Several international studies have highlighted the vulnerability of transgender people with regard to public health. Based on this evidence, in 2012 the FOPH included the transgender population in the implementation of NPHS.
A population often invisible to public health
Several international studies highlight the greater vulnerability of transgender people with regard to public health, particularly in relation to HIV and other sexually transmitted infections. According to a meta-analysis of 29 studies carried out in North America, the prevalence of HIV in transgender women (male to female) is estimated at between 11.8% and 27.7% in major American cities, and can be up to 35% in transgender sex workers. For transgender men (female to male), the prevalence is between 2% and 3%.
No official epidemiological data is currently available for sexually transmitted infection amongst the transgender population in Switzerland.
In collaboration with the Agnodice Foundation, the FOPH has included transgender people in the implementation of NPHS.
This takes place at several levels:
- Inclusion of the variable “transgender” in additional mandatory STI declaration forms
- Inclusion of the variable “transgender” in the voluntary BerDa advice and screening tool.
- Inclusion of the variable “transgender” in projects relating to sex work.
Transgender people and sex work
A 2008 study conducted by the Agnodice Foundation in transgender women active as sex workers in Lausanne paints a worrying picture of the risks faced by this population and highlights specific vulnerability factors. These can be summarised in particular as unprotected sexual contact in the context of their professional work, as well as the sharing of syringes for injecting hormones or silicone with the aim of feminising their bodies.
Female transgender sex workers are severely marginalised and frequently the victims of extortion and violence - including police violence. Problematic drug and alcohol use is frequent under pressure from customers. Their psychological health is particularly fragile. Average rates of depression and numbers of suicide attempts are higher amongst this population than the general population.
Their customers present specific characteristics. They seek a feminine body and a functional penis capable of erection and ejaculation. This study estimates that the 50 transgender sex workers who responded have sexual relations approximately 30,000 times per year.
Since 2012, the FOPH has been making its partners on the ground working for HIV/STI prevention aware of the importance of systematically including transgender sex workers in their projects. Transgender people, including transgender sex workers, are the focus of the “Migration and vulnerability factors 2016” Framework.
Last modification 09.07.2019