Gender identity, healthcare access, and risk reduction among Malaysia's mak nyah community

ABSTRACT

Transgender women (TGW) face compounded levels of stigma and discrimination, resulting in multiple health risks and poor health outcomes. TGW identities are erased by forcing them into binary sex categories in society or treating them as men who have sex with men (MSM). In Malaysia, where both civil and religious law criminalise them for their identities, many TGW turn to sex work with inconsistent prevention methods, which increases their health risks. This qualitative study aims to understand how the identities of TGW sex workers shapes their healthcare utilisation patterns and harm reduction behaviours. In-depth, semi-structured interviews were conducted with 21 male-to-female transgender (mak nyah) sex workers in Malaysia. Interviews were transcribed, translated into English, and analysed using thematic coding. Results suggest that TGW identity is shaped at an early age followed by incorporation into the mak nyah community where TGW were assisted in gender transition and introduced to sex work. While healthcare was accessible, it failed to address the multiple healthcare needs of TGW. Pressure for gender-affirming health procedures and fear of HIV and sexually transmitted infection screening led to potentially hazardous health behaviours. These findings have implications for developing holistic, culturally sensitive prevention and healthcare services for TGW.

KEYWORDS:

• Transgender women
• gender identity
• gender-affirming care
• HIV/STI prevention

Acknowledgements

We thank our community partners at the Pink Triangle (PT) Foundation, Pertubuhan Wanita dan Kesihatan Kuala Lumpur (WAKE), and Pertubuhan Advokasi Masyarakat Terpinggir (PAMT) for their assistance in this project.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Britton A. Gibson http://orcid.org/0000-0003-0058-4272

Notes

1. The terms for transgender women used in the quotations below reflect the exact term used by the participants and include trangender, mak nyah, ladyboy, and she-males.

Additional information

Funding

This research was supported by the University of Malaysia's High Impact Research Grant [E000001–20001] and the National Institute on Drug Abuse [R01 DA025943 and K24 DA017072].