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Trans People and Trans Communities in Asia and the Pacific

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Trans People and Trans Communities in Asia and the Pacific BLUEPRINT FOR THE PROVISION OF COMPREHENSIVE CARE FOR TRANS PEOPLE AND TRANS COMMUNITIES IN ASIA AND THE PACIFIC HEALTH POLICY PROJECT 1 This document was produced in partnership with Suggested citation: Health Policy Project, Asia Pacific Transgender Network, United Nations Development Programme. 2015. Blueprint for the Provision of Comprehensive Care for Trans People and Trans Communities. Washington, DC: Futures Group, Health Policy Project. ISBN: 978-1-59560-118-6 The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. The project’s HIV activities are supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). HPP is implemented by Futures Group, in collaboration with Plan International USA, Avenir Health (formerly Futures Institute), Partners in Population and Development, Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and the White Ribbon Alliance for Safe Motherhood (WRA). The information provided in this document is not official U.S. Government information and does not necessarily represent the views or positions of the U.S. Agency for International Development. 1 Blueprint for the Provision of Comprehensive Care for Trans People and Trans Communities in Asia and the Pacific 1 CONTENTS Acknowledgements v Acronyms and Abbreviations vii Overview viii Executive Summary viii Using and Navigating the Asia and the Pacific Trans Health Blueprint x Terminology xi Introduction 1 1.1 Number of Trans People 2 1.2 Social Exclusion 2 1.3 Previous Regional Blueprints 2 1.4 Purpose of Blueprint 3 1.5 Process 3 1.6 Intersex People and Gender Dysphoria 4 1.7 Other Health Issues for Intersex People 4 Human Rights 7 2.1 Introduction 8 2.2 Commitments under International Human Rights Law 8 2.3 Monitoring Countries’ Compliance with these Human Rights Obligations 8 2.4 Regional Commitments 9 2.5 Role of National Human Rights Institutions 10 Priority Human Rights Issues for Trans People in this Region 13 3.1 Introduction 14 3.2 Violence 15 3.3 Discrimination 19 3.4 The Right to Health 31 3.5 Legal Gender Recognition 61 3.6 Next Steps 67 iii 1 Comprehensive Care, Prevention, and Support 69 4.1 Introduction 70 4.2 Information Needs 73 4.3 Client Flow in a Health Facility 75 4.4 HIV Testing, Counselling, and Treatment as Part of Comprehensive HIV and Sexual Health Services 81 4.5 Addressing Mental Health Concerns 85 4.6 Alcohol and Other Substance Use and Dependence 86 4.7 Addressing Stigma, Discrimination and Violence and Promoting Resilience 86 4.8 Specific gender-affirming healthcare related to body modifications 87 Working with Gender-diverse Children and Youth 95 5.1 Introduction 96 5.2 Gender-variant Behaviour or Expression Compared to Gender-variant Identity 97 5.3 Differences between Children and Adolescents 97 5.4 First Clinical Evaluation with a Gender-variant Child or Youth and their Family 98 5.5 Trans-positive Interventions 99 5.6 Confidentiality and Consent 100 Policy Considerations 105 References 115 Appendices 131 Appendix A: Hormone Administration, Monitoring and Use 132 Appendix B: List of Participants—Initial Consultation Meeting 141 Appendix C: List of Participants—First Consultation Workshop 143 Appendix D: List of Participants—Second Consultation Workshop 146 Appendix E: Reviewers of the Draft Blueprint 148 Appendix F: Sample Consent Forms 152 iv 1 Acknowledgements The Coordinating Group would like to thank all of the trans community participants and organisations, health workers and professional bodies, and other individuals and organisations who contributed to this resource. Many people played a role by attending consultations, providing potential case examples, and reviewing drafts. This Blueprint would not have been possible without your input. We are indebted to the Pan American Health Organization and all involved in developing the first Trans Health Blueprints for Latin America and the Caribbean. In particular, we acknowledge JoAnne Keatley, Walter Bockting, and Rafael Mazin for their leadership in developing these initial documents. The Asia and the Pacific Blueprint relies heavily on the clinical protocols in the Caribbean Blueprint, which are based on the work of the University of California, San Francisco (UCSF) Center of Excellence for Transgender Health. These were revised by Dr Asa Radix and reviewed by medical reviewers from this region, who are listed below. In addition to those acknowledged below, lists of participants at the initial project meeting and two subsequent consultations are attached as Appendices A, B, and C. All reviewers of the March 2015 draft are listed in Appendix D. Coordinating Group Darrin Adams (Health Policy Project [HPP], USA), Matt Avery (LINKAGES, FHI 360, Thailand), Nachale [Hua] Boonyapisomparn (HPP, USA), Jack Byrne (HPP, New Zealand), Jensen Byrne (United Nations Development Programme [UNDP], Thailand), Kevin Halim (Asia Pacific Transgender Network [APTN], Thailand), Natt Kraipet (APTN, Thailand), Ron MacInnis (HPP, USA), Ashley Gibbs (HPP, USA), Nadia Rasheed (UNDP, Thailand), Edmund Settle (UNDP, Thailand), Cameron Wolf (USAID, USA), Joe Wong (APTN, Thailand), Felicity Young (HPP, Australia) Contributors Olga B. Aaron (Bringing Adequate Values of Humanity, India), Thanapoom Amatyakul (APTN, Thailand), Kalpana Apte (Family Planning Association of India, India), Nisha Ayub (Justice for Sisters, Malaysia), Rachel Clare Baggaley (World Health Organization [WHO], Switzerland), Andrew Ball (WHO, Switzerland), Thanaseth Banjobtanawat (LINKAGES, FHI360, Thailand), Anonnya Banik (Bandhu Social Welfare Society, Bangladesh), Walter Bockting (WPATH and Columbia University), Rebekah Thomas Bosco (WHO, Switzerland), Mike Burkly (USAID, Thailand), Zhan Chiam (International Lesbian, Gay, Bisexual, Trans and Intersex Association, Switzerland), Eli Coleman (WPATH and University of Minnesota), Kate Montecarlo Cordova (Association of Transgender People in the Philippines, Philippines), Robyn Dayton (LINKAGES, FHI360, USA), Simon Denny (University of Auckland, New Zealand), Manisha Dhakal (Blue Diamond Society [BDS], Nepal), Purnima Dongole (Bir Hospital, Nepal), John M. Eyres (USAID, Viet Nam), Lin Fraser (WPATH, USA), Jamison Green (WPATH, USA), Frits van Griensven (Thai Red Cross AIDS Research Center, Thailand), Cameron Hartofellis (HPP, USA), Yuko Higashi (Osaka Prefecture University and World Association for Sexual Health and WPATH, Japan), Vanessa Ho (Project X, Singapore), Qasim Iqbal (Naz Male Health Alliance [NMHA], Pakistan), Nisha Jagdish (Family Planning Association of India, India), Shambhu Kafle (National Centre for AIDS and STD Control, Nepal), JoAnne Keatley (Center of Excellence for Transgender Health, University of California, San Francisco, USA), Rajat Khosla (WHO, Switzerland), Gail Knudson (WPATH and University of British Columbia), Jun Koh (Osaka Medical College, Japan), Joanne Leung (Transgender Resource Center, Hong Kong SAR, China), Lily Miyata (Kansai AIDS Council, Japan), Ying-Ru Lo (WHO, Philippines), Marcio Maeda (HPP, USA), Daniel McCartney (International Planned Parenthood Federation, United Kingdom), Steve Mills (LINKAGES, FHI360, Thailand), Sesenieli [Bui] Naitala (SAN Fiji, Fiji), Ernest Noronha (UNDP, India), Razia Pendse (Western Pacific Regional Office [WPRO], WHO, India), Hari Phuyal (Supreme Court, Nepal), Midnight Poonkasetwattana (Asia Pacific Coalition on Male Sexual Health, Thailand), Tonia Poteat (Johns Hopkins University, USA), Mehrin Abdul Qadir (NMHA, Pakistan), Thenu Ranketh (Equal Ground, Sri Lanka), Michelle Rodolph (WHO, Switzerland), Obert [Elizabeth Taylor] Samba (Save the Children, Papua New Guinea), Aaron Schubert (USAID, Thailand), Basudev Sharma (National Human Rights Commission, Nepal), Mukta Sharma (WHO, Thailand), Vin Tangpricha (WPATH and Emory University School of Medicine), Aakanshya Timilsina (BDS, Nepal), Annette Verster (WHO, Switzerland), Kaspar Wan (Gender Empowerment, Hong Kong SAR, China), Teodora Wi, (WHO, Switzerland) Rose Wilcher (LINKAGES, FHI360, Thailand), Sam Winter (WPATH and Curtin University, Australia), Pengfei Zhao (Southeast Asia Regional Office [SEARO], WHO, Philippines) v 1 Medical Reviewers Jiraporn Arunakul (Ramathibodi Hospital, Mahidol University, Thailand), Venkatesan Chakrapani (Centre for Sexuality and Health Research and Policy, India), Louis Gooren (VU Medical Center, Netherlands), Mo Harte (Health West, New Zealand), Ichiro Itoda (Shirakaba Clinic, Japan), Rachel Johnson (Counties Manukau Centre for Youth Health, New Zealand), Muhammad Moiz (NMHA, Pakistan), Graham Neilsen (Stonewall Medical Centre, Australia), Asa Radix (Callen-Lorde Community Health Center and WPATH, USA), William Wong (Department of Family Medicine & Primary Care, University of Hong Kong, Hong Kong SAR, China) Writers Jack Byrne (consultant to HPP, New Zealand) and Asa Radix (Callen-Lorde Community Health Center, USA), with contributions to the HIV and other STIs material from Matt Avery (LINKAGES, FHI 360, Thailand) vi 1 Acronyms and Abbreviations APF Asia Pacific Forum APTN Asia Pacific Transgender Network ART Antiretroviral therapy ARV Antiretroviral ASEAN Association of Southeast Asian Nations BDS Blue Diamond Society BSWS Bandu Social Welfare Society CBO Community-based organisation DSD Disorders of sex development FPAI Family Planning Association of India FtM Female to male (trans man) GBV Gender-based violence HPV Human Papillomavirus
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