JAKARTA (Thomson Reuters Foundation) - Millions of transgender people around the world face major challenges in getting adequate medical care despite multiple health issues, from depression to high rates of HIV, researchers say.

The community remains marginalized, and laws and policies denying them gender recognition make access to healthcare even more challenging, said the first of a series of papers on transgender health published in The Lancet medical journal on Friday.

Studies cited in the papers showed there are an estimated 25 million transgender people globally. Transgender people suffer high rates of depression - up to 60 percent - due to stigma, discrimination and abuse, jeopardizing their physical and mental health.

Many are drawn into risky behaviors such as unsafe sex or substance abuse due to such stigma. Transgender people are almost 50 times more likely to contract HIV than the general population.

Globally, there have been at least 2,115 killings of transgender people documented since 2008.

“A key message is that the health and wellbeing of transgender people depends on respect for rights,” one of the lead authors, Sam Winter, told the Thomson Reuters Foundation.

Winter, an associate professor at Curtin University in Australia, said primary healthcare providers have a key role to play in ensuring those rights are achieved and hoped the papers would raise awareness in the medical community.

“The message for healthcare providers is that transgender people, wherever they live, and whatever the area of their lives, have the same rights as their compatriots to the highest attained standard of health.”

Laws in Argentina, Denmark, Malta, Ireland and Norway have been hailed as the most progressive in gender recognition for transgender people, but the majority of countries worldwide have a long way to go.

In Europe, eight states fail to offer legal recognition to transgender people, and 17 states impose sterilization on those seeking gender recognition.

Meanwhile, New Zealand, Australia, Nepal, Pakistan and India have moved or are moving toward recognizing gender diversity beyond male or female.

“CORRECTIVE” RAPE WIDESPREAD

The Lancet issue included first-person accounts from the transgender community.

“Living proudly as a transgender man in the small sub-Saharan country of Lesotho has come at a serious price,” wrote Tampose Mothopeng, director of the People’s Matrix Association, an LGBT support group in Lesotho, and co-author of a paper in the journal.

“The widespread instances of ‘corrective’ rape against transgender men and lesbian women mean that I must constantly be careful and vigilant in every kind of public space, from entertainment venues to walks home from work.”

The authors pressed for a series of actions, including for the World Health Organization to move diagnoses for transgender people from a chapter relating to “mental and behavioral disorders” to “conditions related to sexual health”.

They said this would be a “historic” move to avoid reinforcing stigma.

They also called for physicians to be trained to understand the health needs of transgender people, and that healthcare for the community, such as access to feminising and masculinizing hormones, to be funded on the same basis as other health care.

Last year, the World Medical Association, which represents more than 10 million physicians, adopted a blueprint on how to treat transgender people in ways that respect their choices and rights and do not question their sexuality.

The guidelines recognize that being transgender is not a disorder and explicitly reject “coercive treatment or forced behavior modification”.