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They have also made marked steps in officially recognising transgender people, also called Hijras, as a third gender.
This means that local authorities need to ensure that they have health and social programmes that meet the needs of Hijras and has given them the right to vote.22 Providing welfare, employment initiatives and housing can help address the factors that make transgender people more likely to engage in high-risk sex.23 Services for other needs should also be provided, such as mental health counselling and support for a sex change operation.
This platform means referrals can be tracked across services in real time, allowing programme staff to respond to client drop-out, adapt outreach approaches to target efforts where they are needed, and follow-up with clients via SMS messaging.
Programme data from the first nine months of implementation in the city of Chiang Mai shows:• significantly higher rates of HIV testing uptake (77%) compared with traditional group-based outreach (31%)• higher uptake of HIV test (94%) compared to those reached with traditional “hot-spot” recruitment (54%)• among clients who tested positive for HIV, those reached via social network recruitment were more likely to initiate ART (77% compared with 38%).24Case study: Community empowerment helps HIV prevention services reach thousands of transgender people in India In India, national HIV prevalence is 0.31%, whereas HIV prevalence among the transgender community is estimated to be 8.2%.25 A range of social, economic and legal factors contribute to the increased risk of HIV faced by transgender people who are marginalised and often lack access to health and other basic services.
Targeted prevention approaches that respond to the specific needs of individuals are essential to reducing HIV infections.
In addition, prevention initiatives that empower transgender people and enable them to take the lead in meeting the needs of their own community are the most effective.19 Sexual health care for transgender people is often inadequate, with many policy makers and service providers failing to address the needs of transgender women as a population distinct from men who have sex with men.20 Only 39% of countries in 2014 had specific programmes targeting transgender people in their national HIV strategies.21 India is one country where HIV services have been successfully targeted at transgender people – reaching an estimated 83% of the transgender population.
This makes them less likely or able to access services, damages their health and wellbeing, and puts them at higher risk of HIV.
Pehchan incorporates true community involvement at all programme stages and works with community-based organisations (CBOs) to empower individuals through gender-affirming activities.
However, very little is known about transgender men and their vulnerability to HIV.