As the HIV-world gathers in Kuala Lumpur, Malaysia, for the international AIDS conference I’m not thinking of advances in vaccine development or promising new antiretrovirals such as the integrase inhibitors, or about new approaches to HIV cure. I’m not even thinking of treatment as prevention. Somehow, I keep thinking of transgender people. Why? Simply because findings from a systematic review and meta-analysis of HIV burden in transgenders is what struck me most in what I’ve been reading about HIV and AIDS so far this year. Although I am sort of aware of the obstacles that transgenders face in accessing health care services, it is still shocking to read that 19% of transgenders worldwide is living with HIV, as Stef Baral and colleagues report. The odds of living with HIV compared with all adults of reproductive age across the 15 countries studied were almost 50. And it doesn’t matter, apparently, whether you live in a rich country or not. Baral reviewed studies from USA, six Asia-Pacific countries, five in Latin America and three in Europe and found “remarkable consistency and severity of the HIV disease burden among transgender women”.
Clearly, as public health professionals we don’t have transgender people on our radar screen at the expense of their health. Perhaps it is because public health professionals think that transgender is a rare phenomenon, and therefore problems of this group have no public health impact. When I studied medicine I did my internships in general practice in the inner city of Amsterdam. On the very first day three consultations were transgender related. In my circle of friends and acquaintances, I know of at least one person wanting to transition to the other sex. Now, I could still think this is because I am living in a tolerant city, moving around in not-so-average circles. But this notion left me entirely on the day when I worked in the remote desert town of Nukus, Uzbekistan, where I entered a bar and was greeted by a voluptuous transgender. Still thinking this might be an exception in this predominantly muslim country, I was travelling through another remote Uzbek village where the leader of the local circus appeared to be transgender. Meanwhile I had learnt that both India and muslim Pakistan have substantial communities of hijra, transgender people that have the status of a sort of third sex in their societies. Hijra in India alone are estimated to be over one million. A study from the United States suggests that the estimated number of transgender people in that country is close to 700 000 or 0.3% of the adult population.
Transgender people face risks. Not only are they more vulnerable to HIV, they also face violence, rampant discrimination and exclusion, not to speak of the stress and difficulties that come with the sex reassignment process. Yet as public health professionals we pay far more attention to, say, the health risks and injuries of workers in the mining industry. But, to stick with stats for the US, transgender people outnumber workers in the mining industry by almost three times.
So how is the international AIDS Conference doing, I wondered, in terms attention for the issues of transgender people given the smashing results of Baral’s systematic review? To this end I started to search the conference programme. I found out that 3 out of the 88 sessions addressed transgenders with at least one presentation focusing on transgender issues. Browsing the abstracts, transgender popped up in 11 out of 873 abstracts, but in fact only 3 out of these 11 really focused on transgender health or rights issues. Three abstracts out 873, or 0.3%! This is exactly proportionate to transgender prevalence in the United States, but disproportionately low compared to the HIV risks faced by transgender people. Unfortunately, the conference organisers share the same blind spot with society as a whole that considers transgender people and their problems to be, well, not sexy.
Clearly, as public health professionals we don’t have transgender people on our radar screen at the expense of their health. Perhaps it is because public health professionals think that transgender is a rare phenomenon, and therefore problems of this group have no public health impact. When I studied medicine I did my internships in general practice in the inner city of Amsterdam. On the very first day three consultations were transgender related. In my circle of friends and acquaintances, I know of at least one person wanting to transition to the other sex. Now, I could still think this is because I am living in a tolerant city, moving around in not-so-average circles. But this notion left me entirely on the day when I worked in the remote desert town of Nukus, Uzbekistan, where I entered a bar and was greeted by a voluptuous transgender. Still thinking this might be an exception in this predominantly muslim country, I was travelling through another remote Uzbek village where the leader of the local circus appeared to be transgender. Meanwhile I had learnt that both India and muslim Pakistan have substantial communities of hijra, transgender people that have the status of a sort of third sex in their societies. Hijra in India alone are estimated to be over one million. A study from the United States suggests that the estimated number of transgender people in that country is close to 700 000 or 0.3% of the adult population.
Transgender people face risks. Not only are they more vulnerable to HIV, they also face violence, rampant discrimination and exclusion, not to speak of the stress and difficulties that come with the sex reassignment process. Yet as public health professionals we pay far more attention to, say, the health risks and injuries of workers in the mining industry. But, to stick with stats for the US, transgender people outnumber workers in the mining industry by almost three times.
So how is the international AIDS Conference doing, I wondered, in terms attention for the issues of transgender people given the smashing results of Baral’s systematic review? To this end I started to search the conference programme. I found out that 3 out of the 88 sessions addressed transgenders with at least one presentation focusing on transgender issues. Browsing the abstracts, transgender popped up in 11 out of 873 abstracts, but in fact only 3 out of these 11 really focused on transgender health or rights issues. Three abstracts out 873, or 0.3%! This is exactly proportionate to transgender prevalence in the United States, but disproportionately low compared to the HIV risks faced by transgender people. Unfortunately, the conference organisers share the same blind spot with society as a whole that considers transgender people and their problems to be, well, not sexy.
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