needs of transgender people should be classified as a mental disorder. In May 2010,
the World Professional Association for Transgender Health issued a statement urging
the worldwide de-psychopathologisation of gender variance. The statement pointed
out, “the expression of gender characteristics, including identities, that are not
stereotypically associated with one’s assigned sex at birth is a common and culturallydiverse human phenomenon which should not be judged as inherently pathological or
negative.”6
In 2013, the American Psychiatric Association published the fifth edition of the DSM, in
which “Gender Identity Disorder” was replaced by “Gender Dysphoria.” The American
Psychiatric Association felt that removing the term “disorder” would help reduce the
stigma of being transgender and help transgender persons be better accepted by
the wider community.7 Many transgender advocates welcomed this change, because
the term gender identity disorder implies that one’s gender identity was wrong or
problematic or that it needed medical intervention.8
The World Health Organization is also in the process of revising its classification of
diseases for the 11th edition of the International Statistical Classification of Diseases
and Related Health Problems, to be published in 2017. The WHO’s Working Group on
the Classification of Sexual Disorders and Sexual Health has recommended that in the
new edition of the Classification of Diseases, being transgender should not be referred
to in terms of outmoded mental pathology.9 Led also by transgender activism, there is
growing consensus on two core issues, depathologization and access to healthcare for
transgender individuals.10
Transgender Persons, Sex Work, and HIV/AIDS
Economic marginalization as a result of institutionalized discrimination, stigma, and low
levels of education contribute to a severe lack of opportunities for many transgender
people.11 In the Asia-Pacific Region, a considerable percentage of transgender women
are engaged in sex work.12 Available statistics indicate the following percentages of
6 A.B. Kaplan, “WPATH Releases De-Psychopathologisation Statement on Gender Variance.” Transgender Mental Health, May 26, 2010 http://
tgmentalhealth.com/2010/05/26/wpath-releases-de-psychopathologisation-statement-on-gender-variance/ (accessed September 20, 2014).
7 Chen Fazhan, Chen Zheng, “The Diagnosis and Treatment of Gender Identity Disorder,” [性性性性性性性性性性性性性性性] Journal of Chinese Behavioral Medicine
and Brain Science, Vol., No. 6 (June 2012): 569-70
8 Katy Steinmetz, “The Transgender Tipping Point.” Time.
9 Jack Drescher, Peggy Cohen-Kettenis, and Sam Winter, “Minding the body: situating gender identity diagnoses in the ICD-11,” International Review of
Psychiatry 24, 6(2012): 575, 569, 574;
10 Global Action for Trans Equality. “It’s Time for Reform: Trans* Health Issues in the International Classifications of Diseases. November 2011.
11 Kimberly Keller.“Transgender Health and HIV.”BETA, Summer/Fall 2009. http://www.sfaf.org/hiv-info/hot-topics/beta/beta_2009_sumfall_
transgender2.pdf (accessed July 23, 2014)
12 APTN, UNDP. “Lost in Transition: Transgender People, Rights and HIV Vulnerability in the Asia-Pacific Region, ” Bangkok (May 2012). http://www.
undp.org/content/dam/undp/library/hivaids/UNDP_HIV_Transgen