Improving Transgender Health in Southeast Asia

January 11, 2023

A first-of-its-kind study seeks to guide gender-affirming HIV prevention and care services in Thailand, Vietnam, and the Philippines

While research on improving health outcomes for transgender people living with and without HIV in North America, Europe, and South America has been initiated, less is known about the health factors that impact members of this key population in Asia and how healthcare workers might best respond to their needs.

TREAT Asia helped mark the seventh anniversary of one of the study’s participating organizations in Thailand, the Tangerine Clinic, founded by Rena Janamnuaysook of IHRI (second from right). TREAT Asia staff in attendance included (left to right) Dr. Jeremy Ross, Boondarika Petersen, Chidchon Chansilpa, Dr. Annette Sohn, and, to the right of Ms. Janamnuaysook, Katiphot Kanoknorrasade.

A multisite, prospective observational cohort study, sponsored by amfAR’s TREAT Asia program, in collaboration with the Institute of HIV Research and Innovation (IHRI), Thailand, seeks to close these knowledge gaps and improve related health services.

Led by principal investigator and IHRI Executive Director Nittaya Phanuphak, MD, PhD, SEATrans (The South-East Asian Transgender Health Cohort) is enrolling 300 HIV-negative transgender people and 150 transgender people living with HIV from four community-based organizations and clinics in the region—the Rainbow Sky Association of Thailand (RSAT) and the Tangerine Clinic (IHRI), both in Bangkok, Thailand; Victoria by LoveYourself in Manila, the Philippines; and Glink in Hanoi, Vietnam. These organizations provide clinical services for HIV, sexual health, psychosocial health, and gender-affirming care.

SEATrans will regularly assess the biomedical, structural, and psychosocial risks among transgender people living with or without HIV who access tailored service packages at the participating programs. This includes monitoring health outcomes, including HIV seroconversion, pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) uptake and adherence, viral suppression, and long-term metabolic complications. The study is funded by the U.S. NIH through the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium and TREAT Asia, amfAR.

TREAT Asia team at another of the study’s participating organizations, the Love Yourself Clinic, Manila, the Philippines. Left to right: TREAT Asia’s Katiphot Kanoknorrasade and Dr. Annette Sohn, LoveYourself’s Yanyan S. Araña and Dr. Ronivin G. Pagtakhan, and Dr. Jeremy Ross (TREAT Asia).

There is an urgent need for research that informs evidence-based guidance and health services for transgender people. The reported HIV prevalence among transgender women in Thailand, Vietnam, and the Philippines ranges from 12% to 18%, strikingly higher than the 0.9% among the general population, and data on transgender men in these countries are very limited. Globally, transgender women’s risk of acquiring HIV has been estimated at 49 times greater than the general population. Compared to cisgender people living with HIV, transgender women living with HIV are less likely to be taking ART, and, if they are, they are less likely to achieve viral suppression. Transgender women who are HIV negative have a lower uptake of PrEP compared to other populations as well.

“In general, health disparities among transgender women and men are caused by a range of factors, including stigma and discrimination, violence, and poor mental health, which can put them at risk of acquiring HIV and other health conditions,” says Rena Janamnuaysook, MBA, one of the study’s co-investigators, who is the Implementation Science Program Manager at IHRI and a co-founder of the Tangerine Clinic. “In Thailand, previous studies have shown that almost half of transgender women and men have had negative experiences with traditional healthcare providers related to their gender identity. Our study will provide a better picture of how to provide gender-affirming health services for transgender people living with HIV and without HIV in Thailand, Vietnam, and the Philippines.”