The development of “Practical Guidelines For Trans-Specific Primary Health Care In Malaysia” is a joint project between SEED Malaysia and the Galen Centre for Health and Social Policy.

Overview

This is a guide and reference intended for healthcare professionals in the provision of trans-specific primary health care in Malaysia. It details and provides practical advice pertaining to the assessment and management of transgender patients who seek treatment at health care centres.

The objectives of the guideline are to improve health care provided and quality of life of transgender persons in Malaysia, as well as to help reduce stigma in healthcare settings. The guidelines were developed with the central principle that the self-identification of the individual should override the opinion of professionals at all levels of medical practice.

Objectives of initiative

• To develop localised guidelines for the provision of transgender-specific healthcare services in Malaysia
• To initiate and support the provision of trans-specific healthcare services through a network of participating clinics

 

Background

Malaysia is estimated to have between 30,000 – 40,000 individuals who identify themselves as transgender women. There have been no proper estimates or studies conducted with transgender men, as such no estimation of the population size is available. Nevertheless, based on anecdotes and the number of participants on social media platforms, it can be inferred that this country has a sizeable transmen population.

Malaysia has been cited as being among the worst countries in the world to be a transgender person, with incidences of systematic abuses by religious authorities and police including sexual assault and extortion. Transgender people experience discrimination in access to health care, employment, housing, education, and government services. They have been fired from jobs, evicted from homes, assaulted, and denied access to health care. Perpetrators have included law enforcement officers, teachers, religious authorities and healthcare workers. Laws related to employment, education, and healthcare in Malaysia currently contain no provisions prohibiting or penalising such discrimination.

Despite the fact that this creates unsuitable and unfavourable conditions for public health initiatives such as HIV prevention and treatment programmes, no effort has been undertaken to reform or implement remedial measures to address discrimination towards transgender persons.

Current access to trans-specific healthcare in Malaysia

“One key aspect of the right to health is that it requires that health systems and services are available, accessible, acceptable and of quality. General health services are frequently not accessible to trans persons because of prohibitive costs or discriminatory treatment by service providers or other service users.”

Most transgender persons have experienced discrimination in the health care sector. Health workers have made inappropriate comments, refused to physically examine, and have even denied treatment. This has occurred in both public and private healthcare settings.

As a result, transgender persons generally may not go to public facilities, and in fact may avoid treatment altogether. While private hospitals or clinics are possible alternatives, the issue of affordability may be an obstacle for most.

Despite the fact that most transgender persons take hormones to alter their physical appearance and affirm their gender identity, most do not consult or seek guidance from medical professionals due to the fear of stigma and discrimination. They take over-the-counter hormones with minimum or no medical guidance. This has resulted in incidences of inappropriate and excessive doses which may result in harmful and dangerous consequences.

While there are a limited number of existing community health facilities run by NGOs, most provide for men who have sex with men, and may be unable to address the specific health needs of transgender women and men. Lack of access to appropriate healthcare contributes to the health disparities faced by transgender people, which leads to their high vulnerability to HIV and other sexually transmitted infections.