GENDER-BASED VIOLENCE AFFECTS TRANSGENDER PEOPLE AND OTHER KEY POPULATIONS

Written by Hally Mahler, Project Director, LINKAGES, and Rose Wilcher, Director, Research Utilization, FHI 360

This blog post was first featured on the LINKAGES blog in November 2016.


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In 2015, a friend and colleague, Beyonce Karungi, wrote about what it is like to be a transgender woman in Uganda. She talked about being rejected by family members and about being beaten up and burned with cigarettes for being transgender. She described being harassed by police who wanted to make her a “proper man.” She recounted being raped at gunpoint by a client when she was a sex worker, because she insisted that he use a condom. Beyonce wrote that “… from the standpoint of a transgender woman like myself — our human rights and unique challenges are not addressed and not given the attention they deserve.”

Beyonce’s story is not uncommon. Experiences of violence are widespread among key populations: sex workers, men who have sex with men, transgender people and people who inject drugs. Here are just a few examples:

This violence can often be traced back to homophobia, transphobia and other rigid beliefs about acceptable behavior for men and women. For example, perpetrators of violence against men who have sex with men often claim that they are attempting to “cure” men who are perceived to have rejected their masculinity. Likewise, transgender people experience violence from those who believe they have not fulfilled expectations associated with the sex they were assigned at birth.

Trans women are particularly vulnerable to violence from those who believe that experiencing violence is part of what it means to be a woman. Much of the violence that is directed at female sex workers and women who inject drugs is a manifestation of gender inequality and discrimination against women more broadly. But levels of violence against both are exacerbated by the belief that women who sell sexual services or inject drugs are immoral and have strayed from socially acceptable behaviors for women.

A broader understanding of gender-based violence

From November 25 through December 10, individuals and organizations around the world are participating in the 16 Days of Activism against Gender-based Violence campaign. Every year, this campaign brings attention to the urgent need to eliminate violence against women and girls. But, the campaign is also an opportunity to examine the root causes of gender-based violence and shed light on those who experience such violence but who are not traditionally recognized during the 16 days.

FHI 360’s LINKAGES project promotes an inclusive view of gender-based violence — one that acknowledges that it affects not only women and girls in the “general population,” but also men who have sex with men; transgender individuals; and highly marginalized groups of women, such as sex workers and women who inject drugs. These groups are often omitted from calls to end gender-based violence.

HIV and gender-based violence

Experiences of violence increase the risk of key populations acquiring HIV and deeply affect their desire and ability to obtain health care, get tested for HIV and adhere to HIV treatments. For example, epidemiologic modeling has shown that reducing violence against female sex workers would reduce new HIV infections among sex workers and adults in the general population by 25 percent and 6 percent, respectively.

We will not make sustainable gains against the HIV epidemic if we do not also address the violence that key populations experience at the hands of family, community members, health care providers and police. Here are five ways that everyone who works with key populations can address gender-based and other forms of violence:

  1. Uncover the root causes and gender dimensions of violence against key populations. By conducting gender analyses, as LINKAGES has done in Kenya and Cameroon, we can reveal how gender norms and beliefs underlie much of the violence faced by key populations and identify ways to challenge harmful beliefs and better address such violence.
  2. Support community-led solutions. Community-based organizations headed by members of key populations are taking the lead in delivering the HIV services that their community members want and need, including addressing violence. In addition, outreach workers and peer educators from key population communities can be trained to screen for violence and provide first-line response in line with global best practices.
  3. Work with police and other community power holders so that they become allies in responding to violence and building stronger crisis response systems. Programs must garner commitments from local attorneys, hospital staff, psychologists, peer educators, and police that they will offer client-centered, nonjudgmental services to all survivors of violence, and that they will facilitate key populations’ ability to report violence when it occurs.
  4. Advocate for legal and policy reforms that explicitly protect the human rights of key populations. Even in hostile legal environments, steps can be taken to prevent and respond to violence. For example, we can advocate for the explicit inclusion of sex workers, men who have sex with men and transgender people in any legislation that is created to protect women and girls from gender-based violence.
  5. Draw attention to the science and the stories on the causes, consequences and experiences of gender-based violence among key populations, as well as the evidence-based strategies for addressing such violence. Through the LINKAGES blog series, Key Population Heroes, and our project newsletter, The LINK, we amplify the voices of key population members who have bravely shared their experiences of stigma, discrimination and violence and called on us to join them in fighting for change.

Toward a more inclusive campaign against gender-based violence

Many people think of gender-based violence only in relation to women and girls. But, by developing a more inclusive view, we can help ensure that policies, preventive efforts and response systems benefit all those who experience such violence. Understanding and addressing the broader gender-based aspect of this problem will also allow us to strengthen the networks and combine the resources of the groups that are working to dismantle gender-based discrimination and advance the human rights of all women, girls, and sexual and gender minorities.

During the 16 Days campaign, we will hear from colleagues representing key population communities about how they are affected by gender-based violence and what they are doing about it. We invite you to subscribe to the LINKAGES blog, contribute to the conversation on social media, and join us in advocating for the right of all people to live free from gender-based violence.

Transgender day of remembrance: thoughts from a trans peer educator in Dominican Republic

Interviewee: Macarena Pérez, Transgender Peer Educator, Centro de Promoción y Solidaridad Humana (CEPROSH), Dominican Republic
Interviewer: Betty Alvarez, Consultant, FHI 360


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Transgender Day of Remembrance (TDOR) is an annual observance on November 20th that honors the memory of lives lost in acts of transphobic violence. On TDOR, LINKAGES is honored to feature the work and perspectives of one of our trans peer educators – Macarena Pérez. Macarena works with CEPROSH in the Dominican Republic to help trans women understand their right to live free of violence and access services if they experience violence. The interviewer, Betty Alvarez, is a LINKAGES consultant based in the Dominican Republic.


What does Transgender Day of Remembrance mean to you?

For me, this is a very important and significant day. Just as there is a day that commemorates the fight against violence suffered by cisgender women, we – the transgender community – deserve a day, too. It makes me proud that there is a day on which members of the global transgender community that have become victims of gender-based violence can be remembered, because we are also an important part of society.

How does your work as a peer educator help prevent violence against transgender people? How does it help ensure transgender people have access to services if they are victims of violence?

Being a peer educator has empowered me and helped me understand the importance of education and training. Being able to share my knowledge and life experiences with my peers has strengthened my own identity as a transgender individual and, in turn, helps my peers empower themselves and know their right to live free of violence.

I teach my peers about important gender-based violence information – including its links with HIV – provided to us by the LINKAGES project and CEPROSH. I explain “La Ruta” (route of available services) and give information about our rights and how to identify violence. The members of my community feel more confident in seeking health and gender-based violence services and demanding that their rights be upheld.

What kind of support is available to transgender people in your community if they become victims of violence? How is this different than the support that was available in the past?

Transgender people in my community have several services available to them if they become victims of gender-based violence. There are a number of clinical and psychological services provided by CEPROSH, the gender-based violence unit of the District Attorney’s Office, the local police, and peer educators like myself. These services have been strengthened and made more friendly to trans women with support from the LINKAGES project. We have more entry doors to free KP-friendly services than ever before.

What do you believe still needs to be done to end gender-based violence?

To end gender-based violence against trans women, we need to do a very big job. We need to create a new generation with a new way of thinking. We need to educate people from a young age to understand that being different is not a bad thing and that being different does not mean that we do not have the right to live free of stigma and discrimination. We have the right to live a dignified live.

How does gender-based violence against transgender people increase their risk of HIV and make it more difficult for them to access health services?

Many trans people are ignorant of their rights. We have been mistreated for so long that many of us are afraid to seek help because we are afraid of being rejected and discriminated against while seeking services. So, after being victims of violence, many transgender people do not go to services on time or do not go at all, increasing their risk of HIV and other physical and mental health complications.

Why is it important for HIV programs to offer violence services?

It is very important for HIV programs to talk about violence because when people go to a workshop or an educational session about violence in the community, they empower themselves and discover their value as a human being. Then they are more willing to seek services, including HIV services, when needed. As a trans woman, I have fought and will keep fighting so these kinds of programs continue to increase empowerment in the trans community and reduce the incidence of violence.

The participation of LINKAGES and partners and HIV clinics in offering gender-based violence services is fundamental for all key populations. Transgender people in Puerto Plata are now able to get stigma-free and cost-free clinical services, like post-exposure prophylaxis, and psychological counseling if they are victims of violence.

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Social networks, vulnerability, and sex: Improving HIV case finding among key populations

Webinar hosted by the LINKAGES project as part of the Key Populations: Evidence in Action series.

To access the audio recording of the webinar, please click here.


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On October 5th, the USAID– and PEPFAR-supported LINKAGES project hosted the first webinar in a new webinar series entitled Key Populations: Evidence in Action. This inaugural webinar included presentations on social network interventions to improve HIV case finding among female sex workers, men who have sex with men, and people who inject drugs.

Stephen Mills, FHI 360/LINKAGES/Thailand
Introduction and the purpose of social networking interventions in the HIV cascade

Kiira Gustafson, Population Services International/Myanmar
Innovative active HIV case finding in Myanmar for key populations: A focus on the most underprivileged and underserved groups

Olga Denisiuk, Alliance for Public Health/Ukraine
Optimized case finding as a strategy to improve the HIV care continuum for people who inject drugs

Wame Dikobe, FHI 360/LINKAGES/Botswana
How the enhanced peer outreach approach improved HIV yield among female sex workers and men who have sex with men in Botswana

This webinar series is intended to be a platform for (1) sharing state-of-the-art knowledge, emerging evidence, and promising practices for achieving greater impact on the HIV epidemic through programs for key populations; (2) addressing pressing questions and controversial issues from the perspective of key population experts and community members; and (3) fostering dialogue among a broad set of partners working in key-population-focused research, programming, and advocacy.

The webinars will cover a range of topics, including introduction and scale-up of HIV self-testing and pre-exposure prophylaxis for key populations; cascade monitoring and data use; information and communication technology-based interventions; effective strategies for addressing violence, stigma, and discrimination; differentiated models for delivering antiretroviral therapy; and community empowerment.

This webinar series is open to anyone interested in key populations, including program implementers, researchers, policy-makers, advocates, funders, and community members.