Transgender in Africa: Invisible, inaccessible, or ignored?

Abstract

Transgender people are an important key population for HIV risk globally, and several studies have found HIV prevalence rates in transgender populations that are significantly higher than those among other key populations such as men who have sex with men (MSM). There is a lack of research on transgender populations in Africa, and at present, there is almost no data available on HIV prevalence and risk among transgender people on the continent. It is possible that the invisibility of transgender people in epidemiological data from Africa is related to the criminalisation of same-sex behaviour in many countries and the subsequent fear of negative repercussions from participation in research. Alternatively, transgender people may be being overlooked in research due to confusion among researchers about how to ask questions about gender identity. It is also possible that transgender populations have simply been ignored in research to date. Without research on transgender-specific HIV prevalence and risk, it is very difficult to know what interventions and services are needed for this risk population. Therefore, it is important that researchers, governments, Non Governmental Organisations (NGOs) and donor organisations begin to pay explicit attention to transgender people in their HIV-related research and programmes in Africa. Keywords: transgender, Africa, HIV/AIDS RésuméLes personnes transsexuelles son tune population clé importante pour le risque au VIH à l'échelle mondiale, et plusieurs études ont montré que les taux de prévalence du VIH au sein des populations transsexuelles étaient significativement plus élevés que ceux parmi les autres populations clés comme les hommes ayant des rapports sexuels avec les hommes (HSH). Il y a une carence dans le domaine de recherche sur les populations transsexuelles en Afrique, et présentement il n'y a presque pas de données disponibles sur la prévalence et le risque relatifs au VIH au sein de la population transsexuelle sur le continent. Il est possible que l'invisibilité de la population transsexuelle dans les données épidémiologiques provenant de l'Afrique soit liée à la criminalisation répandue des comportements homosexuels dans beaucoup de pays et la peur des répercussions négatives consécutives à la participation aux activités liées aux pratiques homosexuels. Alternativement, la population transsexuelle pourrait être en train d'être négligée dans la recherche en raison de la confusion parmi les chercheurs sur la manière de poser les questions sur l'identité sexuelle. Il est aussi possible que les populations transsexuelles aient simplement été ignorées dans les recherches jusqu'à présent. Sans la recherche sur le risque et la prévalence spécifique chez les transsexuels, il est très difficile de connaître quelles interventions et quels services sont nécessaires pour cette population à risque. Il est donc important que les chercheurs, les gouvernements, les ONGs et les organisations donatrices commencent à prêter une attention particulière à la population transsexu...

Men at Risk; a Qualitative Study on HIV Risk, Gender Identity and Violence among Men Who Have Sex with Men Who Report High Risk Behavior in Kampala, Uganda

“…These findings are similar to other studies across Africa where MSM report high levels of sexual victimization, physical and verbal abuse[12]. In our study, individuals who identify as transgender described greater perceived stigma and discrimination than men who identified as gay; other studies suggest they also may be at increased risk for infection [17].Greater stigma and discrimination may be due to their appearance and lack of secrecy. Men describe experiences where they are ostracized from their families, dismissed from places of employment, thrown out of schools, severely discriminated against in health care settings and beaten by police for their sexual orientation.…”

“…Recently, research in sub-Saharan Africa has consistently reported high levels of stigma, discrimination and physical abuse, with even higher levels reported among certain sub-groups within MSM, such as men who conduct sex work, or identify as transgender[12], [15]–[17]. Perceived stigma has played a role in health seeking behavior where MSM are less likely to seek health care and have difficulty disclosing their sexual orientation to health providers[18].…”

Sexual Behaviors and HIV/Syphilis Testing Among Transgender Individuals in China

“…Globally, transgender individuals have long been overlooked in public health research and practice 22, 23 . Their burden of HIV and other STIs is already high, and this knowledge gap has constrains the development of effective public health responses 1 .…”

HIV epidemics among transgender women

“…Data were only available from middle and high-income countries with male-predominant, concentrated epidemics. No studies were available from regions with generalized epidemics, such as sub-Saharan Africa [5]. Pooled prevalence can mask significant intra-country variability, hiding “hot spots” of extreme HIV burden.…”