Technical Brief

Alice Armstrong
James Baer
Rachel Baggaley
Annette Verster
Publication Date
September 1, 2015

World Health Organization (WHO)

"Stigma and discrimination against transgender people frequently cause them to be rejected by their families and denied healthcare services, including access to HIV testing, counselling and treatment."

This technical brief aims to catalyse and inform discussions about how best to provide services, programmes, and support for young transgender people. It offers an account of: current knowledge concerning the HIV risk and vulnerability of young transgender people; the barriers and constraints they face to accessing appropriate services; examples of programmes that may work well in addressing their needs and rights; and approaches and considerations for providing services that both draw upon and build the strengths, competencies, and capacities of young transgender people. They are among the key populations at higher risk of HIV that also include men who have sex with men (MSM), people who inject drugs, and people who sell sex. Young people who belong to one or more of these key populations - or who engage in activities associated with these populations - are made especially vulnerable to HIV by widespread criminalisation, discrimination, stigma, and violence, combined with the particular vulnerabilities of youth, power imbalances in relationships and, sometimes, alienation from family and friends. These factors increase the risk that they may engage - willingly or not - in behaviours that put them at risk of HIV, such as frequent unprotected sex and the sharing of needles and syringes to inject drugs.

In the area of HIV risk and vulnerability, the brief examines: unprotected sex; drug and alcohol consumption; other forms of injecting; changes during adolescence; transphobia, stigma, discrimination, maltreatment, and violence; social marginalisation; lack of information and misconception of risk; racial and ethnic marginalisation; relationship status; and selling sex. In the area of legal and policy constraints, the brief examines: criminalisation; police harassment and violence; and restricted access to services. In the area of service coverage and barriers to access, the brief examines: availability and accessibility; uptake of HIV testing and counselling; access to transgender-specific medical procedures; stigma and discrimination by service providers; and lack of capacity among health-care providers. Throughout, quotations by young transgender people around the world are included. In addition, one section of the brief provides concrete examples in the form of text boxes illustrating promising programmes addressing the needs and rights of young transgender people that are being implemented by governments, civil society organisations, and organisations of transgender people themselves. Strategies examined focus on: creating a welcoming environment for young transgender people (Health Outreach to Teens (HOTT), Callen-Lorde Community Health Center, United States, or US); training young key populations in leadership and advocacy (Youth LEAD, Asia-Pacific region); promoting healthy transitions among young transgender people (Silueta X Association, Ecuador); addressing self-stigma through an awareness campaign (Youth Voices Count, Asia-Pacific region); and involving young people in programme feedback (MCC New York Charities, US).

The brief next outlines considerations for programmes and service delivery, stressing the importance of designing and delivering services in a way that takes into account the differing rights and needs of young transgender people according to their age, specific behaviours, the complexities of their social and legal environment, and the epidemic setting. Sample suggestion: "Ensure that services are non-coercive, respectful and non-stigmatizing, that young transgender people are aware of their rights to confidentiality and that any limits of confidentiality are made clear by those with mandatory reporting responsibilities or those who would like to seek assistance for young transgender people." Finally, there is a list of considerations for law and policy reform, research, and funding. Sample suggestion: "Advocate for removal of censorship or public-order laws that interfere with health promotion efforts." An annex examines the United Nations Convention on the Rights of the Child (1989).

This technical brief is one in a series addressing 4 young key populations (see Related Summaries, below). It is intended for policymakers, donors, service planners, service providers, and community-led organisations. This series was led by the World Health Organization (WHO) under the guidance, support, and review of the Interagency Working Group on Key Populations with representations from: Asia Pacific Transgender Network; Global Network of Sex Work Projects; HIV Young Leaders Fund; International Labour Organization; International Network of People who use Drugs; Joint United Nations Programme on HIV/AIDS (UNAIDS); The Global Forum on MSM and HIV; United Nations Children's Fund (UNICEF); United Nations Development Programme (UNDP), United Nations Office on Drugs and Crime; United Nation Educational, Scientific and Cultural Organization (UNESCO); United Nations Populations Fund (UNFPA); United Nations Refugee Agency; World Bank; World Food Programme; and WHO.


UNDP website, January 23 2017. Image credit: © UNICEF/PFPG2014P-0822/Mawa