What Works for Women and Girls

4F. Prevention for Key Affected Populations:Transgender Women and MenTransgender women and men are at significant risk for HIV. Many transgender women andmen engage in paid sex, have low condom use rates, experience high rates of violence andsuffer discrimination when accessing health services (Mahendra et al., 2008; Cascante, 2008;Riono and Praptoraharjo, 2008; Sanchez et al., 2008; Ospina and Letouze, 2008). No evaluatedinterventions were found that provided services for transgender women and transgendermen. Very little information has been published on HIV and transgender women and menin developing countries, with only recent 2008 International AIDS Conference abstracts andwebsites providing information on this topic. Most of the literature does not specify whetherthose included in the study are transgender men or transgender women, despite the differingneeds of each group. Transgender men, who are biologically women, need sexual and reproductivehealth services such as screening for cervical cancer. Yet accessing needed health andHIV services, which usually operate on strict male/female gender identities, may be extremelydifficult.Transgender women and men in many societies face marginalization. A survey of 50 transgenderpeople (gender identity not specified) from Chennai, India found that more than halfare discriminated against by their own families, 70% were denied jobs, and 64% faced violence(Prabakaran, 2008). Participatory action research with sex workers and outreach workers from13 sex worker projects in Central and Eastern Europe and Central Asia found that of 238 male,female and transgender sex workers from 12 countries, more than 45% reported physicalabuse by police and more than 41% reported sexual abuse (Crago et al., 2008). Fifty-five independentstudies from 19 countries (countries not specified) of 2,233 transgender women sexworkers found a 33% HIV prevalence rate (Friedman et al., 2008). Some organizations, suchas Genderdynamix (www.genderdynamix.org.za) and the Triangle Project (www.triangle.org.za) in South Africa, advocate and provide services for transgender people.While not enough studies were found to include as “what works,” some studies were foundshowing programs with positive impacts for transgender women and men. Non-formal educationand livelihood programs for transgender people may improve safer sex practices. SAATHI,a capacity-building NGO in India, provided non-formal education and livelihood programstogether with existing HIV prevention interventions to members of Santi Seva, a communitybased organization of transgender people. While at the start of the project, 80% had unprotectedsex, safer sex practices improved so that fewer than 35% had unprotected sex (Sakar etal., 2008). Another intervention with a positive impact was training police about the rightsof transgender women, resulting in decreased violence. In Mexico, training for 905 police bytransgender women on how violence affected transgender women and their rights led to agreementswith police authorities to promote the human rights of transgender women and withthe Human Rights Commission to follow-up on complaints of violence (Blass et al., 2008).108 CHAPTER 4 PREVENTION FOR KEY AFFECTED POPULATIONS