Transgender people

On 17 July, more than 400 representatives of transgender women and their supporters took part in the first transgender preconference meeting to be held at an international AIDS conference. The event, entitled “No more lip service: trans access, equity and rights now!”, was held in Durban, South Africa, on the eve of the 21st International AIDS Conference. It was organized by the Global Network of Transgender Women and HIV.

The event provided a forum to explore how services can be designed and implemented to be acceptable and accessible to transgender women, as outlined in a recently published practical guidance document, and included special sessions on human rights and gender-based violence. There were also presentations on the latest research into transgender people’s health in the Lancet and the Journal of the International AIDS Society.

The programme also looked at how transgender people could be better engaged in the Global Fund to Fight AIDS, Tuberculosis and Malaria. UNAIDS Deputy Executive Director Luiz Loures and the United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy, Deborah Birx, spoke at the event and stressed the importance of involving transgender people in the AIDS response.

The Journal of the International AIDS Society has launched a special issue entitled HIV epidemics among transgender populations: the importance of a trans-inclusive response. The supplement comprises original research articles, case studies and calls to action, all of which highlight the urgent need for an effective, tailored HIV response for transgender communities.

Transgender women continue to be heavily affected by HIV, being 49 times more likely to be living with HIV than non-transgender adults. Many transgender people lack legal recognition of their affirmed gender and have no identity papers, resulting in their exclusion from education and employment. Transgender people face discrimination and violence, which further increases their vulnerability to HIV infection and hinders their access to care. The United Nations Political Declaration on Ending AIDS, adopted in New York, United States of America, in June, includes specific references to transgender people, but still only 40% of national HIV strategies include transgender people.

The supplement expands the evidence base on the HIV epidemic among transgender communities. It offers practical recommendations for reducing the burden of HIV among transgender people and promoting their broader health and human rights. Focus is also provided on specific subpopulations, such as transgender young people and transgender men who have sex with men.

The supplement was guest edited by researchers from the Johns Hopkins School of Public Health, the Center of Excellence for Transgender Health, Georgetown University and the FHI 360/LINKAGES Project, and was supported by UNAIDS, the World Health Organization, the United Nations Development Programme and the United Nations Population Fund.

The supplement can be viewed at http://jiasociety.org/index.php/jias/issue/view/1480.

Government officials from more than 40 countries and civil society activists representing lesbian, gay, bisexual, transgender and intersex (LGBTI) people have established an international coalition for equal rights to promote and protect rights for the LGBTI community.

The decision was made during the 4th Global LGBTI Human Rights Conference, which is taking place in Montevideo, Uruguay, under the theme of “Non-violence, non-discrimination and social inclusion.” Participants at the conference explored how to ensure that the rights of LGBTI people are included in the implementation of the Sustainable Development Goals, including forging stronger partnerships between governments, multilateral organizations and civil society.

Specific areas discussed included international and regional diplomacy, the shrinking space for civil society, the coordination of donor funding and the inclusion of LGBTI issues in the 2030 Agenda for Sustainable Development.

At the conference, UNAIDS Deputy Executive Director Luiz Loures urged world leaders to put the rights of LGBTI people not only at the centre of the AIDS response but at the forefront of the 2030 Agenda for Sustainable Development.

The new Equal Rights Coalition was inaugurated on 13 July by the ministers of foreign affairs of Uruguay and the Netherlands and promises to serve as a body to ensure coordination and continuity of efforts to advocate for equal rights for all.

The Tangerine Community Health Centre is Asia’s first clinic to provide a full range of health-care and counselling services specifically for transgender people. Transgender people need access to a range of health, social protection and other support services that are tailored to them.

“At the Thai Red Cross Tangerine Community Health Centre we are committed to providing the highest attainable standard of health in an affordable and accessible manner for all transgender people,” said Praphan Phanuphak, Director of the Thai Red Cross AIDS Research Centre, in which the clinic is located.

UNAIDS Deputy Executive Director Luiz Loures visited the clinic with Mr Praphan, its founder, on 21 June. The clinic provides hormone counselling and therapy, sexual and reproductive health services, psychosocial counselling and HIV testing. Trained transgender personnel and gender-sensitive medical professionals manage and provide the services. While the clinic offers a full range of services, it encourages all clients to have an HIV test.

“We like to encourage everyone to have an HIV test and learn more about HIV prevention and treatment as part of a holistic approach to health care for transgender people,” said Krittima Samitpol, Supervisor of the Tangerine Community Health Centre.  

According to Thailand’s Bureau of Epidemiology, epidemiological surveys of transgender women at five sites report high HIV prevalence, ranging from around 9% to 17% in 2014. Despite the risk of HIV infection, many transgender people do not get tested for the virus and studies find only about a third know their HIV status.

Most transgender people in Thailand self-administer hormones they commonly purchase on the Internet or in local pharmacies. Without professional medical care, incorrect use of hormones can lead to liver, kidney and cardiovascular problems. At the Tangerine Community Health Centre, medical professionals oversee testosterone injections for transgender men and transdermal hormone creams and oral hormone therapy for transgender women.

The Political Declaration on Ending AIDS adopted in early June by United Nations Member States noted with alarm the slow progress made in reducing new HIV infections among specific populations.

“To end AIDS, the health and rights of key populations need to be at the centre,” said Mr Loures. “The Tangerine Community Health Centre is transforming the health choices for transgender people.”

The clinic opened in November 2015 and in its first five months received visits from nearly 250 transgender people. Around 80% of the visitors were tested for HIV and the 10% who tested positive were linked to treatment at either the Thai Red Cross AIDS Research Centre or public hospitals.

During his visit to the clinic, Mr Loures spoke with representatives of three community groups: the Thai Transgender Alliance, Service Workers In Group and Rainbow Sky.

In collaboration with UNAIDS and other partners, the United Nations Development Programme (UNDP) and IRTG, a Global Network of Trans Women and HIV, have released a new publication today entitled Implementing comprehensive HIV and STI programmes with transgender people: practical guidance for collaborative interventions. The publication presents concrete steps that public health officials, health workers and nongovernmental organizations can adopt to implement HIV and sexually transmitted infection (STI) programmes with transgender people.

Topics covered in the publication include community empowerment and human rights, addressing violence, stigma and discrimination, and delivering transgender-competent services, especially for HIV and STI prevention, diagnosis, treatment and care. The publication also covers community-led outreach, safe spaces and the use of information and communications technology in service delivery. It describes how to manage programmes and build the capacity of organizations led by transgender people and shows how services can be designed and implemented to be acceptable and accessible to transgender women. Wherever possible, it gives particular attention to programmes run by transgender organizations.

The publication was developed in collaboration with transgender people and advocates, service providers, researchers, government officials and representatives of nongovernmental organizations from all over the world. UNDP and IRTG coordinated its production, with the support of the United Nations Population Fund, the University of California, San Francisco, Center of Excellence for Transgender Health, the Johns Hopkins Bloomberg School of Public Health, the World Health Organization, the United States Agency for International Development, the United States President’s Emergency Plan for AIDS Relief and UNAIDS.

The document is based on recommendations included in the Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations, published in 2014 by the World Health Organization.

Transgender women continue to be heavily affected by HIV, being 49 times more likely to become infected with HIV than non-transgender adults.

The Second African Conference on Key Populations in the HIV Epidemic, devoted to key insights, key advances and key partnerships, took place in Dar es Salaam, Tanzania, from 16 to 18 December. 

The conference brought together more than 200 researchers, policymakers, community actors, health service providers and government representatives from across Africa to discuss experiences, lessons learned and research findings regarding HIV and key populations. They include sex workers, transgender people, gay men and other men who have sex with men, people who inject drugs and others.

Key populations are vulnerable to HIV infection and have been left behind by the AIDS response. Punitive laws, stigma and discrimination are serious barriers throughout the continent for all key populations, with gender inequality contributing to the challenges faced by female sex workers. Migration of key populations within and between countries is another factor linked to their vulnerability to HIV.

Conference participants agreed that peer–led and community-based approaches work best and need scaling up. Effective interventions should be developed with close collaboration of key populations, as well. They also noted that data is important in policy dialogue and in facilitating community engagement.

The conference concluded with a call to action to ensure services for key populations are aligned to their needs and experiences and that key populations meaningfully participate in all areas that pertain to their health and well-being. Participants also called on governments to take down punitive legal barriers, to facilitate access to the justice system and to allocate more resources to serving key populations in the AIDS response.

Geneva, 11 December 2015—UNAIDS and the International Planned Parenthood Federation (IPPF) have signed a memorandum of understanding to Fast-Track access to HIV services by 2020. Under the partnership, UNAIDS and IPPF will support the delivery of high-impact HIV advocacy, prevention and treatment services, particularly in sub-Saharan Africa.

The partnership will boost collaboration in four specific areas: integrating HIV and sexual and reproductive health services and ensuring that people can realize their sexual and reproductive rights; stopping new HIV infections among children and keeping mothers alive; expanding HIV services for young people; and ensuring key populations—gay men and other men who have sex with men, transgender people, sex workers and people who inject drugs—are reached with life-saving HIV prevention, treatment, care and support. In each of these areas UNAIDS and IPPF will work jointly to ensure that there is prompt and concrete joint action on the ground.

“This partnership is about turning targets to results so that no one is left behind,” said Michel Sidibé, Executive Director of UNAIDS. “Many young people, women and key populations are still out of reach and in need of access to sexual and reproductive health and HIV services.”

UNAIDS and IPPF will aim to ensure that young people have the knowledge, agency and means to protect themselves from HIV and that all women have access to sexual and reproductive health and rights, including HIV, services. Ensuring that all people live in equality and dignity, free from discrimination and violence, will also be a goal. Progress on the objectives of the partnership will be reviewed annually.

“We are delighted that we are entering this partnership with UNAIDS,” said IPPF’s Director-General, Tewodros Melesse. “It isn’t about making a difference in London or Geneva. It’s about making a real difference on the ground, so we are able to work together to provide more integrated HIV prevention, testing and treatment services, especially for the most marginalized and underserved in society.”

The partnership will advance the UNAIDS Fast-Track Strategy to end the AIDS epidemic as a public health threat by 2030. To do this will require front-loading investments over the next five years, reaching the UNAIDS 90–90–90 treatment target, expanding access to HIV prevention and ensuring zero discrimination.

The memorandum of understanding was signed at UNAIDS headquarters in Geneva during an event on the rights, roles and responsibilities of men in Fast-Tracking the end of AIDS, organized by UNAIDS, IPPF and Sonke Gender Justice. 

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP,  UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely  with global and national partners to end the AIDS epidemic by 2030 as part of the Sustainable  Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter and Instagram.

IPPF

International Planned Parenthood Federation (IPPF) is the world’s largest sexual and reproductive health and rights provider. Since 1958, IPPF has served the poorest and most vulnerable, delivering health services that empower women and girls, including 149.3 million services to 61.8 million people in 2014.