Human-centered design to understand the needs of transgender women and design the first transgender women's clinic in Yangon, Myanmar

BACKGROUND: With significant advancements in the national response to HIV in Myanmar, the National Strategic Plan aims to provide a comprehensive prevention package for 95% of transgender women (TGW), including testing and treatment. Population Services International Myanmar (PSI/Myanmar) conducted a needs assessment to explore TGW's experiences, needs for and barriers to services at the individual, community, and societal level, to support the national plan.This study is part of a U.S. Agency for International Development (USAID) project funded by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR).
METHODS: A qualitative study using a human-centered design (HCD) approach was conducted with 16 TGWs in Yangon. Participants were identified and recruited through social networks in December 2020 and semi-structure individual in-depth interviews were done. Due to COVID-19 restrictions, data were collected through telephone interviews. Results were generated through consumer journey mapping using public health focused market research approach together with HCD tools.
RESULTS: According to the TGW participants,there is insufficient knowledge about TG health among healthcare workers, particularly hormone therapy, drug interaction between hormones and ART, mental health and cancers common among TGW. Providers' mistreatment and lack of training on trans-competent health services are major barriers for TGW to seek services at public hospitals. Services in the non-profit sector are favored by these women. TGWs use unqualified providers for hormonal counseling and therapy due to the lack of these services in the formal health sector. They reported service gaps for mental and psychosocial support and no established referral mechanism or networking for gender-based violence. Anal cancer screening is not routinely done and treatment is often sought at advanced cancer stages. Those residing outside major cities and in rural areas have limited access to services in urban areas. Trans-competent facilities with trained staff are strongly desired by TGWs.
CONCLUSIONS: The study highlighted that the new clinic should employ staff who are either TGW or TGW friendly, provide HIV and ART services as well as TGW-specific services such as, mental health, gender-based violence, cancers, and hormonal therapy for TGW to meet their needs and reduce barriers to care.

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