Panelists in this session presented perspectives on transgendered communities and HIV through the lens of epidemiology, human rights, migration, legal, funding and best practices.

There are diverse and multiple forms of transgender identity around the world, shaped by culture, individual choices and the legal/social environment, making generalization difficult.

Transgender vulnerability to HIV is shaped by many factors, which include social stigma, transphobia, sex work as survival necessity, substance use, violence, employment/ housing discrimination, and depression/low-self-esteem.

Data on HIV in transgendered communities is limited by lack of population-based studies, lack of gender variables in health surveys/health data, invisibility of some transgendered people, trans-woman/trans-man variations and reliance on pathology-based definitions. HIV prevalence rates vary widely between studies and regions - many have found rates of 30% or higher (especially among those with a history of sex work).

Human rights violations against trans-people are common, often including violence/hate crimes, denial of essential services, police harassment, sexual violence, social stigma/discrimination, problems with obtaining legal identity in proper name/gender.

These circumstances often propel trans-people to migrate, inter- or intra-nationally, searching for more supportive, safer environments. Migration may present opportunities for finding community, belonging, support, identity and love, but it can also make individuals vulnerable to homelessness, abuse, poverty, poor health, infectious disease, addiction and, in the case of undocumented migrants, detention and deportation.

Funding for HIV prevention programs for transgendered communities is inadequate. Programmes are frequently part of MSM programmes, despite very distinct needs. Little funding supports basic human rights work, and transgendered organisations rarely receive funding to carry out prevention, care and support activities. Transgendered communities and organisations are often not recognized by governments, not involved in decision making, not consulted in resource allocation or programme planning.

Progress is being made in some areas – Argentina has enacted laws guaranteeing a right to identity as a fundamental human right. Some funders and national plans are beginning to include transgendered communities.

Panelists emphatically supported the idea that effective programming for transgendered communities must include much more than just condoms – a comprehensive approach that addresses the structural vulnerabilities must include human rights protections, legal changes, employment opportunities, housing, and social/medical services.