Stigma and HIV risk among transgender women, or Metis, in Nepal
E. Wilson1, S. Pant2, M. Comfort1, M. Ekstrand1
1University of California, San Francisco, Center for AIDS Prevention Studies, San Francisco, United States, 2Blue Diamond Society, Kathmandu, Nepal
Background: The HIV/AIDS epidemic in Nepal is concentrated among a small number of high risk groups, including Metis or transgender women. Although transgender women are often included under the MSM classification in surveillance efforts, the vulnerability of transgender women to HIV appears to be disproportionately high and often tied to the stigma and discrimination they face in society.
Methods: This study was conducted to explore the social context of stigma among Metis in Nepal to better understand their risk for HIV. Fourteen in-depth interviews were conducted with Metis in Kathmandu, Nepal. We found that stigma was rooted in contemporary social conservatism. Stigma from families leading to rural-urban migration exposed Metis to discrimination from law enforcement, employers, and sexual partners that impacted their risk for HIV. Specific HIV-related risks identified were rape by law enforcement officers, inconsistent condom use, and high reported numbers of sexual partners.
Conclusions: These data point to an immediate need to work with law enforcement to reduce violence targeting Metis. HIV prevention, housing, and employment outreach to Metis in rural areas and those who migrate to urban areas is also needed. Finally, there is a need for more research to determine the prevalence of HIV among Metis, to explore risk within sexual networks, and to better understand of the relationship between Metis and their families in order to develop interventions targeting the families.