Transgender women in Malaysia, in the context of HIV and Islam: a qualitative study of stakeholders\u2019 perceptions

Sima Barmania,Syed Mohamed Aljunid

doi:10.1186/s12914-017-0138-y

Abstract

BackgroundGlobally, one of the key groups considered to be at high risk of acquiring HIV are transgender women, often a marginalised group. In the Malaysian context there has been a scarcity of published research relating to transgender women, a sensitive issue in a Muslim majority country, where Islam plays an influential role in society. Furthermore, there has been a paucity of research relating to how such issues relate to HIV prevention in transgender women in Malaysia.Thus, the aim of this study is to explore the attitudes of stakeholders involved in HIV prevention policy in Malaysia towards transgender women, given the Islamic context.MethodsIn-depth interviews were undertaken with stakeholders involved in HIV prevention, Ministry of Health, Religious Leaders and People Living with HIV, including transgender women. Thirty five participants were recruited using purposive sampling from June to December 2013 within Kuala Lumpur and surrounding vicinities. Interviews were in person, audiotaped, transcribed verbatim and used a framework analysis.ResultsFive central themes emerged from the qualitative data; Perceptions of Transgender women and their place in Society; Reaching out to Transgender Women; Islamic doctrine; ‘Cure’, ‘Correction’ and finally, Stigma and Discrimination.Discussion: Islamic rulings about transgenderism were often the justification given by participants chastising transgender women, whilst there were also more progressive attitudes and room for debate. Pervasive negative attitudes and stigma and discrimination created a climate where transgender women often felt more comfortable with non-governmental organisations.ConclusionThe situation of transgender women in Malaysia and HIV prevention is a highly sensitive and challenging environment for all stakeholders, given the Muslim context and current legal system. Despite this apparent impasse, there are practically achievable areas that can be improved upon to optimise HIV prevention services and the environment for transgender women in Malaysia.

Highlights

One of the key groups considered to be at high risk of acquiring HIV are transgender women, often a marginalised group
Globally, one of the key groups considered to be at high risk of acquiring HIV are transgender women, defined for the purpose of this study, as women assigned the male gender at birth but who identify themselves as being women
These included officials from the Ministry of Health staff, Religious leaders and People Living with HIV (PLHIV) including transgender women

Summary

Introduction

One of the key groups considered to be at high risk of acquiring HIV are transgender women, often a marginalised group. There has been a paucity of research relating to how such issues relate to HIV prevention in transgender women in Malaysia. The aim of this study is to explore the attitudes of stakeholders involved in HIV prevention policy in Malaysia towards transgender women, given the Islamic context. One of the key groups considered to be at high risk of acquiring HIV are transgender women, defined for the purpose of this study, as women assigned the male gender at birth but who identify themselves as being women. Studies have concluded that transgender women are at increased risk of HIV due to factors, such as high-risk sexual behaviour, commercial sex work and stigma and discrimination [4]. Operario and colleagues conducted a meta-analysis and found the prevalence of HIV was higher in transgender female sex workers compared to transgender women who did not engage in sex work, 27.3% and 14.7% respectively [5]

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