Addressing the HIV and health needs of transgender people

The World Health Organization (WHO) Regional Office for the Western Pacific today launched a report that assesses and addresses the under-recognized epidemic of HIV and other sexually transmitted infections (STI) among transgender people in Asia and the Pacific.

“It remains a sad fact that HIV remains cloaked in stigma and discrimination,” says WHO Regional Director for the Western Pacific Dr Shin Young-soo. “We need to listen more closely to the people who are living with HIV and most vulnerable to HIV.”

The Regional assessment of HIV, STI and other health needs of transgender people in Asia and the Pacific contextualizes and refines WHO guidance on HIV interventions for men who have sex with men (MSM) and transgender people. It was jointly developed by the WHO Regional Office for the Western Pacific and the Asia Pacific Transgender Network, in collaboration with the WHO Regional Office for South-East Asia and the United Nations Development Programme.

The report identifies a clear need to scale up and improve sustained, comprehensive and effective HIV prevention efforts for transgender people. These efforts must be complemented by a better understanding of what interventions work best, and in what contexts.

Transgender people are defined as people whose gender identity or expression differs from their biological sex assigned at birth.

The assessment reports that HIV prevalence among transgender women in the Region appears to be very high, ranging from 7.5% in Australia, 13.5% in Thailand and 31.6% in Indonesia to 41% in India. Reported STIs among transgender people included syphilis, gonorrhoea, chlamydia and herpes. For example, among Hijras in four cities of India, 13.6% had syphilis and 45.4% had herpes complex virus. Among Warias on the island of Java in Indonesia, 26.8% had syphilis and 47% had rectal gonorrhoea or chlamydia or both.

Studies on sexual health in Asia and the Pacific have mostly centred on MSM and have tended to ignore the transgender people who may be putting their health at risk through self-medication with hormones or by allowing themselves to be treated and operated on by non-licensed, non-professional health-care providers in non-traditional settings.

Some transgender people reported having no access to health-care services. In places where they did have access, they reported being subjected to humiliation, stigma and discrimination from health-care providers. Due to costs and lack of medical professionals knowledgeable in transgender health, transgender people said that they often obtained information from their friends or online. In addition, they often self-medicated with hormones or visited street vendors and other non-licensed providers for silicone injections and other procedures, which included soft tissue body fillers that are often not of human-grade silicone.

Some also reported that certain private HIV testing sites do not provide pre- and post-test counselling. These realities, among others, put transgender people at increased risk for HIV and STI, as well as other harmful effects on their health.

The objectives of the report are to:

  • examine the current state of evidence on transgender health in Asia and the Pacific;
  • understand the current needs and concerns of transgender communities in Asia and the Pacific; and
  • make technical recommendations to WHO and Member States regarding transgender health.

The report calls for the following priority actions:

  • Accept and recognize that transgender people have equal rights and dignity, which are protected under the law.
  • Increase knowledge and sensitivity among health-care personnel to help eliminate stigma and discrimination of transgender people in public and private settings.
  • Adopt a comprehensive standard of care for and guidelines on transgender health to benefit both transgender people and health-care providers.
  • Encourage affordable and convenient access to health care specifically for transgender people.
  • Combine the collection of strategic information through transgender-specific surveillance in the Region with more operational and social research to help understand transgender health specific to the contexts of Asia and the Pacific.

For further information, please contact:

Dr Ying-Ru Jacqueline Lo
Team Leader, HIV/AIDS and Sexually Transmitted Infections
Telephone: +632 528 9714
E-mail: loy@wpro.who.int

Mr Ruel E Serrano
Assistant, Public Information Office
Telephone: +632 528 9993
E-mail: serranor@wpro.who.int

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