I have three long-haired boys, and wherever we go in Cambodia, people are confused, certain they are girls. We are constantly asked, “Why?” The answer is simple: They like having long hair. My boys’ push against traditional gender expressions is perhaps acceptable only because Cambodians have come to expect odd behavior from foreigners.
Yet, it is a different matter for a Cambodian transgender individual with long hair. Transgender individuals in this setting face many acute challenges, and their unconventional appearance is only one of them.
Transgender individuals in Cambodia carry a high burden of HIV. According to a study conducted by FHI 360 in select urban centers of the country, transgender individuals have an HIV prevalence of 4.15 percent (compared to 0.6 percent for the general population). Despite this striking percentage, they have historically been left out of HIV prevention and care programs. When they were included, they were incorrectly targeted as men who have sex with men. This means that there were no distinct behavior change communications or services for this group.
Like men who have sex with men, transgender individuals have an increased risk of HIV, but their needs and the issues they face are different. This is exactly what a group of transgender individuals told FHI 360 during a discussion held in 2012 as part of the development of Srey Sros (“Pretty Girls”). Srey Sros is a package of HIV and related services developed specifically for the transgender population in Cambodia by FHI 360, with funding from the U.S. President’s Emergency Plan for AIDS Relief through the U.S. Agency for International Development.
Many transgender individuals have specific needs due to depression, substance and illicit hormone use, and silicone injections. They lack social support, experience social exclusion due to stigma and discrimination, and face limited economic opportunities. According to FHI 360’s 2012 study in Cambodia, transgender individuals share a common set of risk factors:
- 66.8 percent (595) of 891 study participants had sex for the first time before or at 18 years of age, and 18.1 percent had sex before 16 years of age
- 54.8 percent reported having experienced discrimination
- 42.2 percent reported using hormones or having had sex reassignment surgery to change their physical appearance
- 30 percent reported having been raped or physically assaulted
- 21.6 percent reported ever using drugs, and of the study participants who had used drugs during the past three months, 42 percent had had sexual activity during or after drug use
FHI 360 conducted the study to support policy development and implementation, such as the Cambodian National Centre for HIV/AIDS, Dermatology, and STD Control’s 2013 standard operating procedure for HIV programming, in which transgender individuals were identified distinctly as one of four priority populations. The study, along with qualitative data that was collected, also served as input for the development of Srey Sros.
To combat stigma and discrimination, Srey Sros has partnered with national and local governments, local nongovernmental organizations and the transgender community. The vision of creating a supportive environment for transgender individuals is slowly becoming a reality. “I feel more comfortable with the services that the Srey Sros program provides me, and I understand more about preventing HIV for myself and my sexual partner,” said Hen Srey Pov, a transgender woman living in Siem Reap Province. “I have knowledge about hormone therapy and I understand my rights. We can see that stigma and discrimination is decreasing from the community, service providers, local authorities and our families.”