‘Self-issues’ and their linkage with sexual risk-taking in the context of HIV is a topic not well known to public health practitioners and policy makers. To explore these issues, a 3-day consultation, organized in October 2012 in Bangkok by Youth Voices Count, brought together young men who have sex with men (MSM) activists and transgender women below the age of 30 from 14 countries in the Asia and the Pacific region..
‘Self-issues’, as these youth put it, is a term to describe a specific set of issues that positively or negatively impact self-acceptance, self-esteem and confidence. While HIV and human rights experts understand how laws and legal environments constitute barriers to provision of and access to HIV and other health services, self-issues, including self-stigma, are much harder to deal with: it involves the knowledge, skills, perceptions and experience of young people that ultimately influence individual choices of the type of sexual activity they decide to perform with their partners – be it protected or unprotected.
The ‘experts’ categorize young men who have sex with men and young transgenders as ‘target groups’ for programmes; a typical indicator of success in these expert interventions is the number of condoms distributed. However, their lived realities are more complex. Little is understood about their lifestyles and sexuality, particularly how the culture of ignorance and silence dominates thinking and directly impacts their psychological well-being as they grow up: that being gay, lesbian, bisexual or transgender is somehow ‘un-natural’, ‘bad’, ‘wrong’ or immoral’.
Look at the experience of a young female transgender, similar to many stories shared at the consultation, and imagine the impact these self-issues have on self-acceptance and self-esteem: to be perceived by your family and society as a person with no career prospects (apart from working in beauty parlors or the ‘entertainment’ industry); to be the subject of domestic abuse or sexual coercion; to be bullied by your peers in school and harassed by police officers; and to be ‘exclusive’ from the sexual education that only talks of heteronormativity. The World Health Organization, which is the international public health institution that is supposed to provide normative guidance to countries, even embraces the ‘abnormality’ of transgender, recognizing their identity as one form of mental and behavioural disorders.
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