Beyond the Gender Binary: HIV Support for Those Who Check Neither M Nor F

Much of the support for people living with HIV still adheres to the gender binary -- even as a part of the recent push for competent care for transgender people. This may meet the needs of binary trans individuals, but it still excludes those of us whose trans or genderqueer identities are neither man nor woman. Thus, while clinicians are slowly but surely adopting the appropriate language and gaining better understanding of trans identities, there's still a need for psychosocial support services that recognize and affirm gender-expansiveness.

In all fairness, this is new territory for clinicians and support providers. There's a reasonable learning curve in acknowledging and providing services to people who are non-binary (not having an exclusively masculine or feminine gender identity and thus living outside the binary) or agender (having no gender at all).

It requires unlearning care and support expectations based on genitalia or gender expression. It means allowing individuals to guide providers in how they want to be treated. And it definitely requires consulting with non-binary stakeholders to get it right.

I've learned from my work with HIV-positive black gay men that self-advocacy and the ability to successfully navigate health care are skills best developed in supportive settings with people who are facing similar health battles. Personal health management and health outcomes for black gay men and for anyone who regularly attends support groups are remarkably better than for their peers who don't, in my experience.

But, I'm not convinced the gender specificity of support spaces has been a contributing factor to those positive outcomes. Are we making sure that everyone, of any and every gender or no gender at all, has the necessary support for dealing with their diagnosis and successfully managing a lifetime of health care?

Is It Arbitrary to Separate HIV Support Services by Binary Gender?

It could be that separating HIV support services by binary gender is generally arbitrary. We've come to understand gender as a spectrum for many and irrelevant for others. For those of us who identify as non-binary, it's the gender specificity of most social spaces that leaves us out. I'm curious as to what, besides full inclusion, happens when that specificity is removed and people of any or no gender are explicitly welcomed to receive what they need.

That's not to suggest that every gender-specific support space should be deconstructed. What's certain, though, is that non-binary and agender individuals affected by HIV cannot be expected to adapt to spaces that do not intentionally include us.

It's human nature to seek spaces where we'll be acknowledged and affirmed. It's actually integral to our total wellness. That affirmation can happen in gender-expansive spaces that intentionally welcome all bodies, all lived experiences and all identities.

Taking too long or refusing to offer affirming care and support costs lives -- which is why we're now attempting to play catch-up to address the startling statistics on HIV rates and outcomes among black trans women. My concern is that we're abandoning more lives than we realize when we stubbornly attach holistic care and psychosocial support to the gender binary. As a person who is non-binary, I've fallen through that crack -- and I'm certainly not the only one.

Inclusivity Beyond Gender Binaries

What I've needed most, over the past decade living with this condition, is to feel that my status makes me part of one unified and resilient community. Gendered spaces have denied me that experience.

Finding support that's not just trans-inclusive but inclusive entirely beyond gender is as important as my treatment adherence, but I'm realizing that I'll either have to advocate for that relentlessly or create such spaces for myself and others like me.

Borrowing from what we see in many rehabilitative addiction spaces, such as Alcoholics Anonymous, it's possible for us to create HIV support environments that are truly inclusive and affirming by centering the shared health condition. The individual identities that intersect with that shared condition can be discussed as needed.

This is already being done, but not widely enough. For example, in New York City, the Positive Life Workshop is structured in a way that helps HIV-positive people of any gender identity with adherence to treatment, care navigation and the various other factors involved in managing life with the virus.

Largely, the concerns of people living with HIV are the same across identities -- though the barriers absolutely vary. For example, all HIV-positive people are concerned about treatment side effects in the long term and advancements toward a cure. We're all concerned with living our longest, healthiest lives.

Good health outcomes can be encouraged and achieved by accepting people of all identities in supportive spaces and not being hyper-focused on any particular gender identity. It's not a matter of reinventing the wheel but of recognizing the opportunity to be more inclusive and of being intentional about doing just that. We should be proactive instead of waiting to collect specific data that shows health disparity among non-binary communities.

Lourdes Ashley Hunter of the Trans Women of Color Collective has spoken recently about curating affirming and reflective social justice spaces that transcend gender. In conversation with her and in preparation for my workshop in the Beyond the Binary track at this year's Philadelphia Trans Health Conference, I've seen very little difference between our needs in social justice and support spaces. Rather, I've come to see our HIV support spaces as social justice spaces.

It's in our best interests to strive to affirm all types of people impacted by HIV as we enter a political era that brings a dangerous conservative health care reform to the forefront of our fight to end to the epidemic. There is potential for many of us living with the virus to have our access to quality health care diminished or lost. Within our community, we have to make sure no one is left without support and left behind.

Francisco-Luis White is an Afro-Latinx poet and storyteller living in Washington, D.C. White is the author of Found Them (CreateSpace, 2016), a chapbook dealing with transformation and departure in response to trauma along their gender/sexuality journey. White presented at Fire & Ink IV: Witness, a conference for LGBTQ writers of African descent; Carolina Conference on Queer Youth; and the United States Conference on AIDS. They have been recognized by National Black Justice Coalition as an LGBTQ Emerging Leader to Watch. In 2013, they were endorsed by Jill Stein and the Massachusetts Green Party as a candidate for Boston City Council. White has featured at Busboys & Poets (Sparkle) and the You Can't Kill A Poet Reading Series in Philadelphia. Currently, they're working on a collection of poems titled August to August. Learn more at franciscoluiswhite.com.