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How Stigma Hurts Transgender Lives

Worldwide, transgender people are more likely to be depressed and anxious and to have HIV/AIDS, but some policy fixes could help.
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Stigma kills. That’s the lesson from a series of papers reviewing the health of transgender people around the world, published today in the medical journal the Lancet. Although the research is a bit scarce, what does exist suggests transgender people are far more likely than the average citizen to suffer from depression and anxiety and to have HIV/AIDS, according to the reviews.

These higher risks don’t necessarily come from the (still not totally known) biological or environmental factors that make someone transgender. Instead, these risks stem at least in part from the stigma and social exclusion trans people face. Not having a supportive social group is a risk factor for depression and anxiety, for example, and where openly transgender people have few career options, some may turn to unsafe sex work, which puts them at risk for contracting HIV. “In no other community is the link between rights and health so clearly visible as in the transgender community,” Sam Winter, a psychologist at Curtin University in Australia and one of the review authors, said in a statement.

Here are some highlights from the review series:

  • Just how many people are transgender? Estimates from the United States, Europe, and New Zealand range from 0.4 percent to 1.2 percent of the population.
  • In a national survey of gender non-conforming people in the U.S., 41 percent of respondents said they had tried to commit suicide. Among all American adults, only about 4 percent are estimated to have had suicidal thoughts in the last year.
  • In an Internet survey of self-identified trans Australians, 25 percent said they had been diagnosed with an anxiety disorder in the past year, compared to 20 percent of Australians in general.
  • Trans Americans were twice as likely to be unemployed as their gender-conforming peers, according to a survey. Ninety percent said they either hid their trans identity at work, or had experienced harassment for it. Sixteen percent said that, because they couldn’t find other jobs, they resorted to sex work or selling drugs.
  • Among six nations in Asia, Europe, and the Americas, an estimated 19 percent of transgender women have HIV/AIDS. Among high-income countries only, that number rises to 22 percent. Transgender women are almost 50 percent more likely to be HIV-positive than the average citizen.
  • Beyond health risks, trans and other non-gender-conforming people are sometimes the targets of hate crimes. The advocacy group Transgender Europe collects reports of the murders of trans and other gender non-conforming people worldwide. They’ve counted 2,115 gender non-conforming people killed since 2008. One hundred have been killed so far this year.

In a statement, the authors of the Lancet series offered their recommendations for policymakers to reduce society-wide stigma against trans people and improve trans health:

  1. The World Health Organization should revise its International Classification of Diseases so that transgenderism falls under “conditions related to sexual health” and not “mental and behavioral disorders.”
  2. Countries should cover health care for transgender people, including hormone treatments, in the same way they cover other health care.
  3. Anti-discrimination laws should cover transgenderism. “Where anti-discrimination law is absent,” the statement says, “the practical result is often that discrimination is legal.”
  4. Most surveys and studies cover transgender people in high-income nations and middle-income nations in Asia. Researchers should report on the needs of trans people in Africa, the Middle East, Central Asia, and former Soviet countries, where they may face intense discrimination.