This is the abstract presentation of Manisha Dhakal of Blue Diamond Society Nepal, which was made as part of the 12th session of 10th Asia Pacific Conference on Reproductive and Sexual Health and Rights (#APCRSHR10) Virtual. This session was held in lead up to #WorldAIDSDay and #16DaysofActivism against sexual and other forms of gender-based violence, on the theme of "HIV/AIDS and sexual and reproductive health and rights (SRHR) in Asia and the Pacific". Chair: Jennifer Butler, Director, UNFPA Pacific Sub Regional office based in Fiji Plenary Speaker: Eamonn Murphy, Regional Director, UNAIDS, Asia and the Pacific | “Solidarity and Accountability: HIV, SRHR and the COVID response” Abstract Presenters: ------------------------- * Jude Tayaben | Successes, Pitfalls, and Moving Forward: Adivayan Youth Health Center- A school-based program addressing Adolescent Sexuality, and Reproductive Health Issues in Benguet, Philippines * Samreen, Manisha Dhakal | Integrating transgender health into HIV and SRHR programming in Indonesia, Nepal, Thailand and Vietnam * Harjyot Khosa | Stigma, sex work and non-disclosure to health care providers: Exploring dynamics of anal sex through community led monitoring to bridge gaps in HIV care continuum services * Angela Kelly Hanku, Agnes K. Mek | I can, I want, I will and Young & Positive: Two visual method projects with young women living with HIV in Papua New Guinea For more information on the session, please visit www.bit.ly/apcrshr10virtual12 Official conference website: www.apcrshr10cambodia.org Thanks

1. Integrating trans health in HIV and SRH programming
Findings of Research on
Barriers to access HIV and other healthcare services faced by
transgender people in Nepal
Manisha Dhakal
Blue Diamond Society
Nepal

2. Methodology
• Community led and driven research project
• Research along with advocacy
• The study was conducted in two key cities: Nepalgunj and Kathmandu.
• People who identify themselves as transgender men and transgender
women were participated in this study.
• 250 transgender persons were interviewed. For the Quantitative Study 67
were trans men, 181 were trans women, others are intersex and gender
fluid
• 5 Focus Group Discussions were conducted

3. Findings
• Exist of provision of community and peer led services
• Community led services mostly focused on HIV prevention and testing
[The rise in infections for the transgender community from 6.2% in 2015 to 8.5% in 2017 in IBBS study]
[Of those 17 individuals who tested positive for HIV 17.6% (n=3) were trans men and 82.3% (n=14) were trans
women. ]
• Poor Mental health issues
[Mental health revealed poorer outcomes with a mean average of 3.7 on the scale.]
[sex workers having overall worse mental health (3.7) than non sex workers (4.0).]
[Over one third (33.3%) of the sample has had thoughts about ending their life. The mean age for suicide
attempts was 18.8 years] Hormone replacement therapy and gender transitioning surgery are important
factors for gender affirmation for transgender people
The data reveals that 34% (n=82) of respondents had used hormones with mean age of first use at 22.9 years,
and youngest, at 15 years. Trans women (43.6%) are more likely to use hormones than trans men (7.5%).
• Transgender had experienced seriously assault. Furthermore, sex workers were more likely to
experience assault than non sex workers
[19.2% (n=48) of respondents had experienced seriously assault Furthermore, sex workers (n=32) were more
likely to experience assault than non sex workers (n=16). ]
• Practical barriers including, costs, transport, clinic timings, lack of trans specific guidance and standards
of care and safety and security.
The study found that 18.4% (n=46) of the sample that needed health care services in the last six months did
not receive it because of costs associated with treatment
4.8% (n=12) had delayed treatment due to distance
10.1% (n=25) delayed due to lack of transport
6.4% (n=16) because of clinic timings

4. Findings
• The lack of inclusive health services
• Stigma and discrimination
• Lack of services for hormone use and transitioning
[Most trans people purchased hormone medication from pharmacies (57.6%),
only 3.2% received hormones from a health care provider.]
• Lack of services to address mental health issues
• No mechanism to address violence and assaults form the government]
[In seeking help following an assault, most survivors went to seek help at
NGO/CBO (29.8%) followed by peers (27.7%), and 23.4% did not seek help
from anyone.]
• Lack of capacity of health care providers on gender identity

5. Recommendation
• End all forms of discrimination especially in Health Care Settings
• Increasing access and availability of HIV and health services for transgender
people;
 Investment
 Policy Change
 Institutionalization
 Capacity enhancement
• Integrate trans inclusive health care services including gender affirming care
as part of HIV service provision and increase the number of trans competent
health care providers across the country
• Scale up mental health services for transgender people to ensure access and
availability
• Strengthening community and peer led transgender groups to ensure quality,
transparency and accountability of government and non-government led
health services

6. Advocacy Action
• Submission of UPR report in 3rd cycle of Nepal UPR
• Translation of Trans Health Blue Print Fact Sheet in
Nepalese Language
• Dissemination of findings with wider stakeholders
• Support our community in Covid-19 crisis
• Province level workshop with Health care providers in 6
provinces of Nepal
• 22 Local level CBOs independently organized advocacy
meetings with local level stakeholders, clinics, hospitals
and government

7. THANK YOU