WHO G UIDANCE FOR TRANSGENDER PEOPLE Melbourne, July 2014 Kate Montecarlo A ssociation of Transgender People in the Philippines

O UTLINE 1. Background 2. Transgender People and HIV 3. Transgender community and WHO 4. Work to be done

C OMMON DEFINITIONS A person who’s gender or gender identity does not conform to the norms and expectations traditionally associated with the sex assigned to them at birth. People may self-identify as transgender, female, male, transwoman or transman, trans-sexual, or, in specific cultures, for example: hijra, kathoey, or waria. Express their genders in a variety of masculine, feminine and/or androgynous ways.

V ULNERABILITY TO HIV HIV prevalence among transgender women in many countries is as high as or higher than among MSM. Sexual risk differs among different subgroups e.g. higher among transgender people who have receptive anal intercourse 19.1% pooled HIV prevalence 14 countries: US, Asia–Pacific (6), Latin America (5), and Europe (3): Baral S et al. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet, 2013, 13:214–220.

A DVICE FROM WHO C IVIL S OCIETY R EFERENCE G ROUP HIV among transgender people is a gap in WHO guidance Transgender people are at increased vulnerability to HIV and general inequity in access to health services Urgent need for WHO to review available data on the specific issues faced by transgender people and document values and preferences of transgender people in relation to HIV.

“We are 2014 and its ridiculous that health care and service providers are still ignorant about who we are and what our needs are.... Health care is a universal human right and we as trans individuals should get the services that we need.” Transwoman, 44, United States. B ASIC HUMAN RIGHTS

WHO S URVEY ON V ALUES & P REFERENCES Summary of findings There are many physical and psychological health needs Specific gender related health services such as transition related information and care HIV is of lesser significance Barriers in the health care system Lack of services, high costs, poor capacity/quality of services, stigma and discrimination, laws, culture. Need to collect specific transgender data for better strategic information

WHO R ECOMMENDATIONS IMPORTANT FOR TRANSGENDER PEOPLE Address structural barriers : 1. Supportive laws and legislation, including decriminalization of behaviors of key populations 2. Stigma and discrimination, train the health sector to provide appropriate services of quality 3. Community empowerment 4. Violence

WHO GUIDANCE ON HIV FOR TRANSGENDER PEOPLE Existing WHO (2011) MSM and transgender people combined New WHO guidelines on HIV for Key Populations Recognise and present transgender people as a specific separate population Includes a specific review of evidence and values & preferences And a specific brief on young transgender people

K UDOS “Without addressing the needs of key populations, a sustainable HIV response will not be achieved.” “The high vulnerability and specific health needs of transgender people necessitates a distinct and independent status in the global HIV response.” “ All countries should consider the importance of reaching these key populations.... To accomplish this, it is essential to work with key population groups and networks as partners in developing and providing services.”

W ORK TO BE DONE Strengthening the bio-psychosocial aspect Laws, religion, culture, economic dislocation Research and information Global indicators on transgender specific programs

C ONCLUSION Still a lot to do to improve our health and wellbeing …………………But, this is an important first step We will collaborate with WHO in the next steps Development of a technical update Development of an implementation tool Revision of ICD10