HIV In The Transgender Community

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The Role Of Masculinity In Increased HIV Rates Of Transgender Persons Of Color

Kristen Martinez, a Seattle-based therapist at Pacific NorthWell who specializes in LGBT+ issues, explores the relationship between masculinity and the increased HIV rates in the transgender community, particularly affecting persons of color.


Why are the rates for contracting HIV so high amongst the transgender population? And why are these risks even higher for transgender persons of color? What does this mean for counselors working with these clients? In “The Role of Masculinity in Increased HIV Rates of Transgender Persons of Color”, Kristen Martinez, M.Ed., Ed.S., LMHCA, NCC, will help to tease out some of the risk factors associated with being transgender and a person of color with regards to increased likelihood of contracting HIV. One of the most important risk factors involves the constraints of conformity to hegemonic masculinity, which uniquely affects transgender persons as they consciously and sometimes visibly perform or ‘do’ gender. Come gain familiarity with clinical issues of the transgender population while taking a closer look at the importance of intersectionality in the lives of transgender clients. This hour-long talk provides needed information about a complex and serious transgender issue and proposes clinical implications. There will be a question and answer session at the end of the talk to accommodate audience members’ comments, knowledge, and valuable feedback.

Opening Remarks

It is an understatement that gender is important to our society. It is one of the first single markers that people notice when interacting with other people. It is the way that we categorize others. This leads into the obvious importance of ethnicity in our society, too. This is another social marker that we wear, whether we like it or not, which advertises to others many traits about us that may or may not be true or correct. Though these are things that we largely cannot control or change and we are mostly stuck with for the rest of our lives (gender notwithstanding), it doesn’t mean that they are inconsequential. These differences are not value-free differences.

It is to these value-laden differences that I now turn. I am a bit hesitant to be honest with you, even being here right now speaking about this subject. I believe that my message, since it comes from me, a white, cisgender woman, pales in comparison to the same message delivered by a person of color, a transgender person, or someone who possesses familiarity with both worlds. I don’t know what it’s like to be a person of color in a racist society, nor do I know what it is like to be a transgender person in a transphobic society with a gender binary. I don’t know personally the ways that the two of these traits intersect. However, I hope that I can do this topic justice for the time being, until more transgender people of color can illuminate their experiences with us.

Also, it is worth mentioning that I am not speaking about white transgender individuals today. As is customary with research, there is always much more knowledge gained about white participants of any demographic than about participants of color. This is a bias that goes back to when research first began. So, though I am neither transgender nor a person of color, my hope is to raise some direly-needed awareness about this critical population, which shines light on the multitudinous ways in which gender and ethnicity can intersect with regards to culture, social class, masculinities, patriarchy, and much more.

Let’s get down to business and talk a little bit about what has come to be called hegemonic masculinity.


  • Introduction to an overview of the social process of hegemonic masculinity, including internal hegemony (one group of men over all others) and external hegemony (all men over all women). There exists a hierarchy of masculinities. Masculinities are configurations of practice (Connell & Messerschmidt, 2005).

  • Explain how hegemonic masculinity correlates with sexual risk-taking behavior and gender patterns in health (Connell & Messerschmidt, 2005). Gender differences in health behaviors exist, and health behaviors are a way to ‘do’ gender (Courtenay, 2000). “[H]ealth-related beliefs that men are independent, self-reliant, strong, robust and tough” (Courtenay, 2000, p. 1387) impact the ways in which men act.

  • Transgender men are viewed with a masculinity subordinated to hegemonic masculinities. Transphobia runs rampant in society, especially since our societal beliefs are based in dichotomous gender roles and not a gender continuum. Embodiment, or embodied masculinity, in transgender men is very important as a way to ‘prove’ masculinity (Connell & Messerschmidt, 2005).

  • Transgender persons have increased risks of: being kicked out of their houses; inability to find or secure housing; dropping out of school; and inability to find or secure a job. Additionally, they have to deal with the high cost of gender confirmation surgery, which all leads to increased risk of sex work as viable job option and thus, increased risk of contracting HIV (Nemoto, Operario, Keatley, & Villegas, 2004). Increased risk of contracting HIV stems from sexual behavior or drug use, both high-risk behaviors (Nemoto et al., 2004).

  • Transgender women need gender validation, and sex without a condom is a way to create intimacy (Nemoto et al., 2004; Melendez & Pinto, 2007). Gender-related abuse or intimate partner violence (IPV) is another avenue in which to contract HIV – the male active role vs. the female passive role (Melendez & Pinto, 2007).

  • Gender violence is also perpetrated against the transgender community by heterosexual men in an effort to subordinate these masculinities or derogate femininities. Gender policing often occurs. Differences in “human capital” exist based on gender, and a “patriarchal dividend” is given to men in subordination of women (Schilt, 2006, p. 466).

  • Additionally, men of color are viewed as marginalized masculinities, and thus must assert their masculinity via more dangerous ways that are accessible to them (as they usually lack many resources with which to gain masculine capital or status). Discuss protest masculinity (Connell & Messerschmidt, 2005).

  • Transgender people of color feel that they violate cultural or family norms (Nemoto et al., 2004). Emphasize how “the experiences of transmen who fall outside of the hegemonic construction of masculinity, such as FTMs of color … illuminate how the interplay of gender, race, age, and bodily characteristics can constrain access” to a patriarchal dividend (Schilt, 2006, p. 466).

  • Discuss clinical implications: intersectionality in case conceptualizations and clinical practice is important; there is a need for health promotion strategies that contest hegemonic masculinity (Connell & Messerschmidt, 2005); explore social context of risk behaviors (Nemoto et al., 2004); educate about HIV rates within the transgender population (Nemoto et al., 2004); support transgender-affirmative health care; there is a need for more transgender-affirmative counselors and counseling; participate in political and social justice advocacy for transgender rights.

  • Pose question and answer session to audience.

Concluding Remarks

If you have learned anything here with me during our time today, I hope it is that you should always keep your eyes peeled for the influence of contextual factors when you are conceptualizing clients and their issues. Clients do not exist in a vacuum, just as we, in this room, in this city, in this society, do not exist in a vacuum.

I confess that sometimes it may be tempting to view the issues of clients as specific to their intrapsychic worlds. Maybe it is just something that is inherent to their being, something that they are just bringing to the proverbial table. I caution you, though, that this is a dangerous step on the path to what I call “other-ing”. Because this step leads to characterizing the next clients you have that may be similar in demographic characteristics to your last client, and this leads you to believe that “they” are all the same, and that this defect lies somewhere within all of them. They are not like me – they are the “other”.

“Other-ing” leads to other things as well. It leads to snap judgments and quick categorizations. It leads to you thinking that every one of these clients is alike and thus should be treated and conceptualized alike. “Other-ing” is right down the road from pathologizing, and a few blocks away from objectifying and dehumanizing. “Other-ing” is a slippery slope.

My humble goal is simply to refresh your memory about client conceptualization. Yes, social categories exist that can alter clients’ realities. Yes, some clients possess similar characteristics or have gone through similar experiences. Yes, there are issues unique to specific populations, such as the transgender person of color population. However, just because these all are “Yes” answers, these “Yes”es do not add up to generalizing about clients and treating every client of a certain background the same. Your clients, like you, are unique human beings with their own personal experiences. Take all of this with a grain of salt, please.


Connell, R. W., & Messerschmidt, J. W. (2005). Hegemonic masculinity: Rethinking the concept. Gender & Society, 19, 829-859.

Courtenay, W. H. (2000). Constructions of masculinity and their influence on men’s well-being: A theory of gender and health. Social Science & Medicine, 50, 1385-1401.

Melendez, R. M., & Pinto, R. (2007). ‘It’s really a hard life’: Love, gender and HIV risk among male-to-female transgender persons. Culture, Health & Sexuality, 9, 233-245.

Nemoto, T., Operario, D., Keatley, J., & Villegas, D. (2004). Social context of HIV risk behaviours among male-to-female transgenders of colour. AIDS Care, 16, 724-735.


Schilt, K. (2006). Just one of the guys? How transmen make gender visible at work. Gender & Society, 20, 465-490.

Wester, S. R., McDonough, T. A., White, M., Vogel, D. L., & Taylor, L. (2010). Using gender role conflict theory in counseling male-to-female transgender individuals. Journal of Counseling & Development, 88, 214-219.