que el acceso a las transgénero de hombre a mujer es mayor que el de los transgénero de mujer a hombre. Tendremos que hacer algo al respecto, aunque no estoy segura qué será. Por otra parte, en México estamos teniendo mucha respuesta del Instituto Nacional de Salud Pública. Quieren colaborar para trabajar con la población transgénero. El siguiente año tenemos que comenzar a pensar en cuales intervenciones de prevención deberemos empezar a invertir. Todo parece indicar que la mayoría de las conductas de riesgo sucede en California y en la frontera, por lo que es lógico que el ímpetu de los esfuerzos para la prevención sea en California y en la frontera pues ahí es donde una gran cantidad de las conductas de riego tienen lugar y son identificadas.

Response María Teresa: It's actually very interesting - it's almost like a concentrated microcosm in the transgender group of what we see in the larger group. All of the same risk factors, but only more concentrated that we seen in transgenders. So, for example, same thing. Incredible, constant migration back to Mexico all the time and so as far as looking it from transmission dynamics, this is why it is so important to partner with Mexico with the Secretaría de Salud because there's no border, it's just one continuous society, sexual relations, interpersonal relations. As far as what's going on right now with the follow up, we're still collecting data, we're also analyzing and the other half of it which I have not presented is that Mexico is doing the same thing, and they do it during the wintertime when it's more likely that the Mexicanos are back visiting their families, although, you know, you don't go every year. This past winter it was in Oaxaca, rural areas in Oaxaca, Jalisco, Michoacán, Zacatecas, and one more that I'm forgetting. We're also planning on then doing it also in Baja California, specifically Tijuana. So while the survey is still going on, we still want to focus on transgenders - it looks like the access is greater for male-to-female - we're going to have to do something about the female-to-males, I'm not sure what - but also in Mexico, I mean, we're getting a lot of response from the Instituto Nacional de Salud Pública, that they want to join in collaboration with us in order to be able to target this group. And then, next year we have to start thinking of what prevention interventions we need to start investing in. It looks like the majority of the risk behavior is occurring in California and at the border; so it makes sense that the impetus of prevention efforts should actually be in California and at the border because it looks like that's where a lot of the behavior is occurring and where it gets picked up, too, I mean, you know, this is where all the risk behavior occurs.

Question: [Not audible but it is about the survey terminology/wording to refer to transgender people]

Response María Teresa: I should have explained - we used transvesti, we used transgenero, we used transsexual - we used about four or five terms. The common denominator ends up being the word transvesti, which is so misleading, and that's why I mentioned it. But in Mexico, I mean, we're working directly with CENSIDA and the Instituto Nacional de Salud Pública, and they have sort of like much more experience dealing with research in sexuality and labels, if you will, and so they have the same five or six categories. I think it will be very interesting to see, though, what the difference is in the migrants that we are able to interview here or if there is a difference with the migrants that they are able to interview there.

Question: This morning there was a workshop from some group from Fresno that does work with the transgender community, so it would be a great idea to connect with them [for the purpose of terminology]. I want to ask you something. Like, when you talk about acculturation in this study, how do you see that? Do you see that as a negative or as a positive? My experience is when people talk about acculturation it seems that it is better for migrants to be acculturated to the major culture, but with acculturation comes so many biases that your own community has. So I would like to hear what's your opinion about it.

Response María Teresa: In relation to HIV risk, what we have found from the data is that higher acculturation doesn't mean safer behavior. It just looks like more acculturation means different behaviors, and so, for example, if lower acculturation may be associated with having to do some sex work in order to survive, less control of your environment, discrimination, perhaps being jailed, all these other negative health outcomes, if you want to call them that, and so they said it's a different negative than higher acculturation where we see crank, heroin use, unprotected sex with multiple partners in sex work situations, so for the purposes of HIV transmission it doesn't look like it's better or worse, it's just a different sort of risk.

Moderator/Interpreter: Just to let you know about funding opportunities, just hearing how challenging it is to get the funding, if people have visited the Communities First program of the California Endowment, they have funding for multicultural programs, access to services, and another category, and they specify that they're funding projects for vulnerable populations which in this context, the transgender community really qualifies for this funding. They fund up to $350,000 for a three-year period, and the California Endowment is a very sensitive and comprehensive donor. So you may want to take a look at that web site and check for programs because there is no deadline, they are funding throughout the year, so just take a look at the website for the California Endowment.

Comentario y Pregunta: Solamente tengo un comentario para Karina [Karina Luján presentadora transgénero], quiero felicitarte por el trabajo que estás haciendo. Sé que la comunidad transgénero somos muy difíciles de alcanzar somos muy sensitivas [sensibles] y espero que sigas haciendo tu trabajo; La verdad es que estoy muy orgullosa de que gente transgénero como tú está ahorita enfrente en el panel y nos está representado de muy buena manera. También tengo una pregunta dirigida a Sandra. En este momento como las leyes están cambiando tanto, si el licenciado con el que te consiguió tu asilo político, sigue agarrando asilo político para las mexicanas.

Comment & Question: The comments are congratulations to Karina who is representing the transgender community and doing the great work that she's doing, and Erica feels very proud of Karina doing this work. Also, a question for Sandra is that with all the changes that have been happening with immigration law, if the lawyers keep helping especially Mexican women to request political asylum through sexual orientation?

Respuesta de Sandra: Esto es en general. Cualquier transgénero que pueda demostrar que en su país ha sufrido torturas, persecución por la sociedad, por la policía y tiene un caso muy fuerte, cualquier abogado de inmigración que sepa todo lo que nosotras estamos nosotras pasando claro que lo puede tomar. Si cualquier transgénero tuviera un caso muy fuerte puede aplicar por un asilo político.

Sandra's response: It's like in general what is known is if someone has suffered harassment, violence, or has been victim given the sexual orientation of the person, the person qualifies for requesting political asylum.

Comentario: Yo tenía entendido que no podían arreglar asilo político porque el país [México] no está en guerra. Comment : There was a belief that Mexicans wouldn't qualify for this because the country is not in a war and it has been clarified that Mexicans can apply for political asylum given sexual orientation.

Comment: It is not the political situation, it is because she has been abused or he or she has been abused by their relatives or by the politicians or by whoever, that is for sexual harassment they can fix it .

Comentario: Yo de niña tuve que ocultar mi preferencia sexual porque allá en México habían matado a muchas transgéneros y también uno que otro gay. Incluso, hicieron una que otra película homofóbica. Me empecé ya a manifestar de adolescente. Entonces basado en eso, en la homofobia tan grande que hay en México, sí calificamos para asilo político.

Comment: The commentary is that when she was a child she had to hide her sexual orientation and given the homophobia she came up when she was an adolescent, but she believes that given the high homophobia that exists in Mexico, people qualify for political asylum. Comentario de Sandra: Es muy importante que cualquier transgénero que pueda demostrar por medio de una biografía que en su país ha sido torturada y abusada por la sociedad y la policía, es elegible para aplicar para un asilo político por orientación sexual. Y si puede demostrar pruebas físicas de tortura, adelante porque ya ganaron. Quiero mostrar lo que yo mostré [enseña a la audiencia muestras de dos cicatrices una 14 y otra de 17 puntos].

Comment from Sandra: Anyone that is able to give a life history where you prove abuse would most likely get political asylum, and anyone who is able to give physical evidence of this abuse, and so Sandra has just shared with us like 17 stitches and 14 stitches on the other side as a proof of the physical abuse that she had received.

Observaciones Finales: Closing Remarks

Host Joanne Keatley: Before I acknowledge the panel I just want to say in terms of political asylum for being trans-identified, there are some people that specialize in this area actually here in San Francisco. The Transgender Law Center - you can contact them and get specific information around immigration issues and being transgender and I would encourage you to get that specific information because there is a lot of technicalities to the law, but in particular, with Sandra's, you know, kind of example of torture that she experienced in her home country, there are other ways to demonstrate torture. You don't have to have the type of scars that Sandra has in order to qualify for political asylum, so I just encourage you to seek out the legal experts that can give you the information and then you will empower yourselves so that you can get the information to the people that you're targeting in your specific sites. If you want the contact information for the Transgender Law Center or, also, there's a group here working with Catholic Charities that also provides the same service for political asylum, I'll be happy to provide that for you and you can come and get my card and I'll give you the information. But there are people that are specifically working in this area, so I really encourage you to get that information from us.

Before I say goodnight, I want to really thank Maria, Sandra, and Karina for coming today and sharing this information. It's wonderful. I am so honored to have hosted this session and I really appreciate the work that you're doing.

I was acknowledging Maricarmen who took time from her very busy schedule. She's working on her graduate degree at the University of California, Berkeley, and also working at CAPS doing some very important bilingual work, so we really - not as a translator- as a Latino community facilitator - but she did a great job. So thank you very much. Thanks everyone.

Anfitriona Joanne Keatley: Antes de agradecerle a las panelistas su participación quiero decir que en San Francisco hay personas que se especializan en casos de asilo político de personas transgénero. Se puede contactar al Transgender Law Center (Centro Legal para Transgéneros) para obtener información específica sobre inmigración y transgéneros. Quiero exhortarlas a que obtengan información específica al respecto porque hay muchas tecnicalidades legales. No necesitan tener el tipo de cicatrices que Sandra tiene para calificar para el asilo político, hay también otras formas de demostrar tortura. Por eso las animo a que vayan a buscar asesoría legal tanto con el Tansgender Law Center como un grupo de trabajo del Catholic Charities (Caridad Católica) quienes también ofrecen servicios para obtener el asilo político.

Quiero agradecer a María, Sandra y Karina por haber venido a compartir esta información el día de hoy. Estoy muy honrada de haber sido la anfitriona de esta sesión. Es un placer tenerlas aquí en el panel hoy hablando con nosotros sobre el trabajo que están haciendo en la comunidad. Gracias de parte de todas las que estamos aquí. Y otra cosa. Le quiero dar gracias también a Maricarmen. Maricarmen es muy ocupada ahorita, está estudiando la maestría en la Universidad de Berkeley y también está trabajando en CAPS donde yo trabajo también. Así es que es algo que le pedí, que me hiciera el favor de venir hoy. Muchas gracias. Gracias a todo mundo.