According to the policy brief titled “The Value of Investing in MSM Programs in the Asia-Pacific Region”, for APCOM/ USAID Health Policy Initiative (APCOM Policy Brief No. 1, March 2008), there is strong evidence establishing male-tomale sex as one of the driving forces of HIV transmission in the region. HIV prevalence among MSM and transgender populations ranges from 3% to 31% in Asia-Pacific countries1 (5 to 15 times higher than overall HIV prevalence). In India, for instance, the latest estimates by National AIDS Control Organisation (NACO), India, show that prevalence among MSM and transgender populations was 5.7% in 2006 as against the overall adult prevalence of 0.36%.
Technical and funding support based on such evidence for large scale strategic interventions that address male-to-male and transgender sexualities and related HIV vulnerabilities is only now beginning to materialize in the region. One of the first steps needed in scaling up this response is to map the populations concerned and their representative groups, organizations and networks. This study was commissioned by APCOM and carried out by SAATHII, and aimed to map the situation of and HIV ‘infrastructure’ for transgenders in the South Asian countries of Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka.
The mapping study focused on transgenders, given that not enough is known about their specific vulnerabilities to HIV and the response that is already under way to address these vulnerabilities.
The study aimed to:
a) Create a database of groups, organizations and networks addressing HIV prevention, care, support and treatment issues of transgenders in the South Asian region
b) Assess the geographical spread and coverage of these groups, organizations and networks
c) Assess the type and quality of their current HIV response; and
d) Assess their readiness for scaling-up this response.
The study covered both community-based organizations (CBOs) and other voluntary (and private sector) agencies to gain a comprehensive overview.
Estimating transgender population sizes and the reach of the groups, organizations and networks mapped was beyond the scope of this study. However, as an example, we can consider NACO’s 2006 estimate of 2.35 million MSM and transgender people in India. Even if the transgender population were to be a fraction of this figure, a far higher number of HIV interventions would be needed than the 100 odd mapped by this study. Given the vast geographical areas and huge populations of the countries in South Asia, a total of only 122 groups, organizations and networks serving transgender HIV concerns require urgent attention from both government and civil society agencies.