Global Programme for HIV, Hepatitis and STIs, World Health Organization, Geneva, Switzerland.
UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
J Int AIDS Soc. 2022 Oct;25 Suppl 5(Suppl 5):e26004. doi: 10.1002/jia2.26004.
The World Health Organization (WHO) is guided by its global programme of work and the goal that a billion more people have universal health coverage (UHC). To achieve UHC, access for those most vulnerable must be guaranteed and prioritized. WHO is committed to developing evidence-based guidance to work towards UHC for trans and gender diverse (TGD) people. This commentary describes WHO's work related to TGD people over the last decade.
In 2011, WHO developed guidelines for the prevention and treatment of HIV and sexually transmitted infections (STIs) in men who have sex with men and TGD people. In 2013, the "HIV civil society reference group" called on WHO to provide specific guidance for TGD people. Values and preferences of TGD people were considered by WHO for the first time, which informed the development of the 2014 WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations. The 2014 Guidelines included a comprehensive package of HIV-related health and enabling interventions with specific considerations for TGD people, as well as a specific policy brief in 2015. Regional WHO offices developed and/or supported the development of blueprints on transgender health and HIV in 2014 and 2016. A 2015 WHO report on sexual health, human rights and the law elucidated the harmful impacts of discriminatory laws on the basis of sexual orientation and gender identity. In 2019, the 11th edition of the international classification of diseases saw the removal of "transsexualism" as a mental and behavioural disorder. WHO's first guideline on self-care interventions, updated in 2021, included key considerations concerning TGD people. In 2022, WHO's updated key populations guidelines include a prioritized package of not just HIV, but also viral hepatitis and STI health interventions for TGD people. Still, a broader and more specific health approach and a greater focus on social issues are needed to better serve the health needs of TGD people.
WHO's understanding and commitment to TGD people's health has evolved and improved over the past decade. Together with professional and community trans health organizations, WHO should now start developing evidence-informed global guidance on TGD health as part of its remit to support UHC to all.
世界卫生组织（WHO）的工作由其全球工作计划和使另外十亿人获得全民健康覆盖（UHC）的目标指导。为了实现 UHC，必须保障和优先考虑最弱势群体的获得途径。世卫组织致力于制定循证指导，努力实现跨性别和性别多样化（TGD）人群的 UHC。本评论描述了世卫组织在过去十年中与 TGD 人群相关的工作。
2011 年，世卫组织制定了针对男男性行为者和 TGD 人群预防和治疗艾滋病毒和性传播感染（STI）的指南。2013 年，“艾滋病毒民间社会参考小组”呼吁世卫组织为 TGD 人群提供具体指导。世卫组织首次考虑了 TGD 人群的价值观和偏好，这为制定 2014 年世卫组织艾滋病毒预防、诊断、治疗和关怀重点人群综合准则提供了信息。2014 年的准则包括一整套艾滋病毒相关健康和赋权干预措施，并特别考虑了 TGD 人群，以及 2015 年的一份具体政策简讯。2014 年，世卫组织区域办事处制定和/或支持制定了关于跨性别者健康和艾滋病毒的蓝图。2015 年，世卫组织关于性健康、人权和法律的报告阐明了歧视性法律对性取向和性别认同的有害影响。2019 年，第 11 版国际疾病分类将“易性癖”从精神和行为障碍中删除。世卫组织 2021 年更新的自我保健干预措施指南包括了与 TGD 人群相关的关键考虑因素。2022 年，世卫组织更新的重点人群准则包括了针对 TGD 人群的不仅仅是艾滋病毒，还有病毒性肝炎和性传播感染健康干预措施的优先方案。然而，为了更好地满足 TGD 人群的健康需求，还需要更广泛和更具体的健康方法，并更加关注社会问题。
世卫组织对 TGD 人群健康的理解和承诺在过去十年中不断发展和完善。在世卫组织的支持下，TGD 人群的 UHC 目标已经取得了显著进展。与专业和社区跨性别健康组织一起，世卫组织现在应该开始制定循证指导，作为其支持所有人获得全民健康覆盖的任务的一部分，为 TGD 健康提供全球指导。
