MSM and transgender youth: underestimated needs of psychosocial health support

MSM and transgender youth: underestimated needs of psychosocial health support

HIV Australia | Vol. 11 No. 4 | November 2013

By Setia Perdana

Specific data on young MSM and transgender women at higher risk of HIV in the region is sparse, but estimates that do exist give cause for concern.

Many countries in the region have emerging or concentrated HIV epidemics among MSM: 40% in Yangon, Myanmar, 32% in Bangkok, Thailand, 20% in Mumbai, India, 7% in Karachi, Pakistan, and 5% in Beijing, China.1, 2

Similarly, the prevalence of HIV among transgender women has been estimated at 34% in Jakarta, Indonesia, 37% in Phnom Penh, Cambodia, and almost 50% in Delhi, India.3

There is evidence that young MSM (people in their 20s) have a high prevalence of HIV – over 5% in several recent surveys.

Structural barriers to health services at the policy, cultural and institutional level include criminalisation of homosexuality, high levels of stigma and discrimination (of both homophobia/ transphobia and HIV) in health care systems, poverty, and parental consent.

Other arbitrary and inappropriate law enforcement interventions significantly stop young MSM and transgender women from accessing HIV services to learn their HIV status or get treated.

This obstructs HIV interventions, advocacy, outreach and service delivery, increases the vulnerability of young MSM and transgender women to HIV infection and has an immense adverse effect on their health.

In addition to external deterrents, there are ‘self-issues’, which are defined by Youth Voices Count (YVC) as a specific set of issues that positively or negatively affect self-acceptance, self-perception, self-efficacy, self-esteem and self-confidence.

YVC, in its latest policy brief titled ‘I feel like I do not deserve happiness at all’, highlighted the negative impact of psychosocial challenges, particularly low self-esteem and self-confidence, on young MSM and transgender people engaging in sexual risky experiences and the way in which these hinder young MSM and transgender people from accessing designated health care and HIV services.

The policy brief was based on qualitative research YVC conducted among young MSM and transgender women, which found that self-issues are often caused by a lack of understanding and acceptance of sexuality and sexual identity.

Low self-esteem can cause social anxiety, isolation, stress, feelings of helplessness, depression, thoughts of suicide and physical harm, and destructive self-coping behaviours.

In addition, links were observed between the inability to negotiate safe sex in the context of love and relationships, casual sex or sex work and poor self-esteem.

In young MSM and transgender people poor self-esteem may be related to socioeconomic status, breadth of life experience, youth, unsupportive family environment, verbal and physical harassment, assault, bullying, abuse, prejudice, discrimination and marginalisation, peer pressure and heteronormativity.

Among HIV-positive young MSM a link between self-esteem and disclosure was observed. It was seen that HIV-positive MSM with high self-esteem and self-acceptance were more likely to disclose his status or discuss safer sex with his casual sex partner before having sex.

Most importantly, respondents noted that current HIV prevention programs fail to help young MSM and transgender people come to grips with their sexual orientation or to foster an environment that is accepting of gay people, despite the recognition that men who are most accepting of their sexuality and identity are more psychologically healthy, have higher self-esteem, are more likely to disclose their HIV status to their casual sexual partners, and are less likely to engage in sexual risk-taking.4

Given the observed link between self-stigma, risky sexual behaviour and HIV vulnerability among young MSM and transgender women, interventions to respond to self-stigma and its interlinkage with HIV vulnerability are necessary. Friendly, non-judgmental services must be promoted among health providers.

Law and legal environments that criminalise homosexual sex must be addressed. Strategies to create a supportive environment are also needed, such as providing safe spaces for young MSM and transgender women that support their psychosocial issues and offer an understanding of their sexual orientation and gender identity.


1 UNAIDS. (2007). Men who have sex with men – the missing piece in national responses to AIDS in Asia and the Pacific, UNAIDS, Bangkok.

2 UNAIDS. (2006). Epidemiology of HIV and risk behaviours among men who have sex with men in Asia and the Pacific, draft. UNAIDS, Bangkok.

3 WHO SEARO. (2009). HIV/AIDS in South East Asia Region 2009, WHO SEARO.

4 Waldo, C., Kegeles, S. and Hays, R. (1998). Self-acceptance of gay identity decreases sexual risk behavior and increases psychological health in US young gay men. Int Conf AIDS, 12, 209.

Setia Perdana is on the Core Working Group of the Youth Voices Count in Islands South East Asia countries sub region Working Team of Indonesian Young Key Affected Populations Forum (Fokus Muda)