An intensive three-day training based on international guidelines on the implementation of comprehensive HIV and STI programs with transgender people (TRANSIT) was held from 29 to 31 May in Bishkek, Kyrgyzstan. The training was organized by the NGO Kyrgyz Indigo and the Country Office of the United Nations Population Fund (UNFPA).
Recent studies conducted in Kyrgyzstan show limited access to medical services for transgender people (Research on the attitudes of medical specialists, Kyrgyzstan, ECOM, 2018; Attractiveness of services for MSM and trans people, Bishkek, Kyrgyz Indigo, ECOM, 2019; Mapping of available services for trans people, Kyrgyzstan, Kyrgyz Indigo, ECOM, 2019). At the same time, the government is demonstrating a willingness to improve prevention programs with the support of donors and expanding its own budget.
There are certain achievements that are significant for the Eastern Europe and Central Asia (EECA) region; the establishment of concise legal and social transition procedures and the segregation of transgender people as a separate target group in the state program to overcome HIV infection. The training covered these challenges and barriers for the trans communities and gave an opportunity to reflect on the ways of their solution together with the medical and trans communities.
The training covered 30 medical specialists and 25 transgender people from Kyrgyzstan. It is notable that representative of the trans initiative group from Kazakhstan was also present at the training, who participated all three days and increased his potential in applying skills in his country and conducting such training.
Program of the training was developed by Kyrgyz Indigo’s activists focusing on the improvement of the quality of life of transgender people by increasing the quality of medical services and mobilizing transgender communities. The program included international recommendations and standards of services and relevant information about the situation of trans people in the country. Moreover, there were discussions on prejudice-free services for trans people through interactive games, aimed at preventing discriminatory, stigmatizing cases and increasing empathy of service providers. The participants were inspired for activism and mobilization.
Personal stories, socio-cultural aspects of trans identity and the provision of professional assistance
Trainers were people from the trans community and medical specialists. Participants of the training presented global changes, first of all, the process of introducing ICD-11, which includes modifications directly related to people with gender incongruence. Actual data about trans people in Kyrgyzstan, terms, historical background and legislation issues were discussed as well. There was a separate discussion about realities of trans people, social, cultural, legal contexts and the role of the media in terms of visibility of trans people, which is derogatory and scandalous, and an empathic and adequate at the same time. The chapters of TRANSIT were presented with a special focus on service provision. The participants also discussed the issues of hormone therapy and Kyrgyzstan’s leading experience in Central Asia in this field, which is supported by existing guidance, protocol, and legislation.
Personal stories of trans people have become a link in discussions about human rights, stigma, discrimination, challenges, and needs of the transgender community. Stories of the strong and courageous activists were the impetus for empathy; participants saw them as their close people and imbued with human understanding. These stories and examples allowed organizers to explain the importance of confidentiality, the provision of professional services and the constant desire to analyze and process their prejudices inspired from childhood.
The medical specialists wondered what to do if parents of trans adolescents turn to them, to which they were asked to refer them to psychologists at the Republican Mental Health Center since the help for transgenderness is professional help and support to adolescents and the opportunity to realize oneself how they feel.
The results of the training were a significant reduction of stereotypes and prejudices against trans people in participants; they shared that the training affected them personally, and provided high-quality and specific information about trans health. It is noteworthy that the participant — a student of the psychological faculty asked for an internship at Kyrgyz Indigo and has already applied for volunteering. This extent of cooperation between Kyrgyz Indigo and UNFPA will be continued further for the capacity building of the medical specialists in the country.
Equal and friendly space to address the existing problems
The second and third days passed with the participation of transgender people from the cities of Bishkek and Almaty. All chapters of the TRANSIT were presented with a focus on services, stigma, discrimination, violence and community empowerment. There were interactive games and small theoretical sessions.
Along with the terms and discussions of the legislation and the mentions of trans people on a national level, participants were presented with a table of all trans-specific services existing in Kyrgyzstan, as well as their accessibility and location. The table was created as a part of the Service Mapping Study (Kyrgyz Indigo, ECOM, 2019).
A session on HIV and STIs from a medical expert was perceived as very useful — everyone had the opportunity to ask questions to the medical specialist. For instance, harm reduction programs, hepatitis, HPV, alcohol dependence and mental health characteristics of trans people. Practical exercises were organized to discuss and address actual problems on the topic of:
“Why are we afraid to visit the doctors?”, “How to talk to the police?”, “How to go through customs?”, “How to act when you are recorded on video?»
During the session on empowerment, participants were organized as one initiative group. A problem tree was created where the participants who mostly had no work experience in non-governmental organizations, showed tremendous involvement and quick understanding of the topic.
Based on the problem tree, a group identified the strengths and weaknesses of the team and picked a problem — the lack of empowerment of trans communities. After which they developed a list of activities to solve this problem. The results of the training were the personal inspiration of each participant and a sense of unity through safe and friendly space, the skills to respond to crises and the sharing of stories when people expressed the importance of caring for themselves, their body and health. Participants had a general understanding of the legal and social and cultural situation of trans people, not only in the country but also in Central Asia.
One of the biggest outputs of the training was the creation of the concept, activities and expected results of the future project to increase the potential of trans people which will be applied for the call from the Eurasian Coalition on Man Health in the EECA region.
The training was recorded on video and will be shown to other trans activists who envy to conduct their training based on this guide. All three days were incredibly emotional, intense, in the atmosphere of friendliness and equality. During these days all participants were actively involved and had the opportunity to ask questions and receive answers. The Kyrgyz Indigo team has also gained valuable experience in conducting TRANSIT training and invites all interested parties to ask for support, looking ahead to implement the solutions that were placed during the training.
TRANSIT — practical guidance designed to provide recommendations to stakeholders on effective implementation of prevention programs with transgender people. It was developed in 2016 and translated into Russian in 2019. The first training based on the TRANSIT in Kyrgyzstan was held in December 2018.