Transgender people

For the Transgender Day of Visibility, UNAIDS talked to transgender activists about the challenges they face and the importance of improving the visibility of transgender people.

Erika Castellanos is a transgender woman from Belize who recently moved to the Netherlands to work at GATE (Global Action for Trans Equality) as the Director of Programmes. She has been engaged in transgender and HIV advocacy at the local, regional and international levels.

What are the challenges that transgender people face?

Transgender people are subjected to stigma, discrimination, hate and violence—the number of transgender deaths because of hate crimes is alarming. In many parts of the world, being transgender is criminalized, which makes transgender people invisible in those places and forces them underground.

Many people do not understand what transgender people are, which translates into fear, the cause of stigma and discrimination. From their childhood, transgender people frequently experience rejection by their families, friends and society, finding themselves ostracized.

Why do you think it is important to give visibility to transgender people?

Visibility is power. Only when given visibility can we raise our voices and advocate for the enjoyment of our human rights. Visibility gives us presence, visibility gives us a voice. Ultimately, visibility gives us hope for a better life. Transgender people are an integral part of society who can no longer be ignored.

What do you think of the representation of transgender people by the media?

Almost all media coverage of transgender people is negative, demeaning or focused on the high murder rates and violence that our communities experience. While it is necessary to highlight the violence, negative and demeaning media coverage that dehumanizes transgender people only serves to perpetuate that violence. By portraying transgender people as objects of ridicule, media coverage places our community in further danger of social isolation, rejection from friends and family and violence.

Rena Janamnuaysook is a Thai transgender advocate at the Thai Red Cross AIDS Research Centre. She has extensive local, national and international experience working with HIV organizations.

What are the challenges that transgender people face in your country?

Thai transgender people face multiple challenges. Our country has no gender recognition law. Stigma and discrimination remains a barrier and leads to inequality. A survey conducted in 2015 by the Thai Transgender Alliance and Transgender Europe reported that 50% of transgender people who participated in the survey had a negative experience with health-care providers. In addition, transgender people experienced physical violence and harassment from families and in school and the workplace.

Why do you think it is important to give visibility to transgender people?

It is important to give visibility to transgender people as transgender people are less visible in all aspects of life—family, education, employment, health and the law. The International Day of Transgender Visibility raises public awareness of the needs of transgender people.

How easy is for transgender people in your country to get tested for HIV and get treatment?

A survey conducted by the Thai Ministry of Public Health in 2014 showed that 15% of health-care workers believed that HIV-positive transgender women should be ashamed of their gender identity and HIV status. This resulted in stigma and discrimination in public health facilities and prevented transgender people accessing health-care services, including HIV testing, treatment and support.

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Kirit Solanki is an Indian politician who represents the Ahmedabad West constituency of Gujarat.

Can you tell us about your work with transgender people in India?

I trained as a doctor and became a surgeon. A patient came in and said that she had difficulty going to the bathroom. I realized that she was a transgender person and her sex change operation had not been properly done, effectively blocking her urethra. After a successful insertion of a catheter, word got around that I had saved the woman’s life. I suddenly had queues of transgender women come to my clinic with similar conditions.

What did you observe regarding treatment and care for transgender people?

I saw that so many transgender people needed various operations, but I found out that many of them were avoiding clinics and hospitals. When I finally got them to the hospital, they settled in the female ward. Within a day, the other patients complained, so the hospital sent them to the men’s ward. They fared no better there. That’s when it really dawned on me how pervasive discrimination against transgender people is.

What are you and other members of parliament trying to do?

It took 10 years for the Indian parliament to pass the HIV/AIDS bill, which makes life-saving treatment a legal right and criminalizes anyone who discriminates against someone based on their HIV status. We also have reintroduced a transgender persons bill to ensure zero discrimination, legal recognition and access to social services for India’s transgender community. It’s time for people to change their attitude and respect transgender people

UNAIDS has relaunched its Key Populations Atlas. The online tool that provides a range of information about members of key populations worldwide—sex workers, gay men and other men who have sex with men, people who inject drugs, transgender people and prisoners—now includes new and updated information in a number of areas. And in addition to data on the five key populations, there are now data on people living with HIV.

Chief among the new data is information on punitive laws, such as denial of the registration of nongovernmental organizations, and on laws that recognize the rights of transgender people. The overhaul of the site was undertaken in consultation with representatives of civil society organizations, including the International Lesbian, Gay, Bisexual, Trans and Intersex Association, which supplied some of the new data on punitive laws.

Data on the number of users of Hornet—a gay social network—in various countries has been made available for the atlas by the developers of Hornet, while Harm Reduction International supplied information on the availability of harm reduction programmes in prisons.

“Having data on the people who are the most affected by HIV is vital to getting the right HIV services available at the right locations” said Michel Sidibé, the Executive Director of UNAIDS. “The Key Populations Atlas allows UNAIDS to share the information we have for the most impact.”

The Key Populations Atlas is a visualization tool that allows users to navigate country-specific subnational data on populations particularly vulnerable to HIV. Data are presented on, for example, HIV prevalence among people who inject drugs in 11 sites in Myanmar, key populations sizes, antiretroviral therapy coverage among gay men and other men who have sex with men in 13 sites in India and specific prevention services and preventive behaviours. Updated data on many indicators that were obtained through the Global AIDS Monitoring exercise undertaken in 2017 is now available on the website.

Over the coming weeks, information on people living with HIV will be expanded, with new indicators being added, and data from the 2018 Global AIDS Monitoring will be added when available later in the year.

Phylesha Brown-Acton, from the Asia–Pacific Transgender Network, is a champion for the rights of sexual minorities. A volunteer for the Pacific Sexual Diversity Network, she also established F’INE (Family, Identity, Navigate & Equality), which supports Pacific lesbian, gay, bisexual, transgender and intersex people and their families.

“Experiencing discrimination on a daily basis, seeing it happen to my peers and some of my family members because they were related to me, made me think hard about if I wanted to continue living in a society that defines and restricts me or if I was actually going to do something about it. I decided on the latter, and that is why I became a lesbian, gay, bisexual, transgender and intersex rights activist,” Ms Brown-Acton said.

In her work, she has seen the impact that discrimination in health-care settings can have. “I assisted four transgender women in understanding their health needs. All of them told me that they had not been to a doctor for several years, because every time they went to see a health-care provider the experiences were bad. So instead of going to see a doctor when not feeling well, they were medicating themselves at home with over-the-counter medicines. All of those women were later diagnosed with type 2 diabetes. Their diagnosis was delayed because of discrimination. The same happens to many people living with HIV.”

Despite the persistent stigma and discrimination that transgender people experience, Ms Brown-Acton believes that discrimination in health-care settings can be overcome. “We need to remove bias in thinking and decision-making,” she said. “We need to work with health institutions and practitioners so that they can hear and understand the discriminatory experiences of transgender people.”

Ms Brown-Acton emphasized the importance of including zero discrimination training in medical school curriculums, pointing out that the Asia–Pacific Transgender Network has developed a Blueprint for Action, a comprehensive, accessible transgender health reference document.

Ms Brown-Acton is adamant that people who experience discrimination—including transgender people, people living with HIV, people with disabilities and indigenous communities—must be at the table when decisions are being made. “Transgender people have been shut out many times before. We have been strategic about getting into the meeting rooms, but there is still a lot of work to be done. We must be heard in those meeting rooms, not silenced or ignored.”

Ms Brown-Actor will be speaking at the Human Rights Council Social Forum, which is being held from 2 to 4 October, about the promotion and protection of human rights in the context of HIV and other communicable diseases. To hear more from her and other human rights activists, register to participate in the Human Rights Council Social Forum at https://reg.unog.ch/event/6958/.

Mexico has taken steps to strengthen access to health-care services by lesbian, gay, bisexual, transgender and intersex (LGBTI) people. A new Ministry of Health code of conduct aims to put an end to stigma and discrimination based on gender identity and sexual orientation in all health centres in the country.

Establishing guidelines and specific actions for the provision of health-care services, the code of conduct will be implemented throughout the national health system to guarantee effective access to health by respecting the dignity and autonomy of LGBTI people.

The code of conduct provides for health personnel from public health facilities to be trained in avoiding discriminatory expressions and attitudes and to respect the confidentiality of patients. Among various provisions, it clearly stipulates that so-called treatment to “cure homosexuality or transexuality” must be avoided. It establishes that health centres should maintain a policy of zero tolerance for discrimination and must investigate accusations of discrimination. Health centres should also promote ongoing sexual and reproductive health and HIV prevention campaigns focused on LGBTI people.

The code of conduct was developed through a broad participatory process that included the Coordinating Committee of the National Institutes of Health and High Specialty Hospitals, the National Center for HIV Prevention and Control, Specialized Condesa Clinic of Mexico City, the National Council for Preventing Discrimination and representatives of civil society and LGBTI organizations.

The next steps include a training process on its practical application, with the involvement of civil society and community-based organizations. The implementation will have a pilot phase and will begin in the largest cities in the country.

UNAIDS Regional Goodwill Ambassador for Latin America and the Caribbean and CNN Anchor Alejandra Oraa visited El Salvador from 9 to 11 August to raise awareness about strengthening HIV prevention efforts for adolescents and young people.

In El Salvador, there is a growing concern about the increase in new HIV infections reported since 2011 among adolescents aged between 15 and 19 years. Young people are not receiving the information they need to protect themselves from HIV: only 36.5% of young people aged 15–24 years know how to prevent HIV transmission.

During her visit, Ms Oraa met with youth leaders in order to analyse gaps in access by adolescents and young people to sexual and reproductive health and HIV-related services and comprehensive sexuality education. Young people stressed the need to urgently accelerate efforts to provide youth with the tools they need to make informed decisions to protect their health, rights and dignity.

Young people also talked about the initiatives in place to contribute to the HIV response from their perspective. For example, to improve access to information and education on HIV and sexual and reproductive health, the National Network of Positive Youth, in coordination with UNAIDS, the United Nations Population Fund and the National Youth Institute, organizes outreach awareness initiatives in public places and schools. Between Friends (Entre Amigos), a community-based organization, uses face-to-face approaches and offers combination prevention options for key populations, including young men who have sex with men and young transgender people.

In El Salvador, Ms Oraa leveraged her social media power to launch a new online survey to assess young people’s knowledge about HIV prevention and transmission. The findings of that United Nations Children’s Fund and UNAIDS joint initiative will be used to inform national public policies and strategies to prevent and reduce new HIV infections among young people. 

There is a quiet hum in the room from the mostly young men sitting in chairs, eyeing their smartphones and chatting. Suddenly, a cheerful figure bursts into the executive lounge of the high-rise building in Taguig City, Philippines.

“Thank you, thank you,” said Ronivin (Vinn) Garcia Pagtakhan, the Executive Director and Founder of LoveYourself, a community-based organization providing health and empowerment services to men who have sex with men and transgender people. The team were wrapping up after a major event promoting HIV testing.

Mr Pagtakhan, with his shock of brown hair, frosted with a light green tint, bounced from one group to the next, joking and repeating his thanks.

Almost everyone here is a volunteer,” explained Mr Pagtakhan. “I get really moved when I talk about my volunteers. I owe everything to them.”

LoveYourself provides HIV testing and treatment services, as well as oral pre-exposure prophylaxis (PrEP) and tuberculosis screening. It has 25 staff members, who are supported by around 800 volunteers. Mr Pagtakhan founded LoveYourself in 2011, modelling it on a lesbian, gay, bisexual and transgender youth centre he volunteered in while living in San Francisco, United States of America.

“At the time, I felt there was a real problem with the way we were handling HIV prevention among the gay community in the Philippines,” said Mr Pagtakhan. “It was all about fear. I wanted something more optimistic and encouraging. I wanted a place that was lively, where people would want to hang out.”

He was only 25 years old at the time. “As they say, I know my market, because I am part of the community.”

He graduated from nursing school in the Philippines when he was 18 and got the fourth highest score on the national nursing board examinations. “This meant that I was in high demand by other candidates as a teacher helping to prepare people for their licensing exams. I travelled around the Philippines giving classes and I used social media to reach out to students as well,” said Mr Pagtakhan.

He became a celebrity on social media, with 600 000 followers on Twitter, and won the prestigious international Twitter Shorty Awards as the Nurse of the Year. The prize money helped start LoveYourself.

“The first three years, it was like sending your child off to college. I basically supported the organization on my earnings. We didn’t have any donors,” said Mr Pagtakhan. “I like to think out of the box and I had a particular vision. I didn’t want grants to dictate what we did or became. I wanted to create ripples of positive change in the community. LoveYourself isn’t just about HIV, but rather about increasing a person’s self-worth.

The organization has three community centres in the Manila, Philippines, area offering HIV testing and other services. Anyone can drop in, even on the weekends and in the evenings, for free health services.

LoveYourself tested about 20 000 people in 2016 and diagnosed around 1500 new HIV infcetions, which represent around 50% of the newly diagnosed HIV cases reported by the Department of Health in Manila. LoveYourself also works with companies and schools to help them develop HIV policies and to conduct on-site HIV tests.

In July, the organization began piloting PrEP and with support from UNAIDS and the World Health Organization plans to start a demonstration project offering self-testing before the end of the year.

In just six years, LoveYourself has grown to become an important HIV service provider in Manila. Mr Pagtakhan is proud of the organization’s achievements and has bigger ambitions. “We are still renting. I want LoveYourself to own a place, which is a community centre, where we can have health services but also original events and activities,” he said.

For more information on LoveYourself, go to http://www.loveyourself.ph.

Although new HIV infections and AIDS deaths among young people have decreased, in many places knowledge about how to prevent HIV remains worryingly low. Ahead of International Youth Day UNAIDS spoke to four young people about the challenges they face around HIV.

Pavel Gunaev is 16 years old and lives in St. Petersburg, where he is part of the youth-led network of adolescents and young people living with HIV Teenergizer! Pavel said that in his city young people are not aware about HIV.

“AIDS isn't talked about so young people don’t know about the risks or how to protect themselves from HIV,” he said. “As a result, so many uninformed young people are acting and making decisions based on rumors.” Pavel believes that if everyone does more to inform adolescents and young people and dispel the myths around HIV, ending AIDS will be possible.

Chinmay Modi was born with HIV twenty-three years ago. He is a member of the National Coalition of People Living with HIV in India and country focal point for the Youth LEAD Asia Pacific Network.

“The biggest problem is raising awareness and giving young people age-appropriate information,” he said. In his view, parents are not comfortable talking with their children about sex and society shies away from it too. As a result, he explained, young people are engaging in sex and experimenting new things but with little knowledge of the risks involved.

“Condoms need to be promoted and partners should support youth empowerment so that everyone is held accountable,” Chinmay said. He is also frustrated because in India people cannot access stigma-free HIV services at an early age.

In his view, self-stigma is hampering efforts to tackle discrimination, violence and inequalities related to HIV. That’s why, he explained, he wants more people to share their stories and be positive about being positive.

Moises Maciel couldn’t agree more with Chinmay. He is a 20-year-old LGBT and HIV activist. He became a  member of the National Network of Adolescents and Youth Living with HIV/AIDS in Brazil after discovering his positive HIV status two years ago. Since then, he has been on a journey against HIV-related stigma. He has also been motivating his peers to get tested.

“Young people are still at great risk of HIV infection due to a variety of factors such as social marginalization related to gender and racial inequalities,” he said. “In Brazil, young transgender and gay people are particularly targeted,” he explained.

He said that it baffles him to see how stigma and prejudice still dominate despite people living with HIV living healthy lives with the help of antiretroviral therapy. “We should start talking to young people in an open and responsible way about sexuality, sexually transmitted infections, teenage pregnancy and life responsibilities,” Moises said.

Lorraine Anyango, a Boston-based youth health and rights advocate, works to ensure that young people's voices, specifically around HIV, get heard.

“Young people continue to be left out of spaces and discussions on issues that impact their lives,” Lorraine said. “Their autonomy as individual human beings continues to go unacknowledged, leaving them susceptible to the risk of HIV infection.”

In her opinion, young people’s participation in decisions that affect their health can contribute to strengthen national-level accountability, by ensuring that programmes are effectively responding to their needs. Lorraine concluded by saying, “Recognizing youth sexual and reproductive health and rights, and continuing the conversation on HIV will get us closer to ending AIDS by 2030.”