Lost in transition: health of transgender people in Asia Pacific

Abstract

On May 17, International Day of Action Against Homophobia and Transphobia, a report—Lost in Transition: Transgender People, Rights and HIV Vulnerability in the Asia-Pacific Region—was released by the UN Development Programme and the Asia Pacific Transgender Network. Transgender people, defined as “individuals whose gender identity, and/or expression of their gender, differs from social norms related to their gender of birth”, have gained dramatically increased visibility and public acceptance in the past two decades globally. The report notes that the Asia Pacific has rapidly rising rates of HIV infection in transgender people and in men who have sex with men (MSM). Together, most new HIV infections in Asia by 2020 will occur in these groups. Worryingly, the HIV prevalence rate in transgender people, which is even higher than that in MSM, has reached an alarming level—up to 49% in Delhi in one study in 2009. Transgender people's experiences of stigma, harassment, and abuse not only push them to the margin of society, but also have a serious negative influence on their physical and mental health. Worse, many transgender people report that health services are difficult to access, unsupportive, unqualified, or unable to meet their unique needs. A 2008 study on MSM and transgender people in Asia noted that the main disincentives for transgender people to seek treatment are stigma and discrimination, particularly from health-care providers. For instance, in Nepal, being transgender is associated with assaults by health-care staff and refusal of health-care services. The new report acknowledges the absence of adequate and rigorous research in Asia Pacific that addresses transgender people's health vulnerability and needs, and proposes a research agenda to overcome the gap and tackle the problem. Health professionals, researchers, governments, and non-governmental organisations should work together to adapt health care to meet the needs of transgender people in different cultures. With regard to health practitioners in Asia Pacific, the first and foremost step should be recognising and respecting the diversity in gender identity and expression.