HIV care for transgender communities in Myanmar: Slow and uneven

There are approximately 270,000 people living with HIV in Myanmar, according to 2021 data. The number of new HIV infections in Myanmar has decreased each year, from almost 30,000 in the early 2000s to around 11,000 in 2017. Myanmar has also performed reasonably well when it comes to providing treatment access for people living with HIV, and is facilitating viral suppression for 95 percent of those on treatment. Programmes involving PrEP (pre-exposure prophylaxis), a prescription medicine that can reduce one’s chance of becoming infected with HIV, are available since its inclusion in Myanmar’s National Strategic Plan IV 2020-2025.

However, both the COVID-19 pandemic and the political crisis that erupted in 2021 have undermined HIV related programmes, along with the wider healthcare system on which such programmes rely in Myanmar. Stigma and criminalisation continue, in particular related to sexuality, gender expressions, and drug use, weakening any attempt to curb HIV-related morbidity and mortality. This disproportionately harms marginalised communities such as sex workers, people who use drugs, men who have sex with men (MSM), and transgender people already suffering from socioeconomic exclusion or exploitation.

In the context of HIV response and related data in Myanmar, transgender women have typically been categorised in the MSM population, even though many of them do not identify as men. Meanwhile, as underlined by Sakura, HIV prevention and care services (including the PrEP programme) in Myanmar were initially targeted only towards the so-called MSM community, and “only a couple of years back the PrEP programme was widened for the transgender community,” added Sakura.

“Transgender people often face discrimination not only due to their gender [expressions], but also because society tends to associate them with HIV spread and infection,” explains Sakura as she describes her HIV prevention work in six townships across Yangon, as well as parts of Rakhine and Mon State. Indeed, a 2021 report by the UNFPA shows that transgender women are more likely to experience violence and discrimination compared to others who do not identify as heterosexual or cisgender (such as – but not limited to – people identifying as lesbian, gay, bisexual, transgender, and queer, or LGBTQ+), who are already highly vulnerable to stigma and abuse, including in medical settings.

“Prior to Covid, there seemed to be more teasing and stigma targeting the transgender community, but now transgender people seem to have more freedom and mobility,” added Sakura as she talked about the growing visibility of transgender and other LGBTQ+ people, including in social movements across Myanmar.

“Societal perspective has been slowly changing for the better, because there have been more social media and online campaigns against discrimination, for instance in the form of videos. These online campaigns are more attractive nowadays, and social influencers – like famous make-up artists – are involved in talking about topics that are considered taboo such as sexual and reproductive health and rights (SRHR), PrEP, et cetera,” explained Sakura, sounding optimistic about the post-Covid changing attitudes towards transgender people.

Nevertheless, many people still do not take transgender people seriously. Noe Noe, who is now involved in a SRHR education project of MMTN, was previously reluctant to be fully involved in this work because she was afraid of being discriminated against. She said, “when trying to educate the general population [about SRHR], some people don’t want to listen to us and they don’t respect us. Some people would tease and insult us.”


So how does one persevere and keep doing this challenging work? When we asked her, Noe Noe answered, “my strategy is to be as patient as possible. Sometimes I want to respond to those who insult and tease me, but I have to control my emotions. The Buddhist teaching of ‘tolerance’ helps me to ‘tolerate’ those insults and instead focus more on the goal of the work.”