January 20, 2014
Recently, UNDP’s HIV, Health & Development Group launched a Discussion Paper on Transgender Health and Human Rights, prepared by Jack Byrne, an expert on trans health and human rights issues.
The aim of this paper is primarily to inform UNDP’s work and that of other UN agencies and foster greater understanding on the health and human rights issues that impact trans people and consequently influence their social marginalization. The broad themes discussed in this paper include violence, discrimination, health, legal gender recognition and social inclusion from multiple geographic and social contexts.
The paper draws on the experiences of trans people around the world. Through Action Points contained in each section, the paper suggests practical ways that UN staff can start to be more inclusive of trans people, both in daily interactions and in their broader work, particularly in the areas of HIV, health, the rule of law and development. It is hoped that this paper will also be useful for others in their work and advocacy, including trans advocates, human rights defenders and policymakers.
Access to health care
With regards to general health care, the document stresses that although trans people have the same range of general health needs as other groups, they face systemic discrimination trying to access general health services. This includes being treated with contempt and refused care. The UN Committee on the Elimination of Discrimination against Women has expressed concern about transgender, intersex, lesbian and bisexual women as ‘victims of abuses and mistreatment by health service providers.’
For the vast majority of trans people, a physical examination will disclose their gender identity. Health records also routinely disclose this information. This makes trans people highly vulnerable to ignorance or prejudice, including fear of violent reprisals if health professionals breach conﬁdentiality. Many trans people cannot aﬀord the procedures needed to medically transition. In other cases, the procedures may simply not be available where they live.
Trans people who have not medically transitioned may experience signiﬁcant distress when revealing their body to others. Health care professionals are often insensitive to this vulnerability. They may be ignorant of the speciﬁc health needs of trans people or lack the professional training required to meet their health needs. Given these barriers, many trans people fail to seek or receive vital health services.
Further, many trans people do not ﬁt easily within the sex-segregated categories of women’s and men’s health conditions. For example, trans women may require prostate examinations and some trans men still require cervical smears. Trans people have died after being denied access to such services. Competency in working with trans patients includes being sensitive to the needs of those trans people who do not have a ‘typical’ male or female body, or whose identity documents do not match their preferred gender or how they present.
Absence in research
In addition to the lack of access to care, very few health surveys collect data about gender identity. This severely limits the capacity of health services and policy makers to identify health risks, protective factors or health outcomes for trans people. Especially with regards to HIV monitoring and research, the invisibility of trans people in research also leads to their invisibility in prevention programmes: while the burden of HIV is high in many transgender groups, few prevention programmes have included them in their outreach.
Access Discussion Paper Transgender Health and Human Rights (December 2013)
Currently the Discussion Paper is available only in English; UNDP hopes to have translations in other languages shortly.