Transgender people

Celebrated Indian dancer, actress and prominent transgender activist Laxmi Narayan Tripathi has been working for transgender rights for more than two decades. Nevertheless, the recent decision by the Indian Supreme Court to grant hijras and other transgender people the right to formal recognition as a third gender took her by surprise. “We’ve been fighting for it,” she said “but I personally never thought this judgement would ever be made in my lifetime.”

Underlining how the transgender community had long endured discrimination and ignorance in India, Ms Tripathi welcomed the ruling. “It’s wonderful. These days I feel very proud to be an Indian,” she said.

Prior to the ruling, members of the transgender community in India were forced to classify themselves as either male or female on identification documents. However, the landmark ruling of 15 April 2014 not only introduces the third gender recognition, but also stipulates that transgender people have access to the same rights to social welfare schemes as other minority groups in the country. 

While handing down the landmark ruling, Justice K.S. Radhakrishnan, who headed the two-judge Supreme Court bench said, “Recognition of transgenders as a third gender is not a social or medical issue but a human rights issue.”

The decision will apply to all individuals whose present physical characteristics do not correspond with their sex at birth. With a population of over 1.2 billion and an estimated 0.5–1 million transgender people, India has joined the list of other countries in the region, to formally recognize the rights of the third gender. In addition, the Indian Election Commission introduced an “other” category on voter registration forms for this year’s election, so transgender people could register.

The HIV Sentinel Surveillance (HSS) for 2010–2011 found that transgender people had the highest HIV prevalence among all surveyed populations in the country, with 8.8% estimated HIV prevalence nationally, compared with 0.3% among the general population. However, in India, as in Asia and the Pacific as a whole, focused programmes and initiatives for transgender people are largely lacking in national responses to HIV.

Despite the progress on gender identity recognition for transgender people, significant challenges lie ahead. Activists warn that there is still a long way to go to ensure hijras and transgender community members are able to gain equal access to education, housing, employment and health services, including HIV services.

The ruling is clouded by the Supreme Court decision at the end of 2013 to reinstate Section 377 of the Indian Penal Code, which recriminalizes adult consensual same-sex sexual conduct. In 2009, the Delhi High Court had found unconstitutional the application of the 150-year-old law criminalizing “carnal intercourse against the order of nature” between consenting adults. Now, again in India, gay and other men who have sex with men, lesbian, bisexual and transgender people face the possibility of criminal prosecution. Activists and communities of key populations at higher risk have reported an increase in cases of blackmail and criminal activities against gay men after Section 377 was reinstated into law. Fear of discrimination, identification and legal repercussions dissuade people from accessing health and HIV services, hampering HIV prevention and treatment efforts.

“The transgender identity ruling is certainly to be welcomed and represents a significant step forward for India. But we want governments and civil society to support all people to be able to exercise their rights and access HIV information and services, including gay and other men who have sex with men, and lesbian, bisexual and transgender people, and for them to be able to do this without fear of criminalization,” said UNAIDS India Country Director Oussama Tawil, echoing the messages from a statement made by UNAIDS in late 2013 calling for India and all countries to repeal laws that criminalize adult consensual same-sex sexual conduct.

For Laxmi Narayan Tripathi, her commitment to the movement for equal rights and access to services for transgender people in India and across the world continues. “It will take a lot of effort on our part. We are championing having education on transgender issues as part of the education system so that young minds are made aware of transgender issues from an early age. The governments of respective countries should acknowledge transgender people and implement legislation to facilitate acceptance of transgender people—just as we are.”

Existing discriminatory laws, policies and practices as well as negative attitudes among health practitioners are some of the main obstacles impeding access to health services for many people.

This is one of the main conclusions coming out of a debate convened by UNAIDS on 11 March to explore how discriminatory barriers to health services affect different population groups including people living with HIV, undocumented migrants, transgender persons, and persons with disabilities.

For migrant people discrimination often starts at the point of departure, where pre-departure regulations can include mandatory testing for HIV, pregnancy and other health issues. To avoid these tests, migrants may opt for irregular channels of migration, thus becoming undocumented and unable to access health services.

For transgender persons, discrimination is embedded in the International Classification of Diseases, which considers transgender as a mental illness. In many countries, including more than 20 in Europe, transgender people are forced to go through sterilization before gender reassignment surgery in order to change their gender identity.

Speaking about the possible lack of understanding about transgender issues among the medical profession, Mauro Cabral from the Global Action for Trans Equality (GATE) stressed that, “ignorance cannot be an excuse anymore. Doctors must respect, and not judge, patients.”

Another common barrier identified was the perception among the general population in many countries that resources invested in health services are ‘wasted’ on such groups which many in society consider ‘less deserving’.

Monitoring and documenting discrimination was stressed as a strategy to generate evidence to address the problem. In this regard, the Stigma Index and Human Rights Count were highlighted as tools which have been successfully used to monitor discrimination against people living with HIV. For example, the Human Rights Count tool, revealed the practice of involuntary sterilizations of women living with HIV.

“When communities are given the space and opportunity to engage in human rights monitoring, the real obstacles of why people are not accessing health services can be identified and addressed,” said Chris Mallouris, community mobilization adviser at UNAIDS. “We must ensure that communities are at the centre of efforts to address discrimination. They must be there as equal partners,” he added.

The panel debate concluded with a sobering recognition of the long journey ahead to achieve zero discrimination. Participants recognized that action needs to be scaled up to overcome barriers to health services and that no one should be left behind if global health targets are to be achieved.

It only takes a minute with the new Coordinator for the Asia Pacific Transgender Network (APTN), Natt Kraipet to see her determination and drive for bringing issues of transgender rights and health to the forefront in the region.

“This is an important time for transgender people to be in the spotlight. We are too often invisible within societies and especially within health settings and yet we face significant rights and health challenges—including high risk of HIV infection,” said Ms Kraipet.

From 18-20 February, APTN brought together community delegates and experts from eleven countries for a regional community consultation on transgender issues to Bangkok, Thailand in partnership with the Being LGBT in Asia regional initiative and the Asia and the Pacific regional offices of UNDP, UNAIDS, UN Women, WHO and USAID.

Featuring participation from China, Hong Kong, India, Indonesia, Japan, Nepal, New Zealand, Philippines, Singapore, Thailand and Tonga, the consultation aimed to develop a set of steps and actions that APTN could take with partners, to address and prioritize specific human rights and health needs of transgender women and men.

“Much more evidence and knowledge is needed to be able to ensure services and programmes are reaching transgender people most effectively. That’s why we need to be included in public fora where we can highlight challenges and solutions,” Kraipet said.

Research and data on HIV risk and prevalence among transgender people is limited regionally, but some studies have found that transgender women are 50 times more likely to acquire HIV than adult males and females of reproductive age in the general population[1]. Examples of available national surveillance data in some countries in Asia and the Pacific indicate high HIV prevalence among transgender women in cities, for example: 30% in Jakarta, Indonesia, 23% in Port Moresby, Papua New Guinea, 18% in Maharashtra, India and over 10% in Bangkok, Chiang Mai and Phuket in Thailand.

However, focused programmes and initiatives for transgender people are largely lacking in national responses to HIV. And where they do exist, HIV prevention efforts are estimated to reach less than half of the transgender people who need the services.

Critical obstacles to progress

A central focus of the community consultation examined how health and social systems are often not adapted to the realities and needs of the community, particularly in resource-poor settings. Many transgender women and men report lack of technical knowledge among health personnel to advise or deal with transgender issues such as information on hormones, transition operations, psycho-social support, side-effects and if and how antiretroviral treatment can be combined with treatment linked to transgender transition.

“Absence of experts in health services in low-resource areas can lead transgender people ‘underground’ to undertake transition operations and hormone treatment within non-regulated settings—which in turn can lead to greater health complications and increase vulnerability to HIV,” said Steve Kraus, Director of UNAIDS Asia and the Pacific.

Issues such as lack of transgender-specific data, and punitive legal and policy environments were also highlighted as critical obstacles keeping transgender people from accessing health and HIV services.

Signs of success

A number of legal developments and programmes in Asia and the Pacific are showing encouraging signs of progress. In Bangladesh, Nepal and Pakistan several rulings have been made and/or legislation introduced which recognize transgender status for identification and paves the way for transgender people to access social and health rights. In Thailand, transgender identity is increasingly taken into consideration within work and education settings.

The strengthening of APTN and fellow organizations in the region also provides important opportunities. APTN’s efforts have been buoyed with new funding received from the Robert Carr Fund which was secured with support from UNAIDS Asia and the Pacific.

“We want APTN to be a real platform for transgender people; to be a concrete organization that promotes diversity and helps first at the community level,” Ms Kraipet explains. “I am determined that we will see important progress for transgender people and on HIV issues in our region over the next years,” she said.

Brazil is among the leaders in ensuring HIV services reach all people. Created in June of 2009 the Ambulatory Service of Integral Health for Transvestites and Transsexuals is a unique centre in the country.

The centre offers comprehensive care including cardiology, endocrinology, urology and gynaecology, as well as HIV testing and treatment. The facility also provides mental health support, legal counselling and orientation services for income generation.

UNAIDS Deputy Executive Director, Jan Beagle visited the clinic and also spent time with civil society at the Forum of NGOs of São Paulo.

The Forum provides a space for NGOs working on AIDS related issues to share experiences and define common strategies to keep AIDS in the political agenda at national, state and municipal levels.

Message from UNAIDS Executive Director Michel Sidibé

GENEVA, 17 May 2013—More than 30 years ago, gay men lit the first spark that kindled the world’s response to the AIDS epidemic. Thanks to the audacity and courage of lesbians, gays, bisexuals, and transgender people, we have now seen extraordinary progress against AIDS around the world.

However, stigma and discrimination based on sexual orientation or gender identity still drive new HIV infections and are an obstacle to treatment efforts in every part of the world.

We call on political and community leaders to cast aside discriminatory laws and social practices.

The right to health belongs to everyone. Everyone should have access to HIV prevention, care, treatment and support.

Today and every day, UNAIDS stands with our fellow LGBT brothers and sisters for a world without homophobia and transphobia.

Let us work together to realize our vision: a world with zero new HIV infections, zero discrimination, and zero AIDS-related deaths.

Honduras has adopted a reform of the Penal Code that will ensure legal protection against discrimination based on sexual orientation and gender identity.

Honduras is moving a step closer to the UNAIDS vision of ‘zero discrimination’. Its Congress has recently adopted a reform of the Penal Code that will ensure legal protection against discrimination based on sexual orientation and gender identity.

"This has been a historic step for Lesbian, Gay, Bisexual, Transexual and Intersex (LGBTI) populations that have suffered from widespread violence and impunity in Honduras,” said Donny Reyes, Coordinator at Arcoiris, a civil society organization advocating for greater LGBTI rights. “Finally our right to freedom and to live in peace has been formally recognized,” he added.

Between 2009 and 2012, more than 90 homophobia-related killings were reported in the country, according to the Human Rights Observatory of Lesbian Cattrachas Network. These incidents, which are among the highest in the region, are attributed to the high levels of homophobia and transphobia that exists in Honduran society.

The high number of violent deaths and human rights violations against LGTBI people prompted Ana Pineda, the Minister of Justice and Human Rights to promote the reform of the Penal Code.

The amended code establishes as an offence with aggravating circumstances the “discrimination with hatred or contempt on the basis of sex, gender, religion, national origin, belonging to indigenous and Afrodescendant groups, sexual orientation or gender identity”.  This offence may be punishable by up to 3–5 years imprisonment and a monetary fine. The penalty increases if it is a violent crime.

Dialogue between the government, civil society and UNAIDS led to the creation of special units within the General Attorney’s Office to strengthen the investigation of allegations of violence on the basis of sexual diversity. Each unit comprises a qualified legal advisor, an analyst and three investigators. The Units are currently investigating 17 cases of killings on the basis of sexual orientation and/or gender identity.

“Strengthening investigation, establishing a legal framework which sanctions discrimination and making sure that judges will apply the new provisions are both crucial steps to prevent and reduce violence against members of the LGTBI community,” said Ms Pineda.

Reducing vulnerability to HIV

The amended Penal Code is expected to improve access to HIV-related services, education and employment for LGTBI people. The discrimination, exclusion and violence against LGTBI people have exacerbated their vulnerability to HIV infection by discouraging them from accessing health services out of fear.

In Honduras the HIV epidemic seriously affects men who have sex with men (MSM), where the prevalence of HIV has reached 9.9% compared to the 0.6% among the general population.

A recent report in The Lancet highlights that transgender people have at least 50 times the odds of men and women in the general population of becoming infected with HIV—due to biological as well as structural risks for HIV infection such as social exclusion, economic marginalization, and unmet health-care needs.

"This ruling will provide LGTBI people with greater access to HIV related services" said Nicole Massoud, UNAIDS Country Coordinator for Honduras and Nicaragua. “UNAIDS congratulates the State of Honduras for its commitment to promote and defend human rights. The challenge now is to ensure that all professionals are informed and trained on these new provisions to help ensure we reach zero stigma and discrimination.”

Minister of Health and Social Affairs of France, Marisol Touraine presents the Red Ribbon Award during the International AIDS conference in Washington, on July 25, 2012.
Credit: UNAIDS/ Yuri Gripas

When Thet Mon Phyo underwent a gender change operation in 2005, her parents told her not to bother returning home.

“They were ashamed and I had to go and live with my aunt,” 34-year-old Phyo recalled. “When I was young my father often scolded me for my feminine behaviour. Later, my lover left me because his parents persuaded him that same-sex love was unnatural,” she said.

In Myanmar, many transgender people and men who have sex with men (MSM) face widespread stigma and discrimination, complicating efforts to halt the spread of HIV.

According to UNAIDS, the HIV prevalence among MSM and transgender people in some places is much higher than that of the general population (9.4% versus 0.53%). Male-to-male sex is illegal in Myanmar and there are no laws to protect MSM and transgender people from discrimination.

“They are objects of ridicule for some people, even hated,” Phyo said.

“There is discrimination in the workplace and even within families….some MSM are disowned, disinherited and expelled from their homes,” she added.

Phyo is Programme Manager at The Help, Myanmar, a group which focuses on HIV prevention, care, support and advocacy for MSM and transgender people and works to ensure their voices are heard and their issues taken up at the national level. All members of The Help are MSM or transgender and almost half are living with HIV.

The Help Myanmar was awarded a prestigious Red Ribbon Award at the XIX International AIDs conference held in August for its work on the prevention of sexual transmission of HIV and other STDs. The Red Ribbon Award is the world’s leading award for innovative and outstanding community work in the response to the AIDS epidemic.

The Help, Myanmar is working to change attitudes, reduce discrimination and improve access to HIV services. It is a challenging task.

Phyo said MSM and HIV positive people are denied equal employment opportunities and access to proper medical treatment, which in turn discourages them from safe behaviour.

Police often act as barriers in seeking legal protection. Threats and extortion attempts by some police highlight the need for immediate measure to increase public awareness of people’s rights and for the government to enact rights that protect people from discrimination.

Phyo said the authorities have not interfered with The Help’s work to increase MSM and TGs capabilities and set up self-help groups to support them. In fact, The Help sees this as a sign of tacit cooperation. But there is a long way to go.

“We are greatly encouraged for being recognized for helping MSMs and others in the community. The Red Ribbon Award has strengthened our determination to continue our struggle for truth, rights and benefits,” said Phyo.

The Help Myanmar’s efforts may also receive a boost following the recent appointment of Daw Aung San Suu Kyi as UNAIDS Global Advocate for Zero Discrimination.

“She has many things to do, but we believe in her and we think she can make a difference,” said Phyo.

Nearly eighty countries have laws that criminalize same-sex sexual relations. UNAIDS Infographic: I am Gay--5 things I fear.

In many regions of the world, punitive laws and practices against lesbian, gay, bisexual and transgender and intersex (LGBTI)[1] individuals continue to block effective responses to HIV. A range of human rights violations have been documented, from denial of health services and freedom of association to harassment, violence and murder.

Last week, a youth organization in Cameroon is reported to have held an anti-LGBT rally; the news followed a series of arrests and detentions in recent years of Cameroonian men who have sex with men based on their sexual orientation.

In Zimbabwe, where sex between men is illegal, police officers arrested and later released 44 members of the organization Gays and Lesbians Zimbabwe (GALZ) on 11 August 2012 following the launch of a GALZ report documenting human rights violations of LGBT individuals.

In Europe, a report on the human rights situation of LGBTI people—published in May 2012 by the European Region of the International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA-Europe)—documented many cases of violence, hatred and discrimination against LGBTI people.

Studies in the United States, Canada, Europe and Australia have documented high levels of homophobic bullying in schools and lack of support from school authorities. A recent study conducted in the United States, for example, found that more than 84% of young LGBT learners had been called names or threatened, 40% had been pushed or shoved, and 18% had been physically assaulted at school.

Several cities in the Russian Federation recently passed laws prohibiting public information on sexual orientation and gender identity. Similar legislation is pending before the Ukrainian parliament. UNAIDS believes such laws discriminate against LGBT people by curtailing their freedoms of assembly and speech, threaten HIV outreach organizations supporting them, and may be used to justify homophobic bullying and violence.

A ‘climate of hate and fear’

Evidence and experience have shown that punitive laws and practices drive sexual minorities away from HIV services. A study conducted in Senegal, for example, found that prosecutions and harassment of LGBT individuals in 2008 led to “pervasive fear and hiding” among members of these groups. According to the study, some health providers suspended their HIV prevention work with men who have sex with men out of fear for their own safety; those who continued to provide health services noted a sharp decline in participation by men who have sex with men.

"Human rights violations based on people's real or perceived sexual orientation, gender identity or expression sanction the climate of hate and fear that keeps LGBTI people further in the closets,” said human rights advocate Joel Nana, Executive Director of the non-profit organization African Men for Sexual Health and Rights (AMSHeR). “Such violations discourage health-seeking behaviour, deny access to key health services and sustain the increasing incidence of HIV infection among men who have sex with men and transgender people," he added.

High HIV prevalence among men who have sex with men, transgender people

In many regions of the world, men who have sex with men and transgender people experience high HIV prevalence and low coverage of HIV prevention, treatment, care and support services.

Recent studies from sub-Saharan Africa show that HIV prevalence among men who have sex with men ranges from 6% to 31%. In Asia, the odds of men who have sex with men becoming infected with HIV are nearly 19 times higher than in the general population. In Latin America, an estimated half of all HIV infections in the region have resulted from unprotected sex between men.

Studies among transgender people have shown disproportionately high HIV prevalence ranging from 8% to 68%. Without access to HIV information and services free of fear, criminal sanction and homophobia, these trends cannot be addressed.

“World leaders are increasingly speaking out against discrimination and criminalization on the basis of sexual orientation and gender identity,” said Susan Timberlake, Chief of the Human Rights and Law Division at the UNAIDS Secretariat. “In launching its report in July, for example, the Global Commission on HIV and the Law issued a strong call for decriminalization of LGBT people and their protection in the context of the AIDS response.”

Some positive developments

Despite setbacks, there are some encouraging developments in favour of equality, non-discrimination and access to health services for sexual minorities.

On 12 July 2012, the President of Chile signed into law an anti-discrimination law that punishes hate crimes, including against LGBT people. Introduced some seven years ago, the adoption of the anti-discrimination law gained momentum following the brutal murder of Daniel Zamudio, a 24-year-old homosexual man.

On the International Day Against Homophobia and Transphobia, 17 May 2012, the European Region of Education International, the European Trade Union Committee for Education (ETUCE), the European Trade Union Confederation (ETUC) and ILGA-Europe committed to strengthen their collaboration to prevent and combat homophobia and transphobia at national and European levels in school, the workplace and society.

In February 2010, the Government of Fiji became the first Pacific Island nation to formally decriminalize sex between men. Fiji’s new Crimes Decree removes previous references to “sodomy” and “unnatural acts” and uses gender neutral language when referring to sexual offences.

In 2009, the High Court of Delhi held that criminalization of same-sex relations is unconstitutional and that it “pushes gays and men who have sex with men underground,” leaving them vulnerable to police harassment and impeding access to HIV services.

UN advocacy and action

In March 2012, the UN High Commissioner for Human Rights presented a report at the 19th session of the UN Human Rights Council documenting discriminatory laws and practices and acts of violence against LGBT individuals based on their sexual orientation and gender identity. The report called on all countries to decriminalize consensual same-sex relations and to ensure that individuals can exercise their rights to freedom of expression, association and peaceful assembly in safety and without discrimination.

At last year’s UN General Assembly High Level Meeting on AIDS, UN Member States committed to reviewing laws and policies that adversely affect the “successful, effective and equitable delivery of HIV services.” UNAIDS encourages all countries to translate this commitment into action to protect the human rights and health needs of LGBT people.

[1] The acronym “LGBTI” is used as an umbrella short-hand for groups and/or individuals whose sexual orientation or gender identity differ from heterosexuality and who may be subject to discrimination, violence and other human rights violations on that basis. Information and data presented in this article may not apply equally to all the groups represented by this acronym. [Back to top]

Team captains participating in the Mexican World Cup signing the pledge to support the UNAIDS campaign “Give AIDS the Red Card”. Credit: UNAIDS

The game of football has once again scored a goal against HIV at the 2012 International Gay and Lesbian Football Association (IGLFA) World Championship Cup, held in Mexico from 1st to 9th June 2012.

At the tournament, footballers from 8 teams representing the Americas, Europe and Oceania joined the UNAIDS’ campaign “Give AIDS the Red Card” to promote HIV prevention and take a stand against stigma and discrimination.

“We are proud to stand together with UNAIDS and its partners to give AIDS the red card,” said Andoni Bello Lanestosa, captain of the Mexican team. “We can make change happen. We can help reduce HIV transmission by 50% and end violence and discrimination,” he added.

The Latin America region shows an unfortunate record in terms of human rights violations against lesbian, gay, transgender and bisexual (LGTB) people due to their sexual orientation or gender identity. LGTB people face a serious problem of stigma and discrimination that limit their access to health services, education and judicial systems and job opportunities and increases their vulnerability to HIV.

“Experience shows that when people are stigmatized for their sexual orientation or gender identity, they are less likely to access health services and information on HIV prevention,” stressed César A. Núñez, UNAIDS Regional Director for Latin America. “Studies in Latin America show HIV prevalence rates around 10% among men who have sex with men. Among transgender population, HIV prevalence is even higher, between 20 and 28%,” he added.

Two years ago at the FIFA 2010 World Cup held in South Africa, UNAIDS launched the “Give AIDS the Red Card” campaign using the power and outreach of football to unite the world around stopping new HIV infections in children. In this occasion, the campaign, which is based on “Give AIDS the Red Card”, uses the tournament to raise awareness on the HIV prevention needs of the LGTB community.

All team captains participating in the Mexican World Cup signed the pledge to support the UNAIDS campaign. By signing the pledge, the delegations agree to spread the message of the campaign upon return to their respective countries. Along with the team captains, representatives of the International Association of Gay Referees and IGLFA Latin America also endorsed the initiative and signed the pledge.

Football players from the Argentinean and Mexican teams collaborated with the campaign from the beginning. They appeared on posters and advertisement billboards used before and during the ILGFA World Cup. “Sports stars can play an important role in the AIDS response by talking openly about HIV,” said Rubén Mayorga, UNAIDS Country Coordinator for Argentina, Uruguay, Paraguay and Chile. “Football players who join the campaign can inspire people to learn the facts about AIDS, to protect themselves and to fight stigma and discrimination against people living with HIV and LGBT persons.”

The International Gay and Lesbian Football Association (IGLFA) was founded in 1992 and after 20 years, over 80 teams from more than 20 countries from all over the world have become part of this organization.

In India, the HIV epidemic is seriously affecting men who have sex with men (MSM) and transgendered people.
Credit: UNAIDS

Rupali always felt she was different. Born as a boy in India, she liked wearing girls’ clothes and finally at the age of 20, decided to disclose to her family her gender orientation. She declared she wanted to live as a woman.

“When I first decided to tell people about my sexual orientation and gender identity, I was scared,” said the 22-year-old. “But eventually I told everyone—my family, relatives, neighbours and friends.”

Rupali did several jobs, but found it too difficult to live openly as a man who has sex with men and work in a mainstream office. So, for the past two years she has been a sex worker in New Delhi. With the money she earns from her clients she supports her mother and younger brother. Her mother has had a heart problem for several years and Rupali needs to pay for her costly medicines every month.

But her job threatens her health as Rupali has a high risk of HIV infection.

In India, the HIV epidemic is seriously affecting men who have sex with men (MSM) and transgendered people. Among this population, 427 000 (in 2010) are considered at higher risk because they have multiple sex partners and many receive money in exchange for sex.

“When a customer is drunk, it is often difficult to convince him to use condoms,” said Rupali.

While sex work pays her bills, Rupali has been attacked several times. Like many transgendered people, Rupali finds it challenging to be fully accepted by her family and community. “The local thugs keep us in a constant state of terror. We fear them striking our faces with blades or brutally beating us up. But we fear the police even more,” said Rupali.

In India, the prevalence of HIV among MSM reached 7.3%, which is 20 times higher than among the general population. Recent data shows that HIV prevalence among transgender people in major cities like Mumbai and Delhi has soared even higher to nearly 25%. HIV programmes for MSM and transgendered people are gradually being scaled up.

The Pahal Foundation in Faridabad gets funding from the Haryana state government to provide HIV testing, treatment for sexually transmitted diseases, counselling and condoms to 750 MSM and transgender people, but hundreds more use their facilities every month.

“Everyone needs a support system. Without the support of their families and society, men who have sex with men and transgendered people often take their own lives or run away from home,” said Maksoom Ali, Project Manager at Pahal.

The Foundation has found that only a handful of the people they support are open about their HIV status with their families.

“Employment is a real problem for MSMs and transgender people,” said Manoj Kumar Verma, Outreach Worker at Pahal. “Many of us MSM try our best to appear straight, but eventually we get ‘outed’. I know several people who lost their jobs because they were severely discriminated against by their co-workers.”

There has been some progress in India for men who have sex with men and transgendered people. In the next phase of India’s National AIDS Control Programme (NACP4), there are plans to develop and implement programmes focused on the specific needs of transgender people. Three years ago, the Delhi High court decriminalized sex between adult men in a historic judgement.

Rupali is involved with an organization for MSM in West Delhi and she said she wants to contribute to her community. “Everyone has dreams but not all of them come true,” said Rupali. “That’s true for me too but I want to do something for my community and I want to be a better person.”