China's marginalized transgenders

"I usually never left the apartment before 9 or 10 PM. But when I once did my neighbors saw me and accused me of being a female impersonator. They reported me to the neighborhood committee who then brought a police officer to inspect my temporary residence permit. As a result, the landlord kicked me out of my apartment."

These are the words of Haima, a transgender sex worker living in Shanghai, speaking to Asia Catalyst, a non-governmental organization which focuses on health and human rights in China and Southeast Asia. According to its latest report, transgender sex workers like Haima are among the most marginalized and vulnerable populations in China today.

Based on interviews with female transgender sex workers across Beijing and Shanghai, the authors of the 72-page report argue that this minority suffers from intense social ostracism as well as legal and economic marginalization, leaving them vulnerable to both HIV infection and abuse at the hands of law enforcement officials. All of the interviewees featured in the document - 35 each in Beijing and Shanghai - were born male, but "presented as women while doing sex work."

A double life

The research paper, compiled between January and September 2014, and titled "My Life is Too Dark to See the Light: A Survey of the Living Conditions of Transgender Female Sex Workers in Beijing and Shanghai," describes transgender people as an "extremely hidden and isolated" population, often forced to hide their identity and lead a double life given their limited options for employment, education and social activity."

"For a transgender person working on the street, it is very common that people give them weird looks and ridicule them. Because of the social bias, they try not to go out in daytime, but only go out at night, and avoid being seen by neighbors," Tingting Shen, director of advocacy, research, and policy at Asia Catalyst, told DW.

It is difficult to precisely determine how many people are affected by this as China lacks official statistics on its transgender population. Some studies estimate that they comprise between 0.1 percent to 1.1 percent of the total population. A report by the United Nations Development Program estimated 0.3 percent of the population in Asia Pacific is transgender.

Social stigma

Shen explains that the social stigma has forced many transgender people to live hidden lives far away from their families. "Some of them try to run away as most parents cannot understand why their sons behave and dress like women. They choose to live in a more open-minded city that is far away from their families, and they can live that way they want."

As a result, transgender people are thought to barely get support from their families, relatives and friends. 97 percent of the people interviewed for the report came from outside the Chinese megacities of Beijing and Shanghai.

But according to Asia Catalyst, they don't receive much support from the authorities either. As sex work is illegal in China, the police are one of the greatest challenges faced by transgender sex workers. Many interviewees were quoted in the report as saying they had experienced entrapment, extortion, verbal abuse and physical violence.

One of the victims of such abuse is Zhang Baizhi, who has been a sex worker for the past ten years: "The police forced me to take off my pants though I had clearly told them I'm not a real woman," Zhang told DW. "They called me a pervert and humiliated me." Zhang, who lives neither in Shanghai nor Beijing, says she is arrested at least twice a year.

Male or female?

The biggest challenge in a transgender's life is arguably their legal identity. Chinese law stipulates that only those who have undergone sex reassignment surgery (SRS) can alter the gender on their identity cards. Zhang, for instance, sounds and looks like a woman, but still has male genital organs and her ID card describes him as a male.

But as researcher Zhao Jiangang told DW, the problem with SRS is that not everyone wants the surgery and, even so, only few can afford it. Zhao, who set up the Chinese transgender/LGBT grass-roots organization "Trans China" in 2008, also warned of the risks involved: "If anything goes wrong with the surgery, patients are usually not compensated, as the people involved do not want to reveal their identity," said the researcher.

As a result, transgender people often have ID cards which do not match their gender identity, resulting in isolation and humiliation when they seek public services such as renting an apartment. "There is no proper sex education curriculum in China. People know almost nothing about sexual identity. This is also one of the reasons why Chinese people generally do not find transgender identification socially acceptable," Zhao explained.

No legal framework

While transgender people do not necessarily face outright legal penalties in China, the government has never enacted formal laws to protect their rights. Analyst Shen therefore argues that the absence of non-discrimination laws and the difficult access to healthcare and HIV-related services, means they are left without effective protection.

"China lacks a legal and policy framework to address rights issues of LGBT, with a context of an ultra-conservative and potentially damaging philosophy of 'not encouraging, not discouraging and not promoting.' This attitude is preventing any progress on safeguarding the interests of China's minorities," said Shen.

The problem is compounded by an increasing amount of evidence suggesting that transgender women, especially transgender female sex workers are most affected by HIV/AIDS.

Although there is no data available for China, a considerable percentage of transgender persons are engaged in sex work in other Asian countries: Malaysia, 84 percent (2009); Cambodia, 36 percent (2009); India, 90 percent (2009-2010).

The HIV issue

One often cited reason for this is that many simply don't find other jobs. "You can make quick money with sex work which doesn't require many skills. The motivations are different," said Zhao, who is also a cross-dresser.

Globally, transgender women are 49 times more likely to acquire HIV than the general public. The HIV infection rate among transgender female sex workers is 27.3 percent, which is nine times higher than female sex workers, and three times higher than male sex workers.

Bernhard Schwartlaender, the World Health Organization's (WHO) representative in China, told DW that China is witnessing an evolving HIV epidemic, especially among men who have sex with men (MSM) and other groups including students.

In this context, however, researcher Shen points to a key issue: "Transgender individuals are usually overlooked in HIV/AIDS programs. They are often not included in epidemiological research, monitoring or intervention programs relating to HIV/AIDS.

Transgender women are also often included as a sub-population of MSM." This not only limits the attention and resources to the unique HIV-related needs of this population, but also prevents the development of effective public health interventions for them, she argues.

A dangerous treatment

Furthermore, the report reveals there are only a few organizations across China offering services for the other needs of the transgender community, including mental health, psychological counseling, dealing with discrimination or providing so-called transitioning support, especially in terms of hormone treatment used to bring transgender people closer to the gender they identify with.

"For people who are diagnosed with gender dysphoria, hormone replacement therapy is also an essential treatment method," said Shen.

The problem is that hormone therapy can also lead to irreversible changes to the body, and should only be undertaken under the guidance of a medical professional. But, according to the report, there are fewer than ten medical establishments across China capable of providing specialized instructions on hormone use and gender change, with public hospitals often lacking the knowledge required in this field.

In light of this development, the authors of the report call on Beijing to enact anti-discrimination legislation, including gender identity and sexual orientation as protected categories. "Right now China is the process of drafting a new HIV/AIDS action plan for 2016-2020, now is a good opportunity to develop a specific strategy on HIV prevention and care for the transgender community," said Shen.