ABSTRACT
In the more developed economies, any discussion on transgender health tends to focus on the unique health care needs of this small population, particularly during a process of gender transition. It is simply assumed that transitioning transgender persons still obtain unhindered access to routine general health care, not associated with the transgender phenomenon. In reality, transgender persons experience significant discrimination in accessing health care services in more developed countries. In the less developed countries of the global South, there are almost no reliable data sources on the social exclusion of transgender persons, or on prevailing social norms in the context of transgender inclusion. Anecdotal evidence does exist, largely through social media and personal interactions, and such anecdotal evidence indicates that the level of stigma, rejection, humiliation, and even violence encountered by transgender persons seeking either routine or transgender-specific health care is both commonplace and extreme, leading to situations where these populations are entirely excluded. With no systematic data collection taking place, and a consequent lack of funding support to gather essential baseline data, governments in the North and South effectively ignore the discrimination and high levels of insecurity directed at transgender persons. In the absence of such data, researchers are unable to assess the degree to which this insecurity is due to governmental intention, ignorance, or entrenched patriarchal norms, attitudes, and behaviors.
The author formerly led the Dignity for All emergency assistance program, which is the world’s largest outreach to lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI) persons. She also has worked as a development practitioner and academic in over 60 countries, and maintains a relatively large personal yet global network of contacts within the LGBTQI community. While cognizant of the risk of inherent bias, this chapter relies on anecdotal evidence accessed through voluntary and uncompensated key informant interviews (KIIs) within her network, most of whom remain anonymous to protect their safety. The author has used these KIIs, and where available other sources as cited, to characterize the endemic and often structural violence affecting transgender persons in four countries: the United States, Jamaica, Kenya, and Russia. It places this within the contexts of feminism, development ethics, gender based violence, and transphobia, and seeks to create a framework for future analytical data collection and analysis by governments, research institutions, and NGOs.
