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Half of Hawaii’s transgender youth usually sleep in a motel, emergency housing, a friend’s place, car, park or campground, a new Department of Health report shows.

A quarter of the transgender kids in public high schools have tried injecting illegal drugs at least once, compared to just 1 percent of their non-transgender peers. And half have attempted suicide in the past year.

These are just a few of the department’s major findings in its first report focused on the health of transgender youth in Hawaii, which was .

“A lot of our transgender youth, they’re really in survival mode from an early age,” said Lance Ching, an epidemiologist with the department’s

Much of the data sadly did not come as a big surprise, he said, given the anecdotal accounts health officials and community partners have heard for years on the ground level.

Ching said he hopes all the data that has now been captured translates into more grants to help fund programs that address the multifaceted problems faced by the transgender community in Hawaii.

In addition to higher rates of suicide, drug use and homelessness, the transgender youth surveyed in the report also faced far higher rates of bullying and sexual violence than their non-transgender peers.

Kaleo Ramos, Bianka Taska, Sina Sison and others shared their personal stories in the report, explaining the struggles they endured as kids and how over the years they have grown to feel empowered and become important members of society.

Ramos recalled his earliest memory of being transgender at age 5. He knew he was different than the other girls but not how. Feelings of shame and anger led to aggressive behavior and stress.

He decided at age 29 that the best thing for him to be happy was to live his life authentically. He ended his marriage and transitioned. Ramos is now a teacher at an Oahu charter school and working on his seventh college degree. He’s a hula dancer, advocate and parent.

“This survey opens a door to many other conversations that need to happen,” Ramos said. “But we have to press the state to make sure that happens.”

Ching said the personal stories help balance the “gloom” conveyed in the data.

“We want to emphasize that our transgender youth, our transgender community, they’re not alone,” he said.

Hawaii ranks highest in the nation for transgender prevalence with approximately 8,450 transgender individuals, representing 0.8% of adults, according to a 2016 study by the  a think tank at the UCLA School of Law.

The report shows about half of the transgender teens surveyed feel they have someone in school to talk to about things important to them. That’s compared to almost two-thirds of non-transgender students.

Hawaii State Teachers Association President Corey Rosenlee said students need more resources at school, especially counselors.

“We don’t have enough counselors,” he said. “It’s not just for transgender youth — it’s for bullying, it’s dealing with drugs.”

This is the second Hawaii Sexual and Gender Minority Health Report. It included multiple divisions of the health department and 30 external partners, such as Ka Aha Mahu, and the University of Hawaii, Ching said.

The came out in April 2017, focusing on lesbian, gay and bisexual youth and adults. A follow-up report is expected on transgender adults, Ching said.

Kim Coco Iwamoto, a transgender woman, civil rights attorney and former elected Board of Education member, said she has had first-hand anecdotal knowledge of the hardships faced by transgender youth as a foster parent to five trans-identified teenagers. But she said it is even more heartbreaking to see how widespread and systemic the problems are in the department’s report.

She applauded the community for pushing the state to dive deeper into the data and thanked former Health Director Virginia Pressler for convening a working group and current Health Director Bruce Anderson for seeing it through.

“This was especially upstanding because it puts the entire state, all youth service providers in every agency, on notice that they need to all do better by these trans and (lesbian, gay, bisexual) young people,” she said.

Iwamoto said the report offers a baseline that can be used to assess whether the course corrections being implemented are having the desired impacts and outcomes.

“It is our moral obligation to make sure our children are not left in the margins like this,” she said. “And from a more selfish perspective, we cannot afford to continue losing out on the even greater contributions these young people would be making in their communities had they been given the full supports and opportunities that their counterparts enjoy.”

The Department of Education has taken steps to improve its support for transgender students, such as new policies in 2016, after being seen as slow to react. Parents have sued the statewide district for not doing enough to keep kids safe, transgender or otherwise.

And the U.S. Education Department Office of Civil Rights did an investigation that faulted the DOE for not following up with victims of bullying.

The department is now working on a bullying app that will let students report bullying anonymously and is hiring more Title IX coordinators to boost training and help handle harassment complaints.

The Legislature has also tried to beef up existing laws to protect kids, especially in light of the Trump administration undoing policies from the Obama era. Education Secretary Betsy DeVos announced shortly after President Donald Trump took office that Title IX protections did not necessarily protect gay, lesbian, bisexual, transgender and queer youth from discrimination.

Gov. David Ige signed a watered-down version of in July that includes gender identity or expression as sex-based discrimination prohibited under Title IX. That portion of the law takes effect Jan. 1, 2020.

Khara Jabola-Carolus, executive director of the , testified in support of the bill in its early stages. She has been a fierce advocate to end sex trafficking, especially among minors.

She called the findings in the health department’s report “tragic.” The report says 27 percent of transgender youth in Hawaii were forced to have sexual intercourse against their will.

“We need to see it as a crisis,” she said.

The abuse Hawaii’s transgender community has experienced is one of the “devastating effects of the gender hierarchy that was introduced by colonization here,” Jabola-Carolus said.

She highlighted how the report includes native Hawaiian history. Hawaiians have a term and cultural role called mahu wahine or mahu kane, a third or middle gender that describes people who identify with characteristics of both sexes.

That’s not necessarily transgender because they are not transitioning from one gender to another. But the history demonstrates how the concept of mahu in Polynesia used to be far more prevalent and respected, with mahu playing integral roles in cultural practices, the report says.

But in post-colonial Hawaii, mahu is sometimes a derogatory term and transgender residents are often stigmatized.

“This systemic discrimination is a recent thing in Hawaii. That should be one of the most positive takeaways,” Jabola-Carolus said. “This is not natural. It was created and we can uncreate it.”

The , a nonprofit based in Honolulu, specializes in LGBTQI healthcare. Call 808-445-5392 for information.

The , part of the Hawaii Health & Harm Reduction Center, provides resources for the adult transgender community. They can be reached at 808-521-2437 or kuaana@hhhrc.org.

Read the health department’s full report below.

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