When Christina Marsh talks HIV prevention to at-risk youth in Honolulu schools, all eyes and ears are on her. “Young people who may not listen to teachers respect what I have to say,” the 45-year-old TGWA (transgender with attitude) says. “I have personal experience.”

Born male, Marsh has identified as female since childhood, becoming a sex worker at 14 and hitting the mainland at 17. “I’ve been arrested on prostitution and drug possession [charges] in just about every major city in the U.S.,” she says. She served time from 1982 to 1997, including a harrowing two-year stint in Louisiana’s all-male Angola State Penitentiary, where Marsh says she was kept in a secluded ward for her own protection.

She tested positive in 1985 and got HIV meds while finishing her sentence in a Hawaii prison, where she earned her GED and took college courses. Less than a year after her 1997 release, she was drugging and turning tricks again. “That lifestyle is incredibly hard to break from,” she says. “Addiction, prostitution, homelessness—these are main features of life in the urban transgender community.” The 12-step prison programs didn’t save her. Rather, Marsh says, “it was all the people dying around me that motivated me to quit drugs.”

Having seen AIDS devastate her community (estimated TG HIV rates range up to 69 percent), Marsh was driven not just to get help but to give it. She entered rehab and began volunteering at Honolulu AIDS organizations. The only TG board member of Hawaii Cares, an AIDS services consortium, she was key to getting the state’s TGs their own Department of Health funding category. Marsh says TGs now benefit from outreach programs, including a $300,000 housing grant.