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Transgender population at ‘margins of society’ – Paper highlights need for public support and education to understand community

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Prejudice, discrimination, harassment and abuse are damaging to transgender people’s health and wellbeing in ways that are not properly understood, even amongst health professionals, according to a paper recently published in The Lancet.

Lead author Associate Professor Sam Winter, of Curtin University’s School of Public Health, explained that transgender people are often excluded from society due to themselves and their needs being little understood by health care providers, legislators, policy makers, family members and people in general.

“Transgender people face stigma on a daily basis throughout their lives,” Associate Professor Winter said.

“Prejudice, discrimination, harassment, abuse and violence all conspire to drive them to the margins of society where they experience social isolation and poverty, and alarmingly, poor health and wellbeing.

“Worldwide, transgender women are 49 times more likely than the general population to be HIV positive and over 2100 trans people have been murdered in the last eight years – and those are the ones we know about,” he said.

“Transgender people’s issues are often conflated with sexual orientation – for instance a transgender woman will often be perceived and treated, including by primary health care providers, as a gay man.

“Further sustaining and aggravating the stigma is the World Health Organisation’s (WHO) diagnostic classification of transgender people as ‘mentally disordered’,” Associate Professor Winter said.

A proposal for transgender to be removed from WHO’s list of mental disorders and replaced with a diagnosis of ‘gender incongruence’ will be considered during the annual meeting of WHO’s governing body in May 2018.

Associate Professor Winter explained gender incongruence means these people experience life, their inner selves, in a gender different to the sex they were assigned at birth.

“Gender incongruence is not a lifestyle choice,” Associate Professor Winter said.

He also said based on population studies, it is estimated that there are approximately 25 million transgender people worldwide.

He explained that the actual numbers of gender incongruent people are unknown because since they so often face stigma and discrimination, they are less likely to express their gender incongruence, or identify publicly as transgender.

“It is not surprising that they avoid openly identifying as transgender and therefore remain ‘hidden’ in actual statistical data,” Associate Professor Winter said.

“Regardless of numbers, governments and public and private entities should invest in public education on the subject of gender incongruence so that transgender people can enjoy full social inclusion and benefit from the same health and well-being that the rest of society takes for granted,” Associate Professor Winter said.

“Those working with transgender people, including primary health care providers, must be trained in the area to provide services that are sensitive to transgender people’s rights and more responsive to their needs.”

The paper, Transgender people: health at the margins of society, is available here:


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