As a series of transgender-specific events take place in Bangkok, Thailand, representatives from the transgender community, United Nations organisations and USAID have emphasized the need for urgent action to increase focus and positioning of transgender human rights issues within health and HIV responses in the region.

Research and data on HIV risk and prevalence among transgender people is limited regionally, but global studies have found that transgender women are 50 times more likely to acquire HIV than adult males and females of reproductive age in the general population*. Examples of available data in Asia and the Pacific indicate high HIV prevalence among transgender women in many cities, provinces and states, including: 30.8% in Jakarta, Indonesia, 23.7% in Port Moresby, Papua New Guinea, 18.8% in Maharashtra, India and over 10% in Bangkok, Chiang Mai and Phuket in Thailand.

In spite of this, focused programmes and initiatives for transgender people are largely lacking in national responses to HIV. Where they do exist, HIV prevention efforts are estimated to reach less than half of the transgender people who need services. Transgender women and men are often excluded from social protection schemes aimed at promoting health and lifting vulnerable persons from poverty.

Natt Kraipet, Coordinator of the Asia Pacific Transgender Network (APTN) said, “Transgender people are too often invisible within societies and especially within health settings and yet we face significant rights and health challenges—including high risk to HIV. Our specific health needs are neglected, and much more evidence and knowledge is needed to be able to adequately address the questions about how services and programmes can reach transgender people most effectively.”

In order to raising the profile of transgender women and men and develop strategies for increased efforts in these areas, APTN has partnered with the Being LGBT in Asia Regional Initiative and the Asia Pacific Regional Offices of UNDP, UNAIDS UN Women, WHO and USAID, to bring community delegates and experts from countries across the region[6] for a regional transgender community consultation called “Agenda in Transition – Advancing Actions to Secure the Health and Rights of Transgender People in Asia and the Pacific.” The aim of this regional consultation is to agree on a set of steps and actions that APTN will take with partners, to address and prioritize specific human rights and health needs of transgender women and men.

Prior to this consultation, regional transgender men and women attended and hosted sessions at the global World Professional Association for Transgender Health (WPATH) International Symposium—the first time transgender community members from the Asia Pacific region have hosted a community series at the biennial event.

Addressing barriers to progress

Through these various events held in Bangkok, delegates addressed critical obstacles that keep transgender people from accessing health and HIV services, hampering progress in reducing new HIV infections and providing treatment and care. Discussions highlighted how lack of data, punitive legal and policy environments and confusion between issues of sexual orientation, gender identity and expression lead to widespread stigma and discrimination towards transgender people, including ongoing and disproportionate harassment and violence.

“We know transgender people in the region face significant human rights challenges to accessing health and social protection services,” said Clifton Cortez, Practice Leader for the HIV, Health and Development Practice at the UNDP Asia-Pacific Regional Centre in Bangkok. “The community reports frequent harassment, and many often face criminal charges and detention. This discrimination keeps people further away from the services they need.”

A central focus of the community consultation examined how health and social systems are often not adapted to the realities and needs of the community, particularly in resource-poor settings. Many transgender women and men report lack of technical knowledge and expertise among health personnel on transgender issues such as hormones, transition operations, psycho-social support, side-effects and if and how antiretroviral treatment can be combined with treatment linked to transgender transition.

In a number of instances, transgender women and men underlined how lack of knowledge, expertise and understanding within health settings in low-resource areas can lead transgender people to undertake transition operations and hormone treatment ‘underground’ in non-regulated settings, which in turn can lead to greater health complications and increased vulnerability to HIV.

“Transgender people face severe stigma and discrimination and have been neglected in HIV and health responses. We need to ensure that their voice is heard and their specific needs and priorities are addressed. It is very crucial that the transgender community and all the stakeholders work together to develop effective solutions which can lead to gender-sensitive HIV and health responses as well as addressing underlying factors such as human rights and legal barriers,” said Roberta Clarke, Regional Director of UN Women Asia and the Pacific.

“There are crucial gaps in knowledge that need to be addressed. More research is needed on health needs and behavioural aspects of hormone use and surgeries among transgender people, for example,” noted Dr. Zhao Pengfei of the HIV/STI programme at the WHO Western Pacific Regional Office. “Understanding of trans-diversity is also needed. Transgender women and men are very different from each other and each group has its own specific health needs, something the health sector must recognize and respect.”

Following the community consultation meeting, APTN will hold its Second Interim Board meeting, where the actions and recommendations from the consultation will be presented for endorsement.

“Profile and focus on needs and rights of transgender people are growing as we have seen with the formation and strengthening of APTN itself, and this is an important moment of opportunity for the transgender community,” said Steven J. Kraus, Director of UNAIDS Asia and the Pacific. “Critically we need to ensure communities are at the front and centre of human rights, health and HIV efforts, enabling community involvement to be meaningful and consistent.”

* China, Hong Kong, Special Administrative Region of China, India, Indonesia, Malaysia, Nepal, New Zealand, Pakistan,
Philippines, Singapore, Thailand and the Kingdom of Tonga.