But the sea change in New York and progressive politics in San Francisco will do little for transgenders like Barbara Cassis, who is already HIV-positive.

Cassis didn't think much about the potential of getting infected by sharing hormone needles. But she is HIV-positive, and says that other AIDS risk factors don't apply to her. She has never injected illicit drugs, she says, or worked as a prostitute. She assumes she got HIV from unsafe sex or sharing hormones.

Though Cassis has no way of determining the origin of her HIV, it's hard to imagine that she, or her friends, weren't putting themselves at risk. In the '80s and early '90s, she recalls, one so-called doctor parked a gray van in front of popular transgender clubs in New York, from about 10 p.m. till 2 a.m., and later near the Chelsea Piers where transgender prostitutes waited for johns. People lined up for $30-to-$40 shots, administered assembly-line style, climbing in through the van's back door and exiting through the side door, says Cassis.

When hormones were delivered to her house, she remembers, the situation was no more sanitary. "You might get one or two needles with a vial of hormones," she says. "But they were always open. I didn't think about it much at the time, because I was so excited to get the hormones. I remember taking my needle and shooting my girlfriend up, and just rinsing it out with water. I never thought about it."

But now she thinks about it a lot. "Probably hundreds of girls were infected that way, from about 1979 to about 1991 or 1992. Now, the transgender community in New York is small, but there used to be hundreds of girls who would come to the city, get their hormones that way and leave. A lot of them are dead now," she says.

Unsafe sex was another major risk activity for HIV transmission. In the beginning of the epidemic, many transsexuals didn't think they had to worry about safe sex, as gay men did. "Everyone thought of AIDS as a gay man's disease," she explains. "And we weren't gay."

Cassis stopped buying hormones on the street, and found an above-board physician who is now helping her manage her transition. She's also active in the transgender community, and works as an administrative assistant at the Positive Health Project, one of only a few AIDS programs in New York that gives out hormone needles in its needle exchange program. She and several other transsexuals on the group's staff educate others about needle sharing. They also helped to design an unusual pamphlet, "Safety Guidelines for Injecting Hormones," as well as a small brochure, "Calling All Girls: Transgenders and HIV," which warns about the risks of hormone-needle sharing.

Jason Farrell is Cassis' boss at the Positive Health Project. An HIV-positive former intravenous drug user, Farrell set up the needle-exchange program in 1994 in the heart of Hell's Kitchen. While canvassing the neighborhood to assess the needs of the population he hoped to serve, he discovered that most AIDS education and outreach programs had largely overlooked transsexuals. But the stories he heard in transgender bars and clubs worried him.

"If what has been told to me is in fact true, I can only assume that sharing hormone needles was leading people to getting HIV," he says. "It would be no different from me having a shooting gallery in my house and having everyone share syringes. I assume these guys would have infected a lot of people."

Yet despite widespread efforts to educate people about the dangers of sharing needles of any kind, Cassis says she still knows transgender girls who buy their hormones on the black market and reuse syringes or shoot up their friends.

And that's because of the lack of specific efforts to educate the transgender community about HIV risk. "It's obvious that it's a risk factor," says McGowan of the New York City HIV Prevention Planning Group. "And it's obvious that we can do something about it. Hormone needle exchange is a very simple precautionary tool that can be easily implemented and should be."

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