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Failure to provide adequate healthcare for transgender people is holding back development in Africa and the Middle East, a study reveals today.

Transgender people whose healthcare needs are not met experience high rates of HIV and mental health problems such as depression, say a series of three research papers published in The Lancet. The issue is compounded by discrimination and criminalisation of transgenderism in many African and Middle Eastern countries, making transgender people more likely to be victims of violence, one paper found. 

The study found that these healthcare failures place an extra burden of care on transgender people and their families, and can stop them being economically active. 

transgender article health issues infographic.jpg
Adapted from The Lancet

“Faced with stigma, discrimination and abuse, transgender people are pushed to the margins of society,” warns Sam Winter, a health researcher at Curtin University, Australia, and lead author of one study. “The health challenges faced by transgender people are exacerbated by laws and policies that deny them gender recognition.”

The researchers found that, due to criminalisation and low awareness of transgenderism, there is little data and information on the state of health of transgender people in developing countries. 

This could hinder global efforts to ensure good healthcare for all people by 2030 — a target fixed by the Sustainable Development Goals, the authors say.

Transgender people identify with a gender different from the one they were assigned at birth. Another paper in the series found that some developing countries — including Indonesia, Laos and Thailand — traditionally accept transgender people and provide reasonable healthcare for them. 

But laws and cultural attitudes in many African and Middle Eastern countries make it nearly impossible for transgender people to receive tailored healthcare, one paper warns. This includes sexual healthcare, psychological care and treatments to help them become the gender they identify with, such as surgery, hair removal or speech therapy. 

Lack of legal protection means many transgender people in these regions fear for their safety, leaving them unable to pursue normal careers and home lives.  “Living proudly as a transgender man in the small sub-Saharan country of Lesotho has come at a serious price,” said Tampose Mothopen, the director of transgender rights group the People’s Matrix Association. “My public activism on issues of sexual orientation and gender identity and expression makes me vulnerable to threats to my personal safety.”

In an editorial, the authors propose that shifting global attitudes to transgender people could have a trickle-down effect on national legislations in countries receiving international aid and healthcare support. The authors of the papers call for the World Health Organization to remove the transgender diagnosis from its current definition as a mental and behavioural disorder to that of “condition related to sexual health”. 

“A mental health diagnosis is widely regarded as inappropriate and potentially harmful by reinforcing stigma,” they write, adding that the move would be “truly historic”. 


Sam Winter and others. Transgender people: health at the margins of society (The Lancet, June 2016)
Kevan Wylie and others. Serving transgender people: clinical care considerations and service delivery models in transgender health (The Lancet, June 2016)