Giovanna Rincon : « Health is above all a question of rights! »

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The « Paris Community Declaration » was one of the highlights of the IAS 2017 conference in Paris. This initiative was presented at a specific press conference and at the official opening session of the Conference. It is Giovanna Rincon, trans activist and president of the Association accepts-T, which supports trans-migrant women, who gave the introductory speech of this « declaration ». The activist drew on his personal journey and his militant commitment to show how we had been, for the trans community, from recognition to participation, involvement. This is her intervention.

9th IAS Conference on HIV Science (IAS 2017), Paris, France.

« For you to understand my commitment and my struggle, I must make you travel in my history. » I was born in Colombia, in a modest family. When I was 12 years old, my family rejected me and I knew the street. Nevertheless, I can begin to live free and initiate my transition through the taking of hormones. I survived thanks to the help of my companion at the time, who helped me to open my hair salon.
At the age of 19, I began to campaign against HIV and the still clandestine LGBT movement at the time in Colombia. A year later, I’m learning my HIV status.
At the age of 23, I make the decision to immigrate and I leave for Italy where I start the work of sex for the first time, but also in the hope that one day in Europe we can treat HIV. It was then « to stand, or to be left to die ».
I find myself in Italy with a baggage full of stigma, in addition to being trans and HIV positive, I am now a migrant and sex worker.


Throughout my personal life as a professional, I had already experienced discrimination related to my transidentity, but, in Italy, I have discovered the discriminations related to the legal status and the serological status that affect the whole of trans and sex workers through the refusal of general care and the people who then die of AIDS, always more around me.
The advent of antiretrovirals obliges me and my friends to inform us, to mobilize us around questions about ourselves and our community in order to benefit from the best possible care. It feeds all the more our anger that we are living in generalized denial of care; Refusals that marked the beginning of my engagement. I decide to denounce and combat discrimination in the care of migrant sex workers, often considered to be responsible for the epidemic. I then collide with speeches from doctors like: « We are not going to give the tritherapy to a trans foreign whore rather than an Italian who contributes », showing the level of violence against us.


Towards the end of the 90’s years, a trivial event led me to become a community referent: the democratisation of the mobile phone! Be called by colleagues who encounter problems of violence, police harassment, access to care, accompany people at the terminal stage to emergencies. And when I came back the next day to see them, to learn that they had already been repatriated.
This allowed me to overcome the fear of being confronted with institutions and to start to mediate cultural and community mediation.
In 2002, several reasons motivate me to leave Italy:
● Increasingly strong repression and harassment against sex workers;
● The rise of the extreme right and the fact that being undocumented has become a crime. I have been incarcerated twice;
● A very close friend who gets sick of AIDS and who needs to be treated.

● I take the decision to come to France with her. Our arrival in Paris resulted in the discovery of a dense community and associative network that allowed a small visibility for the trans.


This is the moment of the balance sheet for me, the difficulties for the people trans and prisoners are also present in Paris, my convictions come out strengthened, and I decide to convert my experience in expertise and skills in order to help my community.
In 2010, I co-founded the Association accepts-T to make our voice heard about health issues, justice and scientific issues, as well as to accompany the trans community towards a better quality of care and life. We have put in place partnerships with different hospitals, associative structures and caregivers to build care pathways adapted to our specificities, leaving room for community mediation and allowing us to have some funding — which is a crucial issue of health democracy and community participation in decisions concerning them, I would like to underline here.
Our initial self-help project has resulted in a significant mobilization of trans, migrant and sex workers on the issues affecting them, as recently as against the penalization of the clients of sex workers. Of this mobilization was born a community diagnosis on the needs of our communities, including the rapid and community screening we do today: out of 100 tests carried out last year, 16 people had a positive result; People we were able to accompany to a quick and adapted support. And we have brought many other people into prep courses (pre exposure prophylaxis). Reducing deadlines for screening, we have become the carriers of this care and have developed our ability to be associated with research projects.

It remains the question of the few financial resources that we, like other community associations, have: trans associations are among the least subsidized associations in France and in the world.


It will never be recalled enough: « Health is above all rights » and the criminalization of the work of sex puts us all at risk, plunges us into precariousness and makes us even more vulnerable to violence and contamination. Recently, four migrant sex workers, including two trans women, were murdered in the Bois de Boulogne, the high place of prostitution in Paris, close to this conference centre.
In addition, we are witnessing the gradual abolition of social assistance such as the « transport card » allowing foreign and precarious people to travel free of charge, making their access to health care and services more difficult.
While it becomes clear that without legal status and the regularization of undocumented people from key populations, the risk of contamination will remain important, we are witnessing the continuation and worsening of the anti-migratory policies, at the French, European and global levels.
Nevertheless, I recall that what is happening in France is not an exception and in the world: the persecutions and murders of trans people have become the rule, and yet even in countries where laws exist to protect them.
While some studies estimate the average lifespan of trans women at 35 years, an American study conducted internationally by Dr. Stefan Bajra shows that trans women infect 49 times more with HIV than the general population, which equates to almost 50% of the likelihood of contaminating themselves in their lives.
It is only by attention to the margins of the most exposed populations and their specific needs that all stakeholders in the care pathways of people living with HIV will be able to improve and adapt the management of key populations in their entirety.
The UN’s political Declaration on the end of AIDS, adopted in June, includes a specific dimension for transgender people, but only 40% of national strategies to combat HIV take account of us.
The overrepresentation of trans women in trans populations must also not invisibility the realities of trans men, including men who have sex with other men, in terms of health issues and risks of contamination.
We need more research into key populations, especially for cisgenres women and trans women and men.

We need medical research and social sciences to get more information on how and with whom trans people contaminate to adapt our prevention strategies. We need research on the interactions between antiretrovirals and hormones in order to best adapt the treatments offered to trans people. We need research to show how violence and repressive policies are precarious and impact the health of migrant, undocumented or sex workers.


The quality of life of trans women in a country is the best indicator of the respect and inclusion of key populations through research and public policy. Indeed, we combine several exclusion and precarisation factors: transphobia, racism, Sérophobie, precariousness, Putophobie, etc.
It is therefore more than necessary to make the voice of the minorities and the key populations heard, to listen to them and to take them into account, in order to stop the epidemic and to arrive at a satisfactory quality of life for all people living with HIV and the key populations.

Although in 30 years, science has made a lot of progress, we can only see that the epidemic continues to wreak havoc and that we are still far from the account.


I will allow myself – with great emotion – to pay homage and to take up the words of those who, 30 years ago, already launched what has become our watchword: « Nothing for us, without us! », and who have paved the way for tremendous progress in research and care through the Denver Principles (1).
Principles, which we are now trying to modernize and adapt to the new challenges of research and combating AIDS by unveiling the « community Declaration of Paris ». I invite you to sign it widely in order to give strength to this new agenda of the key populations and their central place in the fight against epidemics, and especially to share it and make its claims yours.
(1): At a scientific conference in Denver, Colorado, in 1983, medical and scientific discourse depersonalize so much the sick that people living with HIV, present, decide, in reaction, and on the sidelines of the conference, to write a founding statement of the coalition of people with AIDS. This founding text will be a date. This declaration lays out, in about ten principles for physicians, people living with HIV and the general population, the basis for activism in the fight against HIV/AIDS. And that for decades.

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