amfAR, The Foundation for AIDS Research

Addressing HIV Among Transgender Individuals in Asia

Published September 15, 2015

Community members and experts who participated in the July consultation on TRANSIT in Bangkok.  
Community members and experts who participated in the July consultation on TRANSIT in Bangkok.  

Despite the fact that transgender women are approximately 49 times more likely to be infected with HIV than the general population—which is more than twice as likely as men who have sex with men (MSM)—they are often overlooked in the international HIV response. National HIV programs rarely define them as a distinct key population with their own prevention, treatment, and outreach needs, and instead often group them with MSM and label them as “male” when collecting health and HIV data. After decades of transgender-led advocacy, this is slowly starting to change.

In July, the World Health Organization (WHO) released Transgender People and HIV, its first policy brief focusing specifically on transgender individuals. It also co-hosted a Bangkok consultation— along with USAID, the United Nations Population Fund (UNFPA), the United Nations Development Program (UNDP), and the International Reference Group on Trans* and Gender Variant and HIV/AIDS Issues (IRGT)—for transgender community members and global experts to discuss the Trans Implementation Tool (TRANSIT), a document currently under development. TRANSIT will provide practical guidance on how to implement the strategies for providing transgender individuals with quality HIV services outlined in the policy brief and the WHO’s Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment, and Care for Key Populations, released in July 2014.

“If TRANSIT is used effectively, it could set up a standard of trans health service delivery throughout the Asia-Pacific region and around the world,” says Dr. Nittaya Phanuphak, the Director of SEARCH at the Thai Red Cross AIDS Research Centre and a TREAT Asia Network investigator, who took part in the July consultation. “It could sensitize various stakeholders to the needs of trans individuals regarding health service delivery, and I think it will also create inspiration and enthusiasm among people who read the document.”

TRANSIT includes sections written by transgender advocates describing case examples and scenarios they have encountered in their own communities, and compiles best practices used by policy makers and programs to deliver HIV services, support trans-led advocacy, and prevent and respond to discrimination and violence.  “TRANSIT will contain rich, lively, and practical information,” says Nada Chaiyajit, who attended the consultation and is writing a chapter about her experiences as a transgender advocate and program manager of TLBz Sexperts!, an online peer-counseling service for the Thai transgender community, and a former amfAR GMT Initiative grantee (GMT stands for gay men, other men who have sex with men, and transgender individuals).

She adds that many of the advocacy and service delivery strategies that she will write about have started to have an impact in Thailand, where multiple transgender groups have employed them. “Recently, the situation regarding HIV and sexual health for transgender individuals in Thailand has significantly improved,” she says. “The National Centre for HIV/AIDS has started setting up health services specifically for trans individuals, such as programs organized through the Thai Red Cross AIDS Research Centre.”

The Thai Red Cross’s Dr. Nittaya Phanuphak (center) with other consultation participants 
The Thai Red Cross’s Dr. Nittaya Phanuphak (center) with other consultation participants

Consultation participants also discussed strategies for ensuring that TRANSIT’s guidance is put into practice, such as training workshops for local program managers and government representatives. Another document called the Asia-Pacific Trans Health Blueprint (AP Blueprint)—currently being developed through a collaboration between the Asia Pacific Transgender Network, UNDP, and USAID—could serve as a complementary tool when implementing TRANSIT. The AP Blueprint will profile areas in the Asia-Pacific where  transgender health services are most needed, in effect providing a map of where to prioritize TRANSIT’s strategies and an understanding of the cultural context essential to ensuring the strategies take hold.  

“Finally, transgender people are starting to be considered a unique key population category,” says Kent Klindera, director of amfAR’s GMT Initiative. “And as seen with the TRANSIT document, many Asia-Pacific transgender activists themselves are leading efforts to make this much-needed change and confront the stigma and discrimination that inhibit access to health and other social services.”