Discussions about the health of women should include transgender women
Authors: Rachel L Kaplan, Cynthia El Khoury, Norma Lize
Journal: The Lancet Public Health (2018)

We read with interest Dooa Oraby's Correspondence in The Lancet Public Health (February, 2018)1Oraby D Women living with HIV in the Middle East and north Africa.Lancet Public Health. 2018; 3: e63Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar about the importance of prioritising women and gender equity in HIV/AIDS prevention and treatment in the Middle East and north Africa (MENA). Women in this region still lag behind in markers of gender equity; including women in all sectors of the health-care system could improve HIV treatment coverage.2Madani N Gender equality is crucial to the fight for better HIV treatment access and outcomes in the MENA region.J Int AIDS Soc. 2018; (published online March 5.)DOI:10.1002/jia2.25092Crossref PubMed Scopus (3) Google Scholar Women living with HIV/AIDS in MENA face HIV-related discrimination including denial of health care, confidentiality breaches, and stigmatising testing environments.1Oraby D Women living with HIV in the Middle East and north Africa.Lancet Public Health. 2018; 3: e63Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar, 3Kaplan RL Khoury CE Field ERS Mokhbat J Living day by day: the meaning of living with HIV/AIDS among women in Lebanon.Glob Qual Nurs Res. 2016; (published online May 22.)DOI:10.1177/2333393616650082Crossref PubMed Scopus (6) Google Scholar But discourse on health-care strategies, including the prevention and treatment of HIV/AIDS among women in MENA, overlook transgender women. Any and all discussions about the health of women should include transgender women. This inclusion must prioritise agency and intersectionality by fostering the leadership of transgender women in women's health movements and seeking the contribution of diverse perspectives regarding issues such as socioeconomic status, immigration status, and gender expression. March, 2018, marked the first time transgender women openly participated in International Women's Day activities in MENA. “Transgender women are women” read one of the signs carried at the International Women's Day march in Beirut, Lebanon. Five transgender women marched at the front of the large crowd of women activists and embodied the very inclusion that the slogans demanded and asserted. Plans to initiate the first transgender-led organisation in MENA are underway. Transgender women in MENA, like in many other settings, experience high rates of sexual and mental health disparities because of social and structural barriers.4Kaplan RL McGowan J Wagner GJ HIV prevalence and demographic determinants of condomless receptive anal intercourse among trans feminine individuals in Beirut, Lebanon.J Int AIDS Soc. 2016; 19: 20787PubMed Google Scholar, 5Kaplan RL Nehme S Aunon F de Vries D Wagner G Suicide risk factors among trans feminine individuals in Lebanon.Int J Transgend. 2016; 17: 23-30Crossref PubMed Scopus (22) Google Scholar Public health efforts that aim to advance women's health must mirror what many women's groups are already doing on a community level: prioritising the visibility of transgender women in HIV/AIDS prevention and treatment efforts, and resisting patriarchal hegemony. Transgender women are women. It is time that our research, health-care provision, and discourse clearly and consistently reflect this. We declare no competing interests. Women living with HIV in the Middle East and north AfricaOnly 2% of the total estimated number of people living with HIV reside in the Middle East and north Africa (MENA) region.1 Fewer HIV transmissions in the MENA region compared with other regions had been attributed to several protective factors, including male circumcision and Islamic cultural traditions.2,3 However, relying only on the protective effect of religious and traditional values is not enough to prevent the progression of the HIV epidemic.4 Full-Text PDF Open Access