There are people that those in power would often prefer to ignore. Admitting HIV is a problem means addressing taboo topics like sex, gender identity and drug use – topics some would rather sweep under the rug. The political, social and religious forces imposing this willful blindness stigmatize people most in need of medical care and support. It feeds a vicious cycle in which those most in need remain in the shadows and continue to suffer the consequences.
This has been the struggle for transgender women in the Middle East. Globally, trans women are 49 times more likely to become HIV-positive than other people of reproductive age. There is very little data about HIV in the Middle East to begin with, and funding and attention dedicated to eradicating the epidemic often ignores trans women.
Rachel L. Kaplan, PhD, MPH, a researcher at the UCSF Bixby Center for Global Reproductive Health, is out to change that. Their interest in HIV and its impact on the LGBTQI+ community intersected with their love for the Middle East, leading Kaplan to undertake the first ever study on HIV treatment and prevention among transgender women in Lebanon. In the face of skepticism and sometimes deliberate silence, they have made tremendous progress by partnering directly with the community to fight this marginalization.
Kaplan’s latest research, funded by the National Institute of Mental Health, adapts a peer-facilitated group support model for transgender women in Beirut to address their mental and sexual health needs. The leadership of transgender women is integral to this approach. Everyone on the team except for Kaplan and the project director identified as trans. Building trust is also critical. “It’s been all about building relationships for a very long time and deferring to the local communities in terms of decisions, how things should go, what is needed, and the ways in which folks self-describe and -identify,” says Kaplan. “I’ve learned so much and am grateful for the ability – and responsibility – to leverage privilege and funds toward solidarity and sustainability.”
There’s a lot of excitement around this new approach to tackling the health disparities these women face. Group members described feeling less alone and gave overwhelmingly positive feedback about the program. Locally called “Baynetna” (meaning “between us” or “confidentially” and a play on the Arabic for “girls”), the conclusion of the pilot intervention brought some sadness to many who wanted to spend more time enjoying the new sense of community they had built together.
Kaplan reflects on the perseverance of the women who participate in this research. “There is so much that trans women face in their day-to-day lives that makes showing up for intervention sessions an incredible accomplishment for many. I admire the perseverance needed to keep putting one foot in front of the other.” That resilience was on full display last year when a group of transgender women marched through the streets of Beirut, leading the International Women’s Day parade for the first time.
Kaplan is excited to scale up this program to reach even more women who could benefit. “Studies show that getting support from people who share identities with us is so important for overall health. I do my best to get out of the way for that to happen, so people can get what they need from each other.”
This article originally appeared at UCSF Bixby Center for Global Reproductive Health.
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Promising Model for Improving Health for Transgender Women in Lebanon