To mark Zero Discrimination Day, the Asia Pacific Transgender Network (APTN) is launching its new report, 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 Nepal, Indonesia, Thailand, and Vietnam. This year UNAIDS’s campaign on Zero Discrimination highlights the urgent need to take action to end the inequalities that continue to persist around the world. Everyone has the right to enjoy the highest attainable standard of physical and mental health without stigma and discrimination.
Yet when it comes to access to healthcare, trans and gender diverse people continue to experience unique gender-based stressors and intersecting discriminations. The Cost of Stigma, the first-ever trans-led research implemented in Nepal, Indonesia, Thailand and Vietnam gathered evidence on the availability, accessibility, acceptability and quality of sexual health and HIV, general healthcare and gender-affirming care services and to gain a better understanding of the barriers trans and gender diverse persons experience.
Our research found that discrimination remains to be the strongest barrier to access to healthcare services. In all four countries, trans people shared their experiences of discrimination, and how they had delayed seeking necessary general health care because they continued to fear negative and discriminatory treatment. In Nepal, 35% of respondents had delayed seeking health care due to fear of discrimination, and this figure was higher for trans women, sex workers, and older people. In Indonesia, nearly 40% of respondents delayed for this reason, with more sex workers fearing discrimination. The lowest rate of delaying treatment due to fear of discrimination was in Thailand, where only 9% said they had delayed seeking general health care for this reason. However, in Thailand, fear of stigma and discrimination was the most cited reason for avoiding STI and HIV test and treatment, i.e. people who had experienced discrimination accessing HIV services were more likely to have never visited a provider for PEP (95.8%) as compared to those who had not experienced such discrimination (77.9%). In Vietnam, nearly 52% of survey participants had delayed treatment because of anticipated discrimination. In the FGDs, participants reported stigma and discrimination (including use of derogatory and mocking terms) when accessing general health services. Several respondents shared experiences of breach of privacy, ridicule, and lack of knowledge about trans health care.