Programming for Transgender People in LINKAGES and the Global Context

Transgender people are one of the most vulnerable groups, with an HIV prevalence of 8.5% in Kathmandu Valley, 4.9% in Pokhara, and 11.5% in Terai highway districts. The project recognizes the importance of addressing the unique needs of transgender people, who are often marginalized due to their gender identity. LINKAGES Nepal provides tailored services to transgender people, including outreach staff who are mobilized to promote HIV and STI prevention, distribute free condoms and lubricants, and refer individuals for HIV and STI testing services. The project has a team dedicated to transgender people, which is co-located at service sites for other key populations to provide transgender-competent HIV testing, counseling, care, and support services. All clinical and nonclinical staff at the LINKAGES Nepal clinics are well-trained on gender integration to address harmful gender norms and provide transgender-friendly and gender-affirming services. The project also partners with the Federation of Sexual and Gender Minorities Nepal (FSGMN) to provide national and community-level support for program implementation, policy advocacy, capacity building, and network strengthening. LINKAGES Nepal promotes gender-integrated HIV programming for all key populations, including transgender people, and addresses all forms of discrimination and violence, including GBV against KPs. The project uses U.S. President's Emergency Plan for AIDS Relief (PEPFAR)-recommended two-step questions to ask about gender identity and sex assigned at birth with every beneficiary to create a space in which transgender people feel welcomed as program beneficiaries. Most of the outreach workers, peer navigators, project coordinators, and other staff members serving transgender people are self-identified transgender people in LINKAGES Nepal project districts. Moreover, all the implementing partners providing services to transgender people are trans-led and KP-focused, with more than 10 years of experience working with the transgender people community in the districts. LINKAGES Nepal conducts a rapid community assessment (RCA) in all project districts for size estimation and mapping of transgender people, both sex workers and non-sex workers, with physical hot spot areas in the districts. Results show that many transgender people travel to India and other Nepali cities for labor work, sex work, and dance during festivals, weddings, and other family celebrations. Therefore, LINKAGES Nepal has developed an annual seasonal calendar to track and provide timely services to highly mobile transgender people. The project also supports its implementing partners in addressing S&D, violence, and other structural and programmatic barriers to create an enabling environment for transgender people in the project districts. LINKAGES Nepal has designed and developed transgender people-inclusive social and behavior change communication (SBCC) strategy and materials, and oriented the clinical team on trans-competent services to make beneficiaries feel more welcome and comfortable. In Nepal, transgender people are legally recognized as third gender, and several milestones have been achieved ensuring the rights and inclusion of transgender people. The Supreme Court of Nepal verdict of 2007 recognized third gender in the global south for acknowledging the rights of transgender people. Since then, several milestones have been achieved, including the inclusion of transgender people in the 2015 census, which embraces provision of having a right to choose one's gender identity.