The “Gender Incongruence of Childhood” diagnosis revisited: A statement from clinicians and researchers

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This is an open letter to the World Health Organization (WHO), an agency of the United Nations, from researchers and clinicians working in trans health and rights regarding proposed revisions to the International Statistical Classification of Diseases and Related Health Problems, Version 11 (ICD-11) that relate to healthcare for trans adults and adolescents, as well as gender diverse (GD) children.

We commend WHO for proposed revisions that would move diagnostic categories related to gender transition processes (currently ICD-10’s “F64 Gender identity disorders”) from the chapter of Mental and Behavioural Disorders to a new chapter on Conditions Related to Sexual Health. We also welcome the proposal to eliminate “F65.1. Fetishistic transvestism” and “F66. Psychological and behavioural disorders associated with sexual development and orientation” from the ICD-11 altogether. However, we are concerned about the proposed Gender Incongruence of Childhood (GIC) diagnosis and call on the WHO to reconsider its inclusion. Instead, we urge consideration of less stigmatizing proposals by the GATE Civil Society Expert Working Group and other global experts to facilitate access to psychological support for gender diverse children.

To add your name and voice to this letter, please fill out the form at the bottom. You will be able to view other signatories, after you sign. [Erratum 20150516. Should read, “You will be prompted to view other signatories after you submit your response, or follow the link in the signature section.”] For questions about this open letter, please write Sam Winter. For questions about this web form, contact Kelley Winters.

For signing the letter please go to: www.gicrevisited.org

General comments on ICD proposals related to gender expression and identity

  1. We follow with interest the progress of the ICD revision process. We look forward to seeing the publication of ICD-11, which we are confident will remain, like ICD-10 (http://goo.gl/MlUnk8), the major diagnostic manual used worldwide.
  2. From the ICD-11 Beta Draft (http://apps.who.int/classifications/icd11/browse/l-m/en) current at time of writing we note a number of revisions relevant to the provision of healthcare for transgender people, defined here as those individuals who identify in a gender other than the one that matches their sex assigned at birth.
  3. We support the proposal to abandon the diagnoses of fetishistic transvestism (F65.1) and all diagnoses in the block entitled disorders of sexual preference (Block F66). [Erratum 20150516. Should read, “Psychological and behavioural disorders associated with sexual development and orientation (Block F66).”] We agree that these diagnoses are problematic, in that they have no clinical utility, serve no credible public health need, reinforce defamatory stereotypes, and are potentially harmful to the health and wellbeing of those diagnosed.
  4. We support the proposal to remove from the Mental and Behavioural Disorders chapter the diagnoses most commonly used to facilitate gender affirming healthcare for transgender people, and to locate them instead in a chapter called Conditions Related to Sexual Health.
  5. We believe the proposal for a new chapter placement is in line with contemporary clinical understanding, affirmed by professional associations such as WPATH (the World Professional Association for Transgender Health, (http://goo.gl/89zAwa), that the gender identities of transgender people are not properly viewed as psychopathological. We note that the psychopathologising perspective does not match (and has in fact sometimes undermined) the provision of effective gender affirming healthcare approaches used in contemporary times to support transgender people who have healthcare needs. Indeed it has contributed to potentially harmful approaches aimed at modifying their gender identities. The WPATH Standards of Care Version 7 (http://goo.gl/rven2O) note that such approaches are unethical. We believe too that the psychopathologising perspective has needlessly increased the stigma faced by transgender people, undermining the right to legal gender recognition.
  6. We support the abandonment of the term gender identity disorder, currently used as an overarching name for the block of diagnoses (F64) most commonly used to facilitate gender affirming healthcare for transgender people. We see the proposed replacement term, gender incongruence, as an attempt to reduce the overly pathologising language inherent in the term gender identity disorder. We note however that the term gender incongruence is not universally supported within transgender communities. See recent press releases by STP (International Campaign Stop Trans Pathologization, (http://goo.gl/0GRvA6), and GATE (Global Action for Trans* Equality, (http://goo.gl/GHpzog), the latter in association with STP.
  7. We note that there are currently two proposed gender incongruence diagnoses, one for adolescents/ adults, and one for children under the age of puberty. We note with approval language in the descriptions of these diagnoses which avoids binary thinking, and is more inclusive of the diversity in people’s gender identities.
  8. We note that other aspects of the wording of the diagnostic descriptions have attracted criticism. However we focus in the following sections on the proposal for a gender incongruence of childhood (GIC) diagnosis.

Specific concerns about the proposed gender incongruence of childhood diagnosis

  1. First, we note with concern that, regardless of where in ICD-11 the proposed GIC diagnosis is placed, it pathologises the experiences of young children below the age of puberty who are either exploring their identity, or are incorporating their gender identity into a broader sense of who they are, becoming comfortable expressing that identity, and managing any adverse reactions from others. We note that in a number of cultures worldwide these experiences, which we call here gender diversity, would not be regarded as pathology.
  2. We also note that many children who express pronounced and unwavering convictions regarding gender identity, and who have supportive families, do not display any level of distress. Rather, distress occurs when the child feels that their genitals ought to dictate their identity and behaviour.
  3. We note too that, unlike transgender adolescents and adults, gender diverse children below the age of puberty have no need of somatic gender affirming healthcare. These children do not need puberty suppressants, masculinising or feminising hormones, surgery, or indeed medical intervention of any type. They simply need the opportunity and freedom to explore, incorporate and express their gender identity; they need the support and information that enables them to do these things, as well as manage any adverse reactions of others. In our opinion these developmental challenges do not warrant a diagnosis. Furthermore, a diagnosis wrongly signals to the child and their family that there is something wrong or improper with the child.
  4. We note that the WHO Working Group generating the GIC proposal (http://goo.gl/8JiJi2), and the WHO secretariat, have taken a very different diagnostic approach to persons experiencing developmental processes linked to their sexual orientation. There are currently several diagnoses in ICD-10’s Block F66 (for example sexual maturation disorder and egodystonic sexual orientation) that have the effect of pathologising young people exploring same-sex sexual orientation, incorporating their sexual orientation into their sense of self, learning to express their sexual orientation and dealing with adverse reactions from others. To its credit, the Working Group took the view that developmental processes of this sort – exploration, incorporating, expression and reaction-management in regard to sexual orientation – should not be pathologised. The Group recommended that these diagnoses be removed. The ICD-11 beta draft reflects these recommendations. We are perplexed that the Working Group, and WHO secretariat in preparing the ICD-11 beta draft, have not taken the same approach with young gender diverse children, who engage in similar developmental processes, but linked to gender identity.
  5. We note that the Working Group has recommended that healthcare helping young people who experience discrimination on grounds of their sexual orientation can be provided by way of non-pathologising codes in Chapter 21 of ICD-10 entitled Factors Influencing Health Status and Contact with Health Services. These are the so-called Z Codes in Chapter 21 of ICD-10 (currently Q Codes in the ICD-11 Beta Draft, and placed in Chapter 24). Certain Z Codes may be useful in cases where a person is seeking healthcare for reasons associated with stigma and prejudice. We believe a similar Z Code approach should be taken with gender diverse children below the age of puberty (and their caregivers) who require support from the healthcare system.

An alternative proposal and call to WHO

  1. We note the proposals that arose out of the Civil Society Expert Working Group (https://goo.gl/O1NrbJ) that met in Buenos Aires in April 2013. The meeting was convened by GATE, an international organization focused on promoting trans people’s human rights, including to health. The proposals (GATE, 2013) [Erratum 20160516. Should read, “(https://goo.gl/wuPMkI)” are for facilitating healthcare for gender diverse children below the age of puberty through the use of Z Codes – in most cases minor amendments of already existing Z Codes. Such Z codes would detail the nature of the support being offered to these children and to the adults responsible for caring for them. These codes could facilitate children’s (and caregivers’) access to supportive counselling and information services, as well as to medical examinations linked to approaching puberty. These codes could also be used to facilitate children’s access to school in authentic (gender affirmative) roles. Finally, in those few cases in which young gender diverse children experience distress of an extent and nature demanding clinical mental health care, these Z Codes could be used as markers, attached to generic diagnoses such as depression or anxiety, signaling that the child’s mental health issues are linked to experiences of discrimination on grounds of their gender diversity (with implications for the sort of care needed).
  2. We take the view that arguments for the GIC diagnosis – for example that it will provide a foundation for research and training – appear flawed. We do not believe that research or training in relation to childhood gender diversity would suffer if there were no GIC diagnosis in ICD-11. We note that research into same sex attraction and relationships has thrived since homosexuality diagnosis was removed from the diagnostic manuals decades ago. We believe too that knowledge about the healthcare needs of gay and lesbian youth is better now than it was when homosexuality was a diagnosis.
  3. We note too that key transgender health and rights organisations worldwide other than GATE have spoken out against this proposal. They include ILGA (International Lesbian, Gay, Bisexual, Trans and Intersex association), ILGA-Europe, STP (Stop Trans Pathologization) and TGEU (Transgender Europe). We note also statements arising out of two international meetings examining transgender health, one in Cape Town, South Africa, and the other in Taipei, Taiwan, Province of China. Finally, we note that the European Parliament in the so called Ferrara Report published in July 2015 called on the European Commission to “intensify efforts to prevent gender variance in childhood from becoming a new ICD diagnosis”. This call was reaffirmed in a European Parliament Resolution passed in September 2015. We are aware of a recent member survey by WPATH that found that a majority of participants were opposed to the proposed diagnosis, with this majority much greater among members outside the USA.

– GATE (https://goo.gl/wuPMkI)
– ILGA (http://ilga.org/)
– ILGA-Europe (http://goo.gl/Z1k636)
– STP (http://goo.gl/oERkcm)
– TGEU (Transgender Europe, (http://goo.gl/KRJLlI)
– Cape Town, South Africa (http://goo.gl/vIMwYH)
– Taipei, Taiwan, Province of China (http://goo.gl/cW4Jxf)
– European Parliament Resolution (http://goo.gl/rBAJRA)
– Member survey by WPATH (http://goo.gl/mAVmgu)

Taking into account all the above, we the undersigned, a group of scholars, researchers and clinicians working in transgender health and rights, call on WHO to abandon the proposed GIC diagnosis and incorporate the use of Z Codes as a means of facilitating and guiding support for gender diverse children below the age of puberty. We commend to WHO the GATE Civil Society Expert Working Group proposal (https://goo.gl/NfdDmg).

Original Signatories

Sam Winter, BSc, PGDE, M.Ed., PhD
Associate Professor, School of Public Health, Curtin University, Perth, Australia.
Discipline: Psychologist.
Years working in field of transgender health and rights: 16.
Clinical services offered for transgender people: Yes
Years doing this sort of work: 14 years.
Clinical services for gender diverse children: Yes.

Elizabeth Riley BSc, GDCouns, MA(Couns), PhD
Counsellor, Clinical & PhD Supervisor, Trainer, Sydney, Australia
Disciplines: Health Sciences & Counselling
Years working in field of transgender health and rights: 18
Clinical services offered for transgender people: Yes
Years doing this sort of work: 20 years.
Clinical services for gender diverse children: Yes

Simon Pickstone-Taylor, MBChB
Honorary Senior Lecturer, Gender Identity Development Service, Division of Child & Adolescent Psychiatry, University of Cape Town, South Africa.
Discipline: Child & Adolescent Psychiatrist and General Adult Psychiatrist.
Years working in field of transgender health and rights: 13.
Clinical services offered for transgender people: Yes
Years doing this sort of work: 13 years.
Clinical services for gender diverse children: Yes.

Amets Suess, PhD, MA, BA
Researcher, Area of International Health, Andalusian School of Public Health, Granada, Spain
Discipline: Sociology, Social Anthropology, Art Therapy, Bioethics
Years working in field of transgender health and rights: 14

Kelley Winters, Ph.D.
Gender Diversity Medical Policy Analyst; author, Gender Madness in American Psychiatry: Essays from the Struggle for Dignity (2008)
Discipline: Interdisciplinary scholarship.
Years working in field of transgender health and rights: 21.

Lisa Griffin, Ph.D.
Virginia Commonwealth University, Richmond, Virginia, United States.
Discipline: Psychologist.
Years working in field of transgender health and rights: 21.
Clinical services offered for transgender people: Yes
Years doing this sort of work: 21.
Clinical services for gender diverse children: Yes.

Diane Ehrensaft, PhD
Associate Professor, Department of Pediatrics, University of California San Francisco
Discipline: Developmental and Clinical Psychologist
Years working in field of transgender health and rights: 25
Clinical services offered for transgender people: Yes
Years doing this sort of work: 30 years.
Clinical services for gender diverse children: Yes.

Darlene Tando, LCSW
Gender Therapist, Private Practice
San Diego, California
United States
Discipline: Licensed Clinical Social Worker
Years working in field of transgender health and rights: 10
Clinical services offered for transgender people: Yes
Years doing this sort of work: 10
Clinical services for gender diverse children: Yes.

Hershel Russell M.Ed, (Couns. Psych)
Registered Psychotherapist,Counsellor, Clinical Supervisor, Trainer, Toronto, Canada
Discipline: Psychotherapist.
Years working in field of transgender health and rights: 15.
Clinical services offered for transgender people: Yes
Years doing this sort of work: 20 years.

Brenda R. Alegre,PhD.
Registered Psychologist and Psychometrician
Assistant Lecturer Faculty of Arts, University of Hong Kong, Special Administrative Region of China
Discipline: Clinical Psychology
Years working in the field of transgender health and rights: 10+ years
Clinical Services offered for transgender people: Yes
Years doing this sort of work: 10+ years
Clinical services for gender diverse children: yes

Griet De Cuypere, M.D. Ph.D.
Former Head of the Gender Team Gent, Belgium
Discipline: Psychiatrist – psychotherapist.
Years working in field of transgender health and rights: 30.
Clinical services offered for transgender people: Yes
Years doing this sort of work: 30 years.

Sign the Letter:

For signing the letter please go to: www.gicrevisited.org
To view current signatories in spreadsheet form, see https://goo.gl/yqta4Q

Nepal pride parade: Advocating for LGBTI rights to be written into the new constitution

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Nepal LGBTI community rallied all over Kathmandu. The pride event organized by Blue Diamond Society annually falls on the day of Gai Jatra – one of the oldest and notable of the many festivals celebrated.

In Kathmandu, largest city in Nepal, thousands of people gathered on its streets to watch as over 500 members of the LGBT community paraded through, carrying rainbow banners and banners.

“Our main demand is that the rights of the sexual minorities should be guaranteed in the new constitution,” said Pinky Gurung, of the gay rights group Blue Diamond Society, according to the New York Times.

Just this year, Nepal made a move by including an “others” category for this year’s passports for those who do not identify themselves as either male or female. The government of Nepal has also released citizenship certificates for those who are members of the “third gender.” On the other hand, these certificates are still hard to obtain from some government offices.

The Asia Pacific Transgender Network has been partnering with Blue Diamond Society and has collaborated with the organization on matters related to the rights and welfare of transgender people. This is part of APTN mission in supporting transgender rights and well-being.

E-Newsletter August 2015: Keeping up with APTN

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Robert Carr Civil Society Network Fund

The grant we received from Robert Carr Civil Society Network Fund (RCNF) has been a key aspect of strengthening relations and connections with countries. Last year we were able to successfully work with our partners in Thailand and Malaysia to help them strengthen their work in advocacy.

In terms of support, we provided our country partners with a small grant in order to fund their efforts. Specifically, in Malaysia we supported Justice for Sisters in their advocacy efforts to challenge the Shahria Law for criminalizing transgender women. We did this through activities such as security mitigation training and development of resources for trans women who are arrested. In Thailand we worked in partnership with Thai TGA (Transgender Alliance) to create guidelines for sensitization of the military conscription process for transgender women. Thai law still recognizes transgender women as men, which results in them being abused, discriminated and humiliated during military conscription. These guidelines will tell the military how to properly treat transgender women, and will inform transgender women on how to prepare for the day. It will be a very important resource for many transgender women in aiding them through the military recruitment process.

This year we plan to focus on four more countries in the region – Cambodia, Nepal, India and Pakistan. We look forward to supporting their advocacy efforts and seeing what changes can be brought about.

Communications and Advocacy Outreach

With a large percentage of the world being on social media, it is incredibly important for organizations to have an online presence. APTN recognized this and has been working on building up our social media presence through our Facebook page.

On our Facebook page we share articles, stories and photos of issues that are experienced by transgender people. We also share updates on the work and activities we are involved in. We currently have 2385 likes and we are working on expanding our presence by sharing a wider variety of articles and also posting more frequently. We also have a flickr page where we post photos from our meetings, events and other activities. We plan to invest further in Facebook and other social media sites like Twitter because we believe we can use them as an effective advocacy tool for our community.

This newsletter is another one of our communications efforts. It is supported by UNAIDS and will be published quarterly, containing stories, profiles and updates on the work being done in the region.

Website Launch

We launched the APTN official website in January 2015 with support and funding from UNAIDS.

The website contains information about our network, our work and transgender related events. It also provides viewers with easy access to publications, news and research/data resources about transgender issues in the region.

Another aspect of the website is that we encourage transgender individuals and organizations to submit their stories, experiences and information to the site. This gives people the chance to share their stories and also draw comfort or learn from reading about people’s experiences.

It is expected that this website will connect the transgender community in the region together. It will also be used as an important transgender data resource for the community, partners and academics.

Mapping

The mapping exercise developed by APTN provides a list of existing capacity in the region on transgender issues and also includes the contact detail list of all the organizations and advocates. The development of such a map is extremely vital for advocacy for trans people as it makes it much easier for APTN, partners and stakeholders to communicate and start further partnerships with each other. It gives organizations a chance to strengthen collaborations, both old and new.

The map also identifies the gaps of each transgender organization in the region, therefore providing them with a sense of where they can make improvements to their organization. It also allows for country networks to identify the areas that need to be focused on within the region.

The mapping resource developed by APTN is also the first effort to focus on trans-specific organization/networks or/and advocates. We aim to conduct a yearly exercise to keep the information up to date. We encourage more organizations to participate in the next exercise.

Community-to-community learning between Trans networks/ organizations

The community-to-community learning and mentoring gave us the opportunity to not only share but also learn from other transgender organizations. In this process, we are constantly learning and improving – and there is much to be learnt from other organizations around the world who are working towards the same cause as us. These activities were greatly aided by UNAIDS and Alliance.

We were able to work and partner with organizations in Mexico, Cambodia, Thailand, Nepal and the Philippines. During the TG network meeting in Mexico, we formed a partnership with TGEU. We agreed on the following activities to conduct together:

  • The social experience of trans* people: A global survey by TVT (Transrespect vs Transphobia) project
  • Legal and social mapping
  • Trans violence monitoring

The partnership with TGEU brings about a lot of promising collaborations for the future. Meanwhile in Thailand, we visited Sisters, an organization in Thailand. Sisters is a trans-led community organization providing HIV treatment, care and supports to transgender sex workers and other vulnerable transgender people. The meeting was an extremely productive experience, and after the visit we hoped to be able to connect Sisters with other organizations in the region in order to provide similar services.

Sisters is a great example of the extent to which a community led organization can make a difference. We were also able to visit another successful transgender organization in the Philippines called Colors. Colors aims to better the lives of transgender people and does so through various outreach programs and seminars about the human rights awareness, health concerns (with attention to HIV/AIDS and other STI’s) and appreciating one’s identity. Similar to the learning experience with Sisters, we are aiming to assist country networks to scale up the successful transgender programs across the region.

In Cambodia we had the opportunity to share some trans-positive practices in clinical settings with RHAC (Reproductive Health Association of Cambodia), an organization providing services to trans people. A few months after the meeting, RHAC has started looking at more inclusive and gender-sensitive staffs practices.

Finally, in Nepal, APTN visited Blue Diamond Society (BDS) and learnt more about the work they do the transgender community. We were able to gain a great deal from these programs and hope to continue similar ones in the future, with even more organizations.

Steering Committee

For the past year, APTN has had an interim board in place that has helped to guide us in terms of strategy. We are now moving towards a more permanent structure by electing a Steering Committee.

The Steering Committee is expected to continue the work and strategy that was already endorsed by the interim board. They will also guide APTN in terms of strategy and policies, as well as provide us with technical advice.

It was decided at the last APTN interim board meeting that the Interim Board would elect a Selection Committee made up of individual trans experts to conduct the interview. Over 30 applications were received and reviewed. Nine candidates were short-listed based on their experience as a board member, their technical and communication skills as well as their commitment and vision for APTN.

The Selection Committee was made up of Dr. Sam Winter (Curtin University, Australia), Manisha Dhakal (Blue Diamond Society, Nepal), Kath Khangpiboon (Thai TGA, Thailand), Jack Byrne (New Zealand) and Thomas Guadamuz (Mahidol University,Thailand). Results of the election will be announced later this year.

Advocacy and Strategic Information Products

UNAIDS and the Robert Carr Civil Society Network Fund provided support in our efforts to put out key advocacy and strategic information products. It is very important for transgender people to be represented as a separate community with diverse needs, and not just under the umbrella of MSM. Thus, it is important to spread information about the work we are doing and the needs of our community. We were able to do this year through our information products.

The total list of information products that we produced is the following:

  • Press releases
  • Brochure: distributed at various conferences, workshops and meetings
  • Donor Presentation: provided an overview of the work APTN is doing for new donors

Next year we will continue to put out even more advocacy and strategic information products as begin to collect more data about transgender people in the Asia and Pacific Region.

Registration of APTN as a legal entity

In an effort funded and supported by Robert Carr Civil Society Network Fund and HIV Alliance, APTN was finally registered as a Thai foundation. This comes as a great accomplishment as being registered gives us a lot more opportunities for funding and advocacy.

Donors often require registration in order to award grants. Thus, we can receive funding from a larger circle of donors now. As we are now a legal entity, we are able to have a wider outreach as an organization. It allows us to conduct many more activities in the future and also to reach a larger audience. It also makes it much easier for us to invite consultants and other organizations to work with us as we can now formally extend invitations to them. This benefits us greatly and we look forward to working with a wider scope of individuals.

Finally, APTN is the first regional transgender network to be formally registered as a legal entity in the Asia and Pacific region This is a great step forward in receiving more recognition for transgender issues.

Program development and Institutional Strengthening

Over this past year APTN held an interim board meeting to develop a new strategic plan. During this meeting we were able to identify the key areas that APTN would engage in:

  • Building regional network and country partners capacity
  • Generating strategic information for advocacy and policy
  • Advocacy campaign on legal recognition, employment and social welfare
  • Community-to-community learning
  • Creating APTN profile and partnerships

This strategic plan is still in the draft stages and it will be circulated once it has been finalized by the newly elected Steering Committee.

Development of regional concept note

APTN successfully organized Regional Transgender Community Consultation to Develop the Concept Note for Regional Proposal to the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). We worked with our six country partners including SISTER (Thailand), GWA-INA (Indonesia), MSM – TG network of Vietnam (Vietnam), COLORS (Philippines), NAZ Male Health Foundation (Pakistan) and Blue Diamond Society (Nepal).

Through working with our country partners, we were able to identify the needs and activities for the transgender community to be included in the regional concept note. This was also achieved in collaboration with APN+, APNSW and ANPUD for Global Fund.

The needs and outcomes we identified in the note include:

  1. Commmunity monitoring towards quality of services on HIV Prevention, Treatment, Care and Support program;
  2. Community Study on Community Lead HIV Counseling and Testing Service;
  3. Community based study on the barriers to access to services.

Our input and inclusion in regional concept notes such as this one are incredibly important as it will hopefully result in more data collected about transgender people in the Asia and Pacific Region. These studies will also focus on our community as a separate entity.

Organization and participation in the 20th International AIDS Conference

The 20th International AIDS Conference took place from 20th-25th July in 2014. APTN organized two satellite sessions for the conference. These events were ““APTN and the Voice of Transgender in Asia Pacific” and “The Challenges of Being Transgender”.

It was recognized by the transgender community how important it is for transgender people to be separated from the MSM umbrella. KAP networks, donors, partners and governments also addressed it extensively. We also raised the needs of more investment on the transgender community to strategic partners and key donors such as UNAIDS, Global Fund, Robert Carr Civil Society Network Fund and the Australian Government.

The sessions also gave us chance to strengthen our partnerships with other transgender networks. It also allowed us the opportunity to collaborate more with transgender organizations from America, Australia and Latin America as new partnerships were established.

Participation in key meetings

APTN had the opportunity to attend and participate in two key meetings in 2015: The Asia-Pacific Intergovernmental Meeting on HIV and AIDS (IGM 2015) and Beijing+20

The Asia-Pacific Intergovernmental Meeting on HIV and AIDS (IGM 2015)

During this meeting, we were a part of a Civil Society Organization (CSO) working group that was trying to organize a CSO Forum. This forum would be a platform for CSO’s to address their HIV and human rights issues. In addition to this, APTN also represented as a speaker in a side session called “My Body, My Rights: Fighting HIV through the lens of HIV”. APTN addressed the importance of fulfilling the right to make free and informed decisions on sexuality. We also discussed how vital it is to eliminate discrimination based on Sexual Orientation and Gender Identity (SOGI).

Beijing+20

We were actively involved with the platform “Unzip The Lips”. Unzip is a platform of organizations and individuals fighting for key affected women and girls. We collaborated with Unzip to hold a pre-conference to strategize with other key partners, like women who live with HIV, women who use drugs and sex workers. We were able to come up with strategies such as direct and personal approach to country delegations, and promoting the issues of key affected women and girls.

During the actual conference, we attended a press conference conducted by UN Women. During this press conference, APTN explained the existence of diverse gender identities. We also explained how it is much more suitable to understand gender as a continuum, rather than strike binary categories. In the side events conducted by UNAIDS, we emphasized that transgender women are women and should not be left behind in the women’s rights movements.

APTN’s participation in these two meetings brought about a lot of advocacy for the transgender movement, as well as spread knowledge of sexuality and gender.

Blueprint

The Blueprint for the Provision of Comprehensive Care for Trans Persons and their Communities in Asia and the Pacific is a much-needed publication that will provide public health officials, community led organizations, clinical service providers and more with complete transgender health information. This publication is in collaboration with the United Nations Development Program (UNDP), and the USAID-funded Health Policy Project (HPP), along with support from Linkages. The Blueprint is an adaptation of the PAHO Trans Health Blueprint, which focuses on the Caribbean and other Anglophone countries.

The purpose of the Blueprint is to strengthen and enhance the policy, clinical and public health responses for trans people in Asia and the Pacific. It is expected that the Blueprint will improve access to competent primary and specialized care for transgender people in the region. It will also help to promote the health of trans persons in Asia and the Pacific as it will identify the healthcare needs of the population. This publication is essential as there is no official trans health guide in Asia and the Pacific. However, this publication comes as the third regional Trans Health Blueprint.

The Blueprint details what the health issues are for the region and also includes recommendations for progressing trans health and human rights. Activists will be able to use the information in the Blueprint as evidence to push for changes within their own countries.

The Blueprint was a consultative process, engaging trans communities, stakeholders and experts. In order to complete the Blueprint, we had three regional consultations. Two of these took place in Bangkok while the other one took place in Nepal. After the Blueprint has been finished, funding has been set aside to create advocacy toolkits for selected countries to help turn it into local action plans.

APTN needs your advice for a series of trans resources about transitioning.

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The Asia Pacific Transgender Network (APTN) is creating a series of 5 short electronic resources based on common questions trans people ask about transitioning

Topics
The 5 resources will look at these topics:

  1. I think I might be trans
  2. Telling others (family, friends, your current partner, school or workmates)
  3. Non-medical transition steps (binding, tucking, asking friends to use a different name or pronoun)
  4. Medical transition steps (hormones and surgeries)
  5. Keeping safe and strong (dealing with bullying and transphobia, feeling good about your identity and your body, resilience)

APTN needs your advice

APTN wants these resources to be as useful as possible across the region. Please tell us the main questions people in your community ask about transitioning. We will try to include the most common questions in the resources.

Please send your questions to joe.wong@weareaptn.org by Friday 3 July.

Audience

The resources are for trans people in Asia and the Pacific, and people close to them who want to know more about the transition process. These include, for example, family members, partners, friends, work colleagues and allies.

Format

The resource will be written in English and accessible online, as a series of electronic documents that can also be printed out. They will avoid technical terms and be written in simple, accessible language.

Each resource will probably be between 4 and 6 pages long. Together they will be a maximum of 25 pages. The final versions will include graphics to make them easier and more interesting to read.

Partners

Is your organisation able to help APTN to distribute the final resources in your country? Would you also consider translating them into your local language? If you want to be a project partner, please contact APTN on: joe.wong@weareaptn.org

OP-ed: In quake hit Nepal transgender people turn adversity into opportunity

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This year began with such hope for transgender people in Nepal as the government announced citizens could identify as “other” on their passports. We were getting ready to celebrate the issuing of the first of these pioneering passports, when disaster struck the country. Among the thousands of people who were killed by the earthquake which hit the Kathmandu area a little over a month ago, were Lesbian, Gay, Bisexual, Transgender, Intersexual and Questioning (LGBTIQ) friends too.

Ciatala died when a house collapsed and her body was dug out of the rubble and brought to a teaching hospital. The Blue Diamond Society, dedicated to improving the sexual health, well-being and human rights of sexual minorities in Nepal, had the sad job of arranging a proper funeral. The Society has about 218, 000 members throughout the country. We continue to get reports of community members who are still missing.

The quake cast many transgender people out into the streets, as their homes crumbled; 65 homes of transgender people and their families fully destroyed, at last count. When relief camps were quickly set up, people without families were segregated into male and female camps. Where did that leave the third gender? Once again, a situation was created due to the disaster where the third gender felt excluded in a country viewed as one of the most progressive on gender-identity in the world.

We could not accept this. The Blue Diamond Society sprang into action a few days after the quake and organized a camp specifically for sexual minorities. In communal tents, transgender people- both transgender males and females – felt safer. The community may have lost their homes, yet discovered a new resolve and strength as they shared food, comfort and shelter; rebuilding lives together.

Since the quake, every day, the Blue Diamond’s support and hospice centre has been preparing food for community members. While the society’s three-storey building is still standing, there are cracks on the walls and the structure needs to be repaired. This means that transgender people and other sexual minorities living with HIV, who received care in the Blue Diamond Society hospice had to leave. Most of them have moved to the India-adjoining Terai districts.

Not only in Nepal but in many other countries, transgender people are often at higher risk of HIV. This is because they rarely have identity papers that affirm their gender, and without such legal recognition they are excluded from education and employment opportunities. They face exclusion, discrimination, violence and lack of access to appropriate health care. A UNAIDS report finds that globally, the chance of acquiring HIV is 49 times higher for a transgender woman than other adults of reproductive age.

In Kathmandu, 300 transgender women were making a living selling sex before the quake. Now, not only do the women find it hard to find customers, their landlords increased their rent and they were thrown out of their homes; a clear case of discrimination and rights violation at a time of extreme vulnerability. Without permanent shelter and steady income the trangender women’s living conditions are difficult. However, international relief agencies have provided tents, blankets and water purification tablets to help them get through the initial emergency period.

Gender considerate disaster risk reduction is essential, and transgender people need to be included in preparation planning. Their voices must be heard and their issues must be addressed in the current post disaster risk assessment. The lack of government identification papers which reflect their gender identity often leads to exclusion from relief centres or government handouts. Also, basic facilities such as toilets and bathrooms in emergency shelters are often divided into male and female venues. In the best of times, forcing transgender individuals to choose between male and female toilets can lead to embarrassing encounters and in the worst of times it can spell danger: having to share toilets particularly at night put transgender persons at risk of violence and rape.

While many transgender people in Nepal still face an uncertain future, the community is proud to have come this far. Few disaster relief plans in the past have taken into account the needs of sexual minorities. It is rare for evacuation centres to provide private space for transgender people and other sexual minorities. In partnership with international organizations, the Blue Diamond Society has now organized 15 tents in Kathmandu for people of the LGBTIQ community; and 50 tents to transgender persons and their families, in the other affected districts.

While the road ahead is difficult, we are confident that transgender people in Nepal can continue to be a beacon of hope for their peers across Asia and the Pacific. The transgender community is using the same courage, resilience and tenacity that won them legal recognition, to shape relief efforts in Nepal. We hope their experience can set an example for future emergencies around the world.

Manisha Dhakal, Executive Director, Blue Diamond Society,
Joe Wong, Programme Manager, Asia Pacific Transgender Network

Kathmandu and Bangkok, 3 June 2015

Contacts: manishadhakal.nepal@gmail.com and joe.wong@weareaptn.org

APTN IDAHOT2015: The Importance of Support for Transgender Youth

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Bangkok, 17 May 2015

The International Day Against Homophobia and Transphobia is commemorated every May 17th; an important day for the transgender community to raise awareness to the broader society in order to stop transphobia. Emotional, physical and sexual violence experienced by transgender people is the result of transphobia, causing great damage to the community and their loved ones. The number of murder case of transgender people had shown that the largest groups of murdered transgender people are on the age between 20 to 29 years old.

A report from Transgnder Europe (TGEU) shows that in the last seven years. 131 transgender and gender diverse persons under the age of 20 have been reported murdered. Where the location of death is reported, 38% were murdered on the street and 24% were murdered in their homes.[1] This alarming number of the murder of young transgender people causes great concern for the transgender communities.

The Importance of Support for Transgender Youth

Support from families are urgent and crucially needed for transgender youth as the role of family is to act as the support system for the children. Anecdotal evidence shows that first-hand bullying is experienced by transgender youth within their family.

“Violence by family members ranged from emotional and physical to sexual violence, some also were forced to wear hair and clothes aligned with societal gender norms and often trans youths are neglected when programs are being developed to address violence against youths”, said Joe Wong.

Apart from family support, educational institution is equally important to ensure transgender youth have a safe space and support system when faced with transphobia from peers or family. Many transgender youth discontinue their education due to the stigma and discrimination experienced within the school. A five countries study conducted by IGLHRC showed that LBT youth experienced physical, verbal and sexual harassment and expulsions in school[2]. Protection for transgender and gender diverse students from transphobic bullying from peer group, teachers, senior, and other school staff can help to enable the environment for youth transgender.

Transphobia is also one of the main barriers that prevent youth transgender to access health care services. Many feel reluctant to access the services because of the judgmental attitude of the staff and negative comments and behavior of the healthcare providers. Generally speaking, transphobia can also be found in public spaces, conducted by any official officers, and taking many forms (verbal, non-verbal, and physical violence).

“Sometimes when we talk about the rights of young people – the rights to identify to any identity they are most comfortable with are usually forgotten. The adults in the children’s environment have the responsibility to ensure the safety and support the children to develop healthy self-esteem, not otherwise. Instead of busy worrying about morals of the young people who comes out as trans, ensure them to have universal values such as kindness, honesty, compassion as their core virtue. With these virtues, young people have the opportunity to appreciate themselves better, therefore allowing them to empower themselves to have supportive environment. In the end, kindness and good virtues knows no gender afterall.”, Kevin Halim.

Taken the chance of the international day to reduce transphobia, IDAHOT 2015 aims to raise awareness of the public about the importance to end homophobia and transphobia within the society with more attention for young people. Through the awareness, it is hoped that the society can start support the young people, especially young transgender people and people with diverse gender identity that eventually help them to protect them from transphobic violence.

Asia Pacific Transgender Network urgently call for the following in support of trans youth:

  • Psychosocial support for family with transgender children or youth.
  • Support systems in school that protect and respect the rights of youth transgender from transphobic bullying in school settings, including but not limited, from their peers, senior, teachers, and staffs.
  • Equal opportunities for youth transgender people in education.
  • Equal opportunities for youth transgender people in employment.
  • Increase access in health care setting.

Contact Information:

Joe Wong
Programme Manager
Email: joe.wong@weareaptn.org

Natt Kraipet
Network Coordinator
Email: natt.kraipet@weareaptn.org

Blue Diamond Society updates and appeal for help: The aftermath for the recent devastating earthquake that hit Nepal hard affecting homes of LGBTI people.

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Dear friends and colleagues,

With heavy hearts, sadness and sense of fear, Blue Diamond Society, on behalf of Nepalese sexual and gender minority communities, sends this updates on aftermath of recent devastating earthquake that hit Nepal hard. You must have heard the news and some information already shared from our founder Sunil babu pant and other colleagues of BDS that LGBTI community are also equally affected if not more. The level of devastation in Nepal is huge and much is still not known. Even before the earthquakes, Nepal had electricity power load shading. There is now an acute electricity shortage which severely limits mobile coverage too.

Since the earthquakes the BDS has been trying to contact and search for our members and staff. We found the body of Ciatala (Kumar Bhujel), who identifies as third gender, in a teaching hospital. We reached her in time and found her. Otherwise the security force were ready to do a mass funeral of unidentified bodies. We have informed her mother in Dharan and we did funeral at Pashupati Aryeghat today.

A member of BDS’s care and support team, Jyoti Prakash KC, is still missing. We visited several hospitals in Kathamndu and are unable to find him. Moreover we have got information today that two more transgender; Melina and Bhawani are also missing.

The BDS’s main building and its care and support building are both cracked and damaged. Friends’ and colleagues’ houses have collapsed. Most of LGBTI people are spending nights under some tents with BDS banner for security and identification. There is shortage of gas and food and the BDS has run out of food for the care and support and hospice for HIV positive LGBTI.

Around 300 trans women / metis in Kathmandu survive through sex work. They now have no way of earning money.Many LGBTI members from kavre, Gorkha, Dhading, Nuwakot, Kathmandu, Makwanpur,Bhaktapur, Jhapa, Saptari and several other districts have lost their homes. Relief camps are there but only for general population, segregated facilities into binary genders, excluding THIRD gender. Even accessing toilets are a big issue for TG.

This is just an preliminary report, we will keep updating you as get more information from the ground, especially from remote districts of Nepal.

The needs are huge and for many months to come. The immediate needs: tents, clothes, blankets, umbrellas, water, food and medicine, fuel for generator and BDS’s vehicle for about 4 to 6 months. Its difficult to estimate the amount needed just now but we can suggest something in a week times, however it is going to be a significant amount in BDS terms, any thing from 100 thousands to couple of mullions US dollars.For longer term: fund to repair both the damaged building of BDS, rehabilitation of LGBTI who have lost their homes and income/job creating program to support livelihood of LGBTI, mostly for those sex workers whose income are completely stooped now.

People have been asking us how to support LGBTI people in Nepal. This request has details of the an appeal that has been launched by the Blue Diamond Society.

Please forward it to your networks – we need your support right now.

You can support by different ways, for bigger amounts, please send fund directly to BDS bank account.

Details are:

Account Name: Blue diamond society
Account Number: 01400105200316
Swift Code: EVBLNPKABank Name: Everest Bank Limited, Branch Office,
Lazimpat Kathmandu Nepal
Physical Address: Blue Diamond Society Dhumbarahi Height-4, Kathmandu.
Ph: +977 1 4443350, +977 1 4426652

For smaller amount, any agency in each country can initiate collection of funds for BDS and send it later to BDS.

Thank you for your generosity, concerns and solidarity.

The internet connection and phone lines are still sporadic, but please contact us if you need more information at

Pinky Gurung,
President
+977 9841313377
bdsboard@gmail.com

Manisha Dhakal,
Executive director
+977 9849214901
manishadhakal.nepal@gmail.com

Nepal minister: Government ready to amend anti-gay legal provisions

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This community should be treated as any other human being.
Nepal’s minister for information and communication has said the government is ready to amend discriminatory legal provisions against sexual minorities.

Speaking on Wednesday (4 February) at the first day of a three-day South Asian transgender and hijra consultation in Kathmandu, Minendra Rijal said the government had started the process by issuing passports with a third gender.

‘This community should be treated as any other human being,’ he said, adding that his party, the Nepali Congress, had mentioned equal rights for sexual minorities in its manifesto.

However, Rijal said equality could not be achieved through legal advancement and policies only, but also required changes in society’s attitudes and behavior.

‘I urge the community to stand up and take a lead,’ he said.

‘As a minister, I will prepare myself to be a leader who will lead in such a way that encourages everyone to be more sensitive towards the issues of rights and health for the transgender and hijra community – with the hope of change resulting that will be considered revolutionary in retrospect.’

In South Asia, transgender people often find themselves pushed to the social, legal and economic margins of society thanks to pervasive stigma, discrimination, prejudice, harassment and abuse. In many places they live in fear of transphobic violence.

However, in the recent years Nepal, India, Pakistan and Bangladesh have recognized third gender citizens.

‘This is a good start. But we also need equal opportunities in education, employment and easy access to health services,’ said Manisha Dhakal, deputy director of the Blue Diamond Society.

‘Programs for us should not be restricted to distributing condoms, lubricants and HIV/STI related services – creating an enabling legal environment is equally important for us.’

Gay sex is criminalized in the most South Asia countries but Nepal legalized homosexuality in 2007.

Subarna Karmacharya, director of the National Human Rights Commission of Nepal, vowed to give priority to complaints regarding LGBTI issues and ensure that gay rights receive special mention in its upcoming strategic plan.

The consultation was jointly organized by Blue Diamond Society, Asia Pacific Transgender Network and UNDP under the Multi-Country South Asia Global Fund HIV Program, with support from UNAIDS, USAID, PEPFAR and the Health Policy Project.

See more here.

Leave to Appeal is Granted in Malaysian Crossdressing Case

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The Federal Court has given the Negeri Sembilan state government permission to appeal an earlier Federal Court of Appeals ruling that makes cross dressing legal in the state. However, the court is limiting arguments to constitutional ones, rejecting interventions from the Islamic State Councils of Selangor, the Federal Territory of Kuala Lumpus, Penang, Johor and Perak, as well as UMNO (the malay front of the ruling coalition led by the prime minister).

In the January 27 leave hearing, the panel of five judges told the Negeri Sembilan state lawyer, Shafee Abdullah, that the case should address fundamental constitutional arguments – the question of whether section 66 contravenes articles 5, 8(1), 8 (2), 9 and 10 of the Federal Constitution – rather than addressing the question of whether the Appellate Court has jurisdiction over Shariah law.

Justice for Sisters welcome the constitutional approach mandated by the Federal Court.

Nisha Ayub, Advocacy and Community Engagement Coordinator for Justice For Sisters says: “Our gender identity is one of our fundamental human rights, and the state is duty bound to promote and protect the rights of all its citizens, including transgender persons, from discrimination and violence simply because of who we are. The state also has an obligation to end state-sanctioned violence and oppression towards its constituents, and to put an end to impunity for perpetrators of violence and oppression.”

“There must be separation of state and religion, and the state must uphold rule of law at all costs. In addition, we have to be vigilant of misuse or abuse of power, and not allow the powers that be take away our autonomy,” added Shika Corona of Justice for Sisters.

“Transgender people are often on the receiving end of hatred, intolerance and abuse, against their will. The state’s Shariah law once again attempts to undermine the respect, equality and dignity of transgender people, without concern for those citizens who are on the receiving end of the violence and discrimination. Thankfully, it seems that the Federal Court is firm on the constitutional right to dignity of all citizens, regardless of religion,” said Joe Wong, Program Manager for the Asia Pacific Transgender Network.

For enquries, please contact justiceforsisters@gmail.com

Transgender Day of Remembrance

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The 16th annual Transgender Day of Remembrance (TDoR) is celebrated today and on November 20 each year in tribute to those transgender men and women who have lost their lives to hate crimes or suffered from prejudice. TDoR began in San Francisco and is now held worldwide, bringing greater visibility to the transgender community and highlighting the hatred and ignorance transgender people face daily.

Violence against transgender people is increasing worldwide. A project monitoring transgender violence – Transrespect versus Transphobia Worldwide (TvT) – has documented 1,374 reported killings of trans people in 60 countries over the past six years (January 2008 through October 2013). Two hundred thirty-eight (238) transgender murders were reported in the past year alone (November 20th 2012 to October 31st 2013).

In the Asia Pacific region, 121 murders of transgender persons have been reported by the TvT project. The highest number of cases was reported in India (30 murders), followed by Philippines (29 murders) and Pakistan (20 murders). Perpetrators of violence toward genders often benefit from a culture of impunity, sometimes government-backed. Transgender murders may occur without documentation or with no proper monitoring system. It is difficult to estimate the actual numbers of cases of trans-violence.

Only last month, Jennifer Laude, a transgender Filipino woman, was found strangled and drowned in the hotel bathroom after spending the evening with U.S marine Joseph Scott Pemberton. The Philippine court has charged Pemberton with her murder, but he did not appear in court despite a subpoena.

“The Visiting Forces Agreement (VFA), which the two countries signed in 1998, allows the US military to act in wanton disregard for the Philippine sovereignty… and violates the human rights and dignity of the Filipino people,” said Congressman Walden Bello of Akbayan Party, an ally of the president, according to Reuters. Laude’s murder and the protection given to Pemberton during this period have been met with outrage in the Philippines.

The Transgender Day of Remembrance aims to build awareness and understanding of transgender people and begin to re-establish a climate of acceptance and support for all transgender men and women, especially those who have suffered in the present climate of discrimination and violence.