This is the abstract presentation of Samreen, Human Rights and Advocacy Officer of Asia Pacific Transgender Network (APTN), 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. ASIA PACIFIC TRANSGENDER NETWORK |
STANDIN
G
UP FOR
TRANS
RIGHTS
The Cost of Stigma
Understanding and
Addressing Health Implications of
Transphobia and Discrimination on
Transgender and Gender Diverse People
Evidence from a Trans-led Research in Indonesia, Nepal, Thailand,
and Vietnam
Samreen
Human Rights & Advocacy Officer
APCRSHR10, Virtual
November 23, 2020

2. ASIA PACIFIC TRANSGENDER NETWORK |
STANDIN
G
UP FOR
TRANS
RIGHTS
APTN
is a regional trans-led organisation that is
working to support, organise and advocate for
comprehensive healthcare and the protection
of
legal, social and human rights for
trans and gender diverse people.
APTN is a sub-recipient of the multi-
country Global Fund HIV grant (KPRA)
under Save the Children Nepal (PR) (2018-
2020).
2

3. ASIA PACIFIC TRANSGENDER NETWORK |
Objective of the Key Population Research & Advocacy (KPRA) Study
3
• To conduct a community-led and community-inclusive research on barriers to
accessing HIV and other healthcare services, including sexual health and general
healthcare, for transgender people in Indonesia, Nepal, Thailand and Vietnam.
• To determine how to remove these barriers through community empowerment.

4. ASIA PACIFIC TRANSGENDER NETWORK |
Research Methodology
4
• This community-led research was conducted in collaboration with:
– Indonesia – GWL-INA
– Nepal – Blue Diamond Society
– Thailand – Sisters Foundation
– Vietnam – Vietnam Transgender Network (VNTG) with support of SCDI
• Multi-functional methodology:
– Community-based survey (CBS) (250 respondents per country); focus group discussions (FGD); and key informant interviews (KII)

5. ASIA PACIFIC TRANSGENDER NETWORK |
Key Research Findings: Sexual Health & HIV
5
• Most transgender people across all countries were aware of STIs and HIV, and most had been tested for STIs
and HIV at some point
• Small number of HIV positive respondents; nearly all were on ART.
• Sex workers are most likely tested for STIs across the three countries with the exception of Vietnam. CBOs are
common source for STI treatment.
• Trans women have higher testing uptake for STIs and HIV compared to trans men. In Vietnam, more trans men
tested for STIs.
• Use of preventive and prophylactic treatments like PEP and PrEP was low across the four countries.
• HIV status itself may influence whether transgender patients are refused treatment. HIV-positive respondents in
Nepal and Indonesia were more likely to say they had experienced gender minority stress – a potential
exacerbation of discriminatory treatment related to being both transgender and HIV-positive.
• Experiencing discrimination in HIV services led to delays in accessing general healthcare in Nepal and Indonesia,
but not Thailand or Vietnam.

6. ASIA PACIFIC TRANSGENDER NETWORK |
Key Research Findings: Mental Health
6
• High rates of recent and severe symptoms of depression and anxiety, contrasted with low rates of testing and diagnosis of
depression and anxiety in all four countries. Trans men experienced more anxiety and depression in Indonesia and Nepal
• There was a high prevalence of suicidal ideation and attempts, and little professional help after such suicidal thoughts or
attempts.
• Rates of accessing professional counselling and mental health services (lifetime prevalence) were very low, and only varied
slightly between countries.
• Resilience factors, such as high levels of pride or connections with the community-based organisations, show some
promising signs of positive impacts on mental health. For example, in Nepal and Indonesia, transgender people who were
CBO members had lower rates of anxiety and depression. In Indonesia and Thailand, transgender people high in pride had
better mental health. In Thailand, higher pride was also linked to seeking more help.

7. ASIA PACIFIC TRANSGENDER NETWORK |
Key Research Findings: Where Do the Critical Gaps Lie?
7
• Trans people’s right to health is compromised across the region due to gaps in the availability of
services; discrimination and cost barriers that undermine accessibility; and acceptability issues
due to lack of guidance about providing quality services in ways that are culturally competent for
trans people.
• Stigma and discrimination limit trans people’s access to general healthcare services. Trans people
living with HIV experience double stigmatisation due to their HIV status and gender identity.
• Trans people desperately need mental health support services.
• There are gaps in sexual health services, including HIV prevention and treatment services, for
trans women and no services targeted at trans men.

8. ASIA PACIFIC TRANSGENDER NETWORK |
Recommendations
8
The recommendations focus on the steps that health ministries, academics and
policymakers, health providers and CBOs need to take:
1. Address discrimination and improving the responsiveness of healthcare services
to trans people
2. Address significant information gaps about trans people’s health
3. Ensure trans people’s equal access to mental health services
4. Ensure trans people’s equal access to HIV and sexual health services
5. Improve trans people’s access to gender-affirming care