Transforming transgender communities’ health in Sri Lanka

By Sriyal Nilanka Marasinghe, Family Planning Association of Sri Lanka

Transforming transgender communities’ health in Sri Lanka is a short documentary about the challenges and successes of the healthcare provided to trans persons in Sri Lanka. Trans persons in Sri Lanka experience discrimination or poor service when accessing healthcare services. The video brings together a diverse group of people to address the gaps and challenges in the current healthcare system and advocates for changes to foster a trans-competent healthcare.

Depending on the city or district, trans persons experience some form of discrimination or lapse in services. Through the work carried out with the leadership of the Asia Pacific Transgender Network (APTN) and the support of the National Transgender Network Sri Lanka (NTNSL), the SKPA program has identified the following issues in healthcare system. The primary concern among many respondents was the confidentiality of patients. Prolonged waiting periods, discrimination by health care providers, and medical students observing consultations without client consent were highlighted. Due to a lack of proper patient management systems, clients need to explain their medical history during every consultation. They are also subjected to harassment by cisgender patients as all patients share a common waiting space. Intrusive questioning by staff and other patients, being continuously misgendered by clinic staff and being deadnamed during consultations, inability to use preferred washrooms, and the lack of recommended hormone treatments was highlighted among the gaps.

The documentary sheds light on the initiatives of the Sustainability of HIV Services for Key Populations in Asia (SKPA) Program in Sri Lanka. The SKPA Program is a multi-country grant funded by The Global Fund to Fight AIDS, Tuberculosis and Malaria, covering eight countries: Papua New Guinea, Timor-Leste, Malaysia, Philippines, Laos, Mongolia, Bhutan, and Sri Lanka. It aims to promote sustainable services for key populations, including people living with HIV, sex workers, men who have sex with men, transgender people, and people who use drugs in the region.

AFAO manages the SKPA Program as the Principal Recipient. The Family Planning Association of Sri Lanka (FPA Sri Lanka) is the sub-recipient for Sri Lanka. AFAO, FPA Sri Lanka, in collaboration with the National Transgender Network Sri Lanka (NTNSL), the Asia Pacific Transgender Network (APTN) and the International HIV Research Institute, capacitated trans people in carrying out focus group discussions, provided workshops to understand trans-friendly healthcare and carried out a pilot program offering health services through a community-led health facility. They also carried out workshops for the National STI and AIDS Control Program (NSACP) to provide specialized services to trans persons and information about providing Pre-Exposure Prophylaxis (PrEP) to trans persons. Additionally, with the support of iProbono and NTNSL, SKPA Program also supported carrying out community consultations for the transgender protection bill. Key learnings from the interventions were that the trans communities’ needs are unfulfilled. They are eager to own and lead initiatives to support their communities; however, they require more capacity development, specifically in management, communication, and leadership.

The short documentary provides an insight into the experience of the trans person accessing services, the improvements offered by the HIV response and the SKPA program efforts to support the HIV response in the country.