UNAIDS
Addressing the HIV-related needs of transgender people
43%
TRANSGENDER POLICIES
Only 43% of countries report that their national AIDS strategies address transgender people.
The estimated 15 million transgender people around the globe (14) have a disproportionate risk of acquiring HIV infection, with HIV prevalence as high as 68% (14,15) and considerable vulnerability to gender-based violence. Transgender people confront high rates of stigma and discrimination by engaging in a gender expression that differs from their birth-assigned sex. Their vulnerability is further exacerbated by inadequate access to information, services and economic opportunities. As a result, transgender people often rely on sex work as their only source of income and survival, with involvement in sex work by up to 44% of transgender people (16,17). Although recognition is growing of the epidemic’s severity among transgender people and organization is increasing within transgender communities to advocate for their rights, transgender people remain severely underserved in the AIDS response. Prevention programmes rarely address the specific vulnerability of transgender people. As a result, transgender people remain largely invisible in the AIDS response: in 2012, only 43% of countries reported that their national AIDS strategies address transgender people. Forty per cent of countries report that government provides less than 25% of their transgender programmes and services (18,19).
Building on proven successes: the way forward Although the barriers posed by gender inequalities are severe and often daunting, these socially constructed impediments can be influenced by well-designed initiatives that aim to alter harmful gender norms. For example, in Malawi, where the HIV prevalence among women 15–24 years old is more than twice that of their male peers, the Coalition of Women Living with HIV/AIDS has used an evidence-informed approach to challenge prevailing gender norms through effective communication. Participants’ condom uptake had increased, gender-based violence declined and the number of men having multiple, concurrent partnerships had fallen. Broader community engagement also helped to alleviate HIV-related stigma and discrimination, as reflected in an increase in the number of people publicly disclosing their HIV status and a growth in support group participation (20). Building on such successes, countries should empower women and girls in all their diversity, including women living with HIV, as leaders to catalyse essential cultural shifts towards gender equality and access to quality services. Adequate funding to address the epidemic’s gender dimensions is an essential element of the response. Countries should engage men and boys to promote healthy gender norms and adapt
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