Transgender people are the most affected by HIV but remain largely excluded from policy, program, and funding decisions at national, regional, and global levels, according to a report released in February.
The report, entitled Most impacted, least served, was produced by IRGT (International Reference Group on Transgender women and HIV/AIDS) a global network of transgender women with the support of MSMGF (Global Forum on MSM and HIV).
The author of the report reviewed and analyzed studies assessing HIV infection burdens in transgender people published between 2000 and 2011 and interviewed a dozen key informants, activists and civil society organization representatives, and Global Fund officials and donors.
The report said that transgender people are at elevated risk of facing stigma, discrimination, and repressive laws and policies in many countries, which reduces their access to care and treatment.
According to the respondents, some initiatives have been successful in engaging transgender people in Global Fund processes, such as the Pehchan initiative in India, the Asia Pacific Transgender Network, REDLACTRANS in Latin American and Caribbean, and the IRGT.
But, globally, little data is available on the transgender population. The report aims to close the gap.
The report showed that according to studies, the HIV prevalence among transgender women is 19.1%, which is 49 times higher than the general population. It should be noted, however, that no data was collected in countries with generalized epidemics, including all of sub-Saharan Africa.
According to the report, only 39% of the countries reported to UNAIDS that their national AIDS strategies addressed transgender people.
Since 2009, The Global Fund has adopted several strategies and policies to increase the engagement of KAPs (key affected populations, which include transgender people) in funding and policy processes.
However, their participation remains low. In 2015, of the 140 countries receiving Global Fund support, only 21 individuals on 17 CCMs self-identified as transgender. The report identified several reasons for this, including the following :
- civil society organisations avoid speaking about problems for fear of undermining their relationships with principal recipients and CCM members;
- the selection of representatives is rarely transparent; and
- KAP representatives wear too many hats (LGBTI, sex workers, drug users, etc.).
The report said that in middle income countries transitioning from The Global Fund, transgender people are the hardest hit, particularly in countries with repressive laws.
Some progress has been observed in Latin America and Asia. However, the report said that these achievements are fragile, and at risk of being reversed. The recommendations in the report include (1) support trans-specific data collection; (2) build the capacity of transgender activists; and (3) reinforce the involvement of transgender activists in The Global Fund decision-making processes.