Health disparities among transgender women : accessibility of sexual health services in Kathmandu, Nepal

Abstract

Transgender people in Nepal like in many countries worldwide are vulnerable to HIV, and this leads individuals to experience health disparities in accessing sexual health services. Due to the involvement of receptive anal intercourse, transgender women population's severity towards HIV infection and transmission plays an important factor in their sexual health. Significant research has focused on the high vulnerability to HIV prevalence. However, it should not be forgotten that transgender women also face gendertransition related or/and gender-affirming health care services. The achievement of the highest attainable sexual health has a direct correlation with the protections of human rights. High experiences of health disparities and enabling factors among transgender women affect their access to sexual health services. Thus, this research identifies the key factors that affect transgender women's access to sexual health services. Human Rights-Based Approach (HRBA) to health is used as a conceptual framework for studying and analysing the social, cultural, and personal factors to sexual health rights of transgender women by using the four principles of accessibility, namely non-discrimination and quality, physical accessibility, information accessibility, and economic accessibility. This study uses qualitative narrative approach to understand the underlying factors of sexual health services. This paper draws primary data from in-depth interviews as well as secondary data from various research articles, journals, organisational reports, and news articles. This paper argues that physical accessibility was not a challenge in the given study; however, due to the overall inaccessibility of health services, transgender women continue to face disparities in the health settings. The research findings show that the common factors associated with these principles that hinder the accessibility of transgender women to utilise the health care services, both public and private effectively are social neglect, exclusion, and legal bureaucracy in the gender recognition process. These factors result in health care discrimination, weak service provider-user relationship, lack of knowledge on transgender-specific issues, lack of sexual health literacy, poor trans-specific services, and reported medicine intake without prescription. This research is grounded on a human-rights based approach to health, which focuses on the role of dutybearers to meet their obligations and rights holders to claim their rights. Despite reforming laws and constitution guarantee to transgender women, Nepal's stance in the protection of their rights to sexual health does not meet the international human rights standards. The efforts of the state to realise the human rights obligations, in particular, to transgender-specific sexual health needs and services are not adequately addressed in Nepal. Therefore, both governments and state actors should comply and cooperate to work effectively to enhance the accessibility of services at both the private and public health care settings in Nepal.