The term "transgender" is used as an umbrella term to describe people who "... have gender identities, expressions, or behaviors not traditionally associated with their birth sex" (Gender Education & Advocacy, Inc., 2001). Transgender people are often grouped by their gender vector (Gender Education &Advocacy, Inc.), male-to-female (MTF) and female-to-male (FTM). MTFs are people who have been assigned a male gender at birth, but who identify their gender as female; FTMs are people who have been assigned a female gender at birth, but who identify their gender as male. These two gender identities (MTF and FTM) have been widely used by transgender people and in the transgender literature (for example, Clements-Nolle, Marx, Guzman, & Katz, 2001; JSI Research & Training Institute, 2000; Xavier, 2000). The language used to describe transgender identity is constantly evolving. For descriptions of transgender identity terms see Gender Education & Advocacy, Inc. and Israel (1996).
Although MTF and FTM are often used to group transgender people, it is important to understand the diversity of genders that exists in the transgender community. Some transgender people identify their gender as both male and female; others identify their gender as neither male nor female. As one transactivist wrote, "gender-identity is the manner in which we think of ourselves, our internal conviction about being men or women, male or female, masculine or feminine (and both or neither)" (Singer, 1997).
Historically, particularly in Western culture, people who have not conformed to their assigned gender role have been oppressed, and transgender people have been victims of societal discrimination and marginalization (MacKenzie, 1994). Recently, transgender activists organized to challenge discrimination and violence as well as negative stereotyping by the media (MacKenzie; Parlee, 1996). Growth of the transgender movement accelerated in the 1990s, advocating for civil rights for transgender people and seeking to improve the health and welfare of the transgender community. Researchers also began to document a variety of issues that are relevant to the transgender community, such as discrimination, oppression, and the adverse social and health consequences of discrimination and oppression. Although the volume of information about transgender people is limited, key issues are emerging from the literature--HIV/AIDS, suicide, violence, and barriers to health care access.
HIV/AIDS is a major health concern among the transgender community. Studies have shown that transgender people are at risk of HIV infection from unprotected sexual activity (Bockting, Beatrice, Robinson, & Rosser, 1998; Clements-Nolle et al., 2001; Elifson et al., 1993; Gattari, Rezza, Zaccarelli, Valenzi, & Tirelli, 1991; Pang, Pugh, & Catalan, 1994; Reback, Simon, Bemis, & Gatson, 2001; Xavier, 2000). HIV prevalence rates among transgender people appear uniformly high. For example, in a sample of 515 transgender people in San Francisco, 27 percent were HIV positive (Clements-Nolle et al.); in a sample of 252 transgender people in Washington, DC, 25 percent were HIV-positive (Xavier). These rates are alarming when compared with the general population. In the year 2000 it was estimated that between 850,000 and 950,000 people in the United States were HIV-positive (National Institute of Allergy and Infectious Diseases, 2002). Based on an estimated resident population of 283 million (U.S. Census Bureau, 2002) for the same year, the percentage of U.S. residents infected with HIV is approximately .3 to .34 percent, much lower than the percentage of HIV-infected transgender people found in studies to date.
Suicide among transgender people has rarely been studied. Although researchers have speculated that transsexuals are prone to suicide (Block & Tessler, 1973; Levine, 1978; Wicks, 1977), only two empirical studies were found that asked transgender people about suicide (Clements, Marx, Guzman, Ikeda, & Katz, 1998; Xavier, 2000). …