Transgender Women and Men
Transgender women and men are at significant risk for HIV. Many transgender women and men engage in paid sex, have low condom use rates, experience high rates of violence and suffer discrimination when accessing health services (Mahendra et al., 2008; Cascante, 2008; Riono and Praptoraharjo, 2008; Sanchez et al., 2008; Ospina and Letouze, 2008). No evaluated interventions were found that provided services for transgendered women and transgender men. Very little information has been published on HIV and transgender women and men in developing countries, with only recent 2008 International AIDS Conference abstracts and websites providing information on this topic. No data was found concerning what percent of transgendered women and men work as sex workers. [See also 4A. Female Sex Workers] Most of the literature does not specify whether those included in the study are transgendered men or transgender women, despite the differing needs of each group. Transgender men, who are biologically women, need sexual and reproductive health services such as screening for cervical cancer. Yet accessing needed health and HIV services, which usually operate on strict male/female gender identities, may be extremely difficult.
Transgender women and men in many societies face marginalization. A survey of 50 transgendered people (gender identity not specified) from Chennai, India found that more than half are discriminated against by their own families, 70% were denied jobs, and 64% faced violence (Prabakaran, 2008). Participatory action research with sex workers and outreach workers from 13 sex worker projects in Central and Eastern Europe and Central Asia found that of 238 male, female and transgender sex workers from 12 countries, more than 45% reported physical abuse by police and more than 41% reported sexual abuse (Crago et al., 2008). Fifty-five independent studies from 19 countries (countries not specified) of 2,233 transgendered women sex workers found a 33% HIV prevalence rate (Friedman et al., 2008). Some organizations, such as Genderdynamix (www.genderdynamix.org.za) and the Triangle Project (www.triangle.org.za) in South Africa, advocate and provide services for transgendered people.
While not enough studies were found to include as “what works,” some studies were found showing programs with positive impacts for transgender women and men. Non-formal education and livelihood programs for transgender people may improve safer sex practices. SAATHI, a capacity-building NGO in India, provided non-formal education and livelihood programs together with existing HIV prevention interventions to members of Santi Seva, a community based organization of transgender people. While at the start of the project, 80% had unprotected sex, safer sex practices improved so that fewer than 35% had unprotected sex (Sakar et al., 2008). Another intervention with a positive impact was training police about the rights of transgendered women, resulting in decreased violence. In Mexico, training for 905 police by transgendered women on how violence affected transgender women and their rights led to agreements with police authorities to promote the human rights of transgendered women and with the Human Rights Commission to follow-up on complaints of violence (Blass et al., 2008).
Transgender women and men are often overlooked in HIV prevention planning and treatment programs and little evidence is therefore available on what works for transgender women and men, though there are some promising strategies.