In a rapidly changing China, the gay community is becoming more visible, recognized, and accepted by the general public. The transgender community, however, remains extremely marginalized and face extreme stigma and discrimination.

Transgender people are neglected by policy makers, abused by State and non-State actors, and are unable to fulfill a range of rights, including on privacy, legal identity and personal autonomy.

Last December, China’s leading sexologist Li Yinhe revealed her partner of 17 years is a transgender man. Her disclosure ignited a heated public debate. The term ‘transgender’—or Kua Xingbie—entered the public dialogue for the first time but, before bearing fruit, this promising dialogue on gender pluralism languished.

This January, Asia Catalyst published the first comprehensive English language research report on the living situation of transgender female sex workers in China. Together with two Chinese organizations, we interviewed 70 people who were assigned male at birth, but presented as female for sex work. Among the 70 people, 30 identified as female, 24 as male, and 16 as a third gender; two women had completed sexual reassignment surgery, 30 had breast implants.

I visited one of the women, Chuchu, and interviewed her in her home.

She was articulate and outgoing, with a bright smile on her face. She described her life as a performer and the admiration she receives from her fans. Only after building trust with her was I able to have a better understanding of what life is really like for her.

Because Chuchu’s family does not understand why their only son ‘wants to be a woman,’ she had to leave her home city and travel a long distance to live in Beijing. She has limited contact with her family in order to hide her gender identity from them. Whenever she visits her hometown she puts on men’s clothes and wears hats to cover her long hair. In her business, she looks for clients on her mobile phone and online but, with the Beijing police’s recent crackdown on sex workers, there are fewer clients. She has to be extremely cautious in every area of her life.

Unfortunately, Chuchu’s situation is far from unique. Transgender female sex workers in China face a wide spectrum of discrimination in society and government policies, preventing this highly marginalized group from accessing a range of services and legal protections.

Transgender female sex workers often experience amplified stigma due to both their gender identity and their profession. When seeking public services and particularly health care, they experience isolation and often humiliation, leading many transgender women to self-medicate and engage in dangerous transition practices, such as self-administered hormone therapy.

Fear of exposure causes this diverse group of women to live increasingly hidden lives, away from family, employers, and community members who may subject them to verbal abuse or punitive action such as tenant eviction, job dismissal, or police abuse.

Restrictive legal frameworks compound this discrimination by effectively denying many transgender women the right to a legal identity and/or personal autonomy. Undertaking the most basic tasks becomes fraught, especially if personal ID is required. Banking, travel, hotels, or renting an apartment, can quickly deteriorate into an exercise on public humiliation if the gender presentation on the card does not match the gender marker of the person requesting service.

Discrimination is a huge factor driving transgender women from poor rural backgrounds into sex work.

Although Chinese law permits transgender people to change their gender marker on official documents, the individual must have already completed sex reassignment surgery (SRS), as well as meet other requirements. Transgender people who do not wish to undergo SRS or cannot afford it are left with identity documents that do not match their lived gender, resulting in frequent public humiliation, vulnerability to discrimination, and great difficulty finding or maintaining employment. Without the ability to change gender markers on official documents, these obstacles will last a lifetime.

Within this environment, evidence indicates that transgender women and transgender female sex workers are among the populations most heavily affected by, and at risk of contracting, HIV.

Globally, transgender women are 49 times more likely to acquire HIV than other adults of reproductive age, and the rate of HIV infection among transgender female sex workers is 27.3%, or nine times higher than the rate among female sex workers and three times higher than male sex workers. Despite these data, very little is known about this population and data collection and/or programming targeted for transgender sex workers is almost non-existent.

Lack of data and information about the needs of China’s transgender community is a major obstacle to the development of informed and appropriate policy and legislative reform for this population. UNDP is about to organize the first national consultation with transgender in China. This is a small but important first step, to listen to the voices of transgender community and what they need.

Tingting Shen is the Director of Advocacy, Research and Policy at Asia Catalyst.

A longer version of this article will appear in the LGBTQ Policy Journal at the Harvard Kennedy School.

To find out more about Asia Catalyst, follow them on Twitter and Facebook.