Let’s face it. Getting tested for HIV can be anxiety provoking enough by itself. Add in fears of being misgendered, having to explain basic things about your body to confused staff, or other potential mistreatment trans people commonly face in health settings, and it can be enough for some people to decide to just skip it altogether.

One does not simply walk into HIV testingLast summer Public Health – Seattle & King County did a survey at trans pride and coordinated with trans researcher Elizabeth Forsyth to conduct a series of focus groups to learn more about trans people’s experiences with getting tested. Not surprisingly, it turns out that a lot of trans people are going without getting tested. Only about six out of ten had been tested within the past two years, and one quarter had never tested for HIV in their life.

The survey also identified a number of barriers. Only 19% agreed that “It is easy to obtain HIV services that are sensitive to the unique needs of trans people.” Meanwhile, 53% said that they had felt disrespected at health facilities and 42% said they had postponed health services because clinics are not trans inclusive.

Right now, any place in Washington that provides testing to gay and bisexual men should also provide services to trans people of any gender. But it doesn’t help that historically, community HIV testing services have been focused on or exclusively available to “men who have sex with men.” Some trans women in the focus groups expressed confusion as to whether or not they would be allowed to be tested – one shared that she pretended to be a man when getting tested just to avoid the risk of being denied services. Trans men and non-binary people assigned female at birth were often skeptical of organizations having the ability to understand their bodies, their risk factors, or the kinds of sex they were having. Perception is a big issue here. Even if trans people are welcome and quality services are provided, unless trans people in the community believe and trust that that’s true, many will avoid coming in anyway.

Getting quality help from a knowledgeable tester can make a huge difference. Smitty Buckler, a tester at Gay City in Seattle, shared a story about one trans women who came to get tested, “She was super nervous, so I worked into the conversation that I was trans and she immediately calmed down.” They were able to have a conversation with her about drug use and safety while street hooking and make plans for her to schedule another appointment with her partner to get tested together. Testers are often available to help you understand your risk and help you determine what options you have for being safe. That can make a big difference in some people’s lives.

The survey found that an overwhelming majority – 80% of trans people – said that they would prefer to receive medical care at a clinic that specializes in transgender health issues. The focus groups confirmed that for anything from a clinic or hospital to an HIV testing organization, hiring staff who are knowledgeable and experienced in trans health issues, especially staff who are trans themselves is essential.

“I recently had someone come up and tell me, ‘I need you here.’ and when I asked what they meant they said, ‘I need you alive and I need you here.’ I was having a having a hard time letting it sink in what that meant,” Smitty explained. “This person was telling me in a very direct way that my life matters to them and that what I’m doing here is making a difference in a meaningful way.”

Smitty followed up with the woman they were helping, and she ended up having to cancel the next appointment because her partner was currently in the hospital from a suicide attempt. “I want to impress upon people that when we say trans lives matter that actually means something,” Smitty said, “and we need to support trans people in staying alive. Providing quality and trans-knowledgeable testing services is a part of that.”

Image from Elizabeth Forsyth’s focus group results presentation