Transgender rights are critical for health and well-being

The Lancet: Transgender rights are critical for the health and well-being of transgender people in Asia and the Pacific

Transgender rights received unprecedented recognition in Asia and across the world in 2015. However, a new Series published in The Lancet today reveals that public recognition has yet to translate into a concerted effort to support and improve the health and lives of transgender people.

The Series was launched at the World Professional Association for Transgender Health’s (WPATH) 24th Biennial Scientific Symposium in Amsterdam. It was compiled with input from members of the transgender community and provides an assessment of transgender health worldwide.

The global study points to major gaps in our understanding of transgender health. According to the authors, there is a failure to recognize gender diversity in public health efforts, however, it is noted there is enough information about this marginalized group to act now.

In Asia and the Pacific, there are an estimated 9 million transgender people, many who share common experiences of discrimination. These experiences include issues of invisibility, isolation, exclusion from families, schools, the formal workforce and mainstream economy, and not being recognized as equal citizens.

According to the reports in The Lancet, transgender people lack legal protections that often push them to the margins of society. Routinely denied their rights, transgender people often face stigma, discrimination and abuse leading to marginalization. The report goes on to show that lack of gender recognition further damages their physical and mental health. As a result of this social and legal context, transgender people have high rates of depression, up to 60 percent globally, says the report.

Often excluded from families or the workplace, transgender people are at greater risk of engaging in risky behaviour – sex work or drug use for instance – and studies have shown transgender people are at almost 50 times greater risk of HIV than the general population. Violence against transgender people is widespread and between 2008 and 2016, there were 2,115 documented killings of transgender people across the world, with many other murders likely going unreported or misreported.

“Many of the health challenges faced by transgender people are exacerbated by laws and policies that deny them gender recognition. In no other community is the link between rights and health so clearly visible as in the transgender community,” says one of the lead authors for the Series, Sam Winter, Associate Professor, School of Public Health at Curtin University, Australia. “Faced with stigma, discrimination and abuse, transgender people are pushed to the margins of society, which leave them at risk of further ill health.”

“The 2030 Agenda is based on the principle of ‘leaving no-one behind’. Passing protective laws and policies that guarantee gender recognition is essential to the health and well-being of transgender people,” said Magdy Martínez-Solimán, UN Assistant Secretary General, UNDP Assistant Administrator and Director of the Bureau for Policy and Programme Support. "This groundbreaking Lancet Series on Transgender Health will contribute to the growing body of evidence on addressing the needs of a group that has been excluded in health and development,” he added.

The Series was led by authors from the University of Sheffield (UK), Johns Hopkins University (USA), Curtin University (Australia) and the United Nations Development Programme (UNDP). Several members of the transgender community also contributed to the Series, including as authors of the papers.

A majority of countries worldwide do not offer legal or administrative measures enabling gender recognition for transgender people. In the Asia Pacific region, New Zealand, Australia, Nepal, Pakistan and India have moved, or are moving towards, recognizing gender diversity beyond male/female.

The authors of the three paper Series call for action, including:

• Revisions should be made to WHO’s diagnostic manual, due to be revised in 2018, including removing the diagnoses for transgender people from the chapter relating to “mental and behavioural disorders” and moving it to the chapter on “conditions related to sexual health”. A mental health diagnosis is widely regarded as inappropriate and potentially harmful by reinforcing stigma. The authors say this move would be ‘truly historic’.

• WHO should reconsider the highly controversial diagnosis of “gender incongruence in childhood” for children below the age of puberty, and instead focus efforts on providing children with access to better support and information, to understand and express their gender identity.

• Health care for transgender people, including access to feminizing and masculinizing hormones, should be funded on the same basis as other health care.

• Physicians should be trained to understand the health needs of transgender people, especially in delivering general health care such as mental and reproductive health.

• Governments worldwide must put an end to gender reparative therapies for children, adolescents and adults, widely condemned as unethical.

• It is imperative that anti-discrimination laws are inclusive of transgender people.

• Schools must be more inclusive of gender diversity and all teachers should be trained to work with, and educate about, transgender people and gender diversity.

To access the Series please visit: www.thelancet.com/series/transgender-health

ENDS

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