On August 5, Knowledge SUCCESS and Family Planning 2030 (FP2030) hosted the fourth and final session in the fourth set of conversations of the Connecting Conversations series: Celebrating the Diversity of Young People, Finding New Opportunities to Address Challenges, Building New Partnerships. This session focused on how to meet the SRH needs of young people from sexual and gender minorities.
Sean Lord began the conversation by discussing language. When identifying a person who is from a sexual or gender minority, it is important to use the correct terminology. Learn a person’s preferred pronouns, respect them, and do your very best to use them.
Saro Imran also emphasized the importance of pronouns within the transgender community. In the past 2–3 years, she and other leaders have worked to sensitize Pakistan’s people to ask about individuals’ preferred pronouns.
Ramish Nadeem elaborated on the variety of vocabulary used around the world. The words “queer” and “trans,” for instance, are often used as blanket terms for lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, and asexual (LGBTQIA) identities. Internationally, there are various terms people use, and it is important to not only legitimize all the ways people identify but also the ways people disidentify with certain identities.
Jesse Castelano explained language in the context of HIV/AIDS. People try to stay away from personal identity language in HIV/AIDS work since a person does not have to identify as gay, bisexual, or lesbian to have participated in same-sex relations. Language that reflects the practice—such as “men who have sex with men” or “women who have sex with women”—is encouraged to avoid socially embedded stigmas.
Participants discussed terminology, the importance of pronouns, the variety of vocabulary used around the world, and language in the context of HIV/AIDS.
“Learn a person’s preferred pronouns, respect them, and do your very best to use them.” — Mr. Lord
Ms. Castelano spoke about her work promoting the sustainability of HIV services for key populations. She discussed one of her qualitative research projects, a focus group of transgender women, where she gained insight into their issues, needs, and concerns surrounding the accessibility and delivery of transgender health services. The highest-priority challenge for transgender women participants is access to HIV self-testing. HIV self-testing is often preferred because it promises confidentiality. Another SRH need was breast self-examination, especially for those undergoing gender-affirming hormone therapy. Other major needs that transgender women mentioned were access to pre-exposure prophylaxis (PrEP), free condoms, and sexually transmitted infection (STI) testing.
Ms. Imran enumerated the many hurdles that transgender women in Pakistan currently face. Hormone treatment is expensive, and many local clinics are not safe for transgender women. Community-based organizations are creating guides for transgender women to help them better understand hormone therapy and other aspects of gender affirmation surgery.
Mr. Lord mentioned a Jamaican youth organization called Equality Youth that handles youth-related LGBTQIA issues. Recently, Equality Youth formed several youth focus groups, which discussed youth-related LGBTQIA issues, solutions, and sent a report to the government. The focus groups emphasized access to health care as a big issue for those who identify as LGBTQIA—fear, discrimination, and stigma make people less willing to access help in certain health care spaces. Persons who identify as LGBTQIA do not feel secure and believe they do not receive the necessary support when they are violated.
Mr. Nadeem explained the gaps in cultural spaces. Organizations often only address one aspect of a person’s identity while neglecting or even causing harm related to other aspects. Focus groups among young LGBTQIA Muslims have highlighted that Muslim spaces are often not supportive of their gender and sexuality, whereas many LGBTQIA spaces do not have capacity around Muslim and other religious identities. As a result, some LGBTQIA Muslims feel left out in both spaces. Additionally, in health care, providers may treat people in these identities differently. For example, a provider may not offer the same quality care to an LGBTQIA Muslim person as they would to an LGBTQIA non-Muslim person. Expanding health care providers’ capacities, ensuring they are cognizant of different aspects of a person’s identity, is something that Mr. Nadeem and colleagues are working toward.
Participants spoke about the challenges of promoting the sustainability of HIV services, the hurdles transgender women in Pakistan face, youth-related LGBTQIA issues in Jamaica, and gaps in cultural spaces.
“Focus groups among young LGBTQIA Muslims have highlighted that Muslim spaces are often not supportive of their gender and sexuality, whereas many LGBTQIA spaces do not have capacity around Muslim and other religious identities.” — Mr. Nadeem
Mr. Lord explained that Jamaica is a predominantly Christian country, and there is a saying that certain things should not be seen or heard. Whatever a child or adolescent is going through should be kept to themself, especially if it relates to their sexual orientation or sexual and reproductive health. Many parents will teach their children, “Keep it to yourself; don’t share what is happening to you,” out of fear that their children may be ostracized or lose friendships. Children are left wondering about their identity—who they are and what is happening to them—since such conversations are not encouraged. This leads to dangerous choices in terms of sexual and reproductive health.
Ms. Castelano agreed with Mr. Lord’s point, adding that young people have similar experiences in the Philippines; it, too, is a predominantly Christian country. Parent-child relationships are one of the strongest indicators of LGBTQIA adolescent health. There are unique family experiences related to sexual orientations and gender identities that may have a positive effect (such as warmth and family support) or a negative effect (such as rejection and psychological control), which ultimately affects a young person’s health and well-being.
Ms. Imran noted that in Pakistan the transgender movement is strong despite other aspects of the LGBTQIA movement lacking momentum. The Transgender Persons (Protection of Rights) Act, 2018, is a recent step in the right direction, but there is still a long way to go before transgender people are treated as equal citizens. There is a lot of macro-level progress at government and policy levels but no change on the micro-level. For example, there is little to no family acceptance or sensitization of LGBTQIA topics in schools. Additionally, many members of the transgender community are not financially well-off and are often dependent on their abusers. Ms. Imran and others are making an effort to economically empower transgender people so they have the support to make better life choices.
Mr. Nadeem discussed how young people themselves are drivers of cultural and social change. It is important to display different identities in the media and promote visibility campaigns to educate large audiences. In terms of cultural change work, it is the young people that are targeted and supported to create that change.
Participants explained the influence of religion on social norms in Jamaica and the Philippines. They also touched on the momentum of the transgender movement in Pakistan and the importance of young people as drivers of change.
“There are unique family experiences related to sexual orientations and gender identities that may have a positive effect…or a negative effect…” — Ms. Castelano
Mr. Nadeem discussed the importance of involving young people from sexual and gender minorities in program design from the ground up. It is not just important to build programs with young people in mind, those young people should be involved in designing programs, bringing attention to their needs, and fighting for the legislation and funding necessary. Building capacity within young people and their communities (rather than just relying on service providers that already exist) is the approach that should be taken.
“How are we building a world where our current work is no longer needed and young people have the tools, resources, and support to do this work themselves?” is the question guiding the design of these SRH programs.
Ms. Castelano revealed that some NGOs in the Philippines do not do a good job of involving youth, even though many youth programs are housed within them. Organizations like the International Youth Alliance for Family Planning (IYAFP) give young people a platform for participation in SRH. Sometimes systems bigger than NGOs are needed to ensure that youth are integrated and able to meaningfully participate in projects within organizations.
Ms. Imran explained youth inclusion in Pakistan. Five years ago, there was no concept of inclusion of these youth or diversification of young people in SRH programs. Now, things are changing. Large organizations are making an effort to include more people in LGBTQIA programs. There is also slow but steady progress being made at the international level to increase the inclusion of young people from sexual and gender minorities.
Mr. King spoke about training health care professionals in Jamaica. His organization has trained over 1,000 health care workers to better understand LGBTQIA youth and help address their issues. After the training, there was a follow-up assessment where people would pose as patients in health care spaces to see how they would be received and perceived by the trained health care providers. The training proved effective health care professionals were more aware of LGBTQ people’s issues and how to handle them. University health curriculums have also targeted LGBTQ health inclusion. Once the information is established at that level, it should be helpful for people in the future.
Participants explained the importance of including young people in program design and supporting them in building capacity within their communities.
“How are we building a world where our current work is no longer needed and young people have the tools, resources, and support to do this work themselves?” — Mr. Nadeem
Ms. Castelano discussed how there is a wide difference, especially for those who identify as LGBTQIA. In the Philippines, not all transgender people have the privilege of private care. However, sometimes, initiatives led by community-based organizations and NGOs can be better than private services.
Mr. King added that, in Jamaica, if one identifies as LGBTQIA, their access to health care is based primarily on their socioeconomic background. Those from higher socioeconomic backgrounds can often access good care, but those from lower socioeconomic backgrounds will not be able to receive the best care. Sometimes, people are not given care at all depending on their identity. His organization is trying to increase inclusivity and the ability for everyone to access the same level of quality care regardless of who they are and what they can afford.
Participants discussed disparities in access to public and private services that LGBTQIA young people face.
“Those from higher socioeconomic backgrounds can often access good care, but those from lower socioeconomic backgrounds will not be able to receive the best care.” — Mr. King
Mr. King talked about how LGBTQIA issues are often not openly addressed in Jamaica, causing them to become even bigger issues over time. As an agency that is openly LGBTQIA-friendly, J-FLAG is not allowed to access certain spaces, so it reaches out to people who are better able to access them, such as youth leaders and parliamentarians. The agency trains them on SRH, pronouns, gender identity, etc., then these individuals go back to their spaces and spread the information. Using social media to spread knowledge about SRH is vital, too
Mr. Nadeem related that there is a unified sexuality education framework in certain U.S. states, while in others, there is patchwork at the local/school district/city level. Sexual education is debated at many levels—local, district, state, federal, and international. Many students who are provided abstinence-only education or non-LGBTQIA friendly education report using the internet to educate themselves. So his organization, Advocates for Youth, has launched the Amaze Initiative. The series of short videos targets middle-school-age individuals to engage them on issues they’re most curious about. The videos have been translated into a variety of languages and cultural contexts so those around the world can better access them.
Ms. Castelano spoke about the difficulty of implementing sex education in the Philippines. Several religious groups are against it. Many Catholic schools do not like the idea of including sex education in their curriculum because they claim it is unhelpful and harmful to their belief structure. In agreement with Mr. Nadeem, Ms. Castelano stated that the reality is that most young people get their sexual health information from the internet, which is why organizations like IYAFP use online platforms to effectively provide sexual education to youth.
Participants talked about sexual health education for LGBTQIA youth in the contexts of their work.
“The reality is that most young people get their sexual health information from the internet.” — Ms. Castelano
Ms. Castelano explained that luckily, in the Philippines, there are some religious leaders who are open-minded and willing to consult with the community. If they reached out to people who identify as LGBTQIA and tried to understand their lived experiences, it would really help reconcile differences between religious beliefs and sexual orientation and gender identity.
Mr. King professed that there is some support from the religious community in Jamaica. Some religious leaders have children who identify as LGBTQIA, so they understand the issues when LGBTQIA-friendly organizations approach them. Some of these leaders engage with the organizations and teach people how to navigate religious spaces while confronting potentially taboo topics.
Mr. Nadeem spoke about targeting young people who identify as religious themselves, rather than targeting religious leaders who are not as amenable to discussing the LGBTQIA experience. A lot of culture-shifting work needs to happen to ensure young people can fully and visibly inhabit their religious beliefs and sexual orientations/gender identities in their daily lives. Building the capacity of religious young people internally in order to create their own communities and navigate spaces in ways they see fit is the approach he recommends. There has also been a bottom-up effect—when young people begin to change and demand a different world for themselves, some religious leaders start to change too.
Ms. Imran spoke about a parliamentary bill in Pakistan that offers protections for transgender and intersex people, but these protections are not in place for other sexual and gender minorities. She emphasized that transgender people are leading the movement—not just in Pakistan but in South Asia as a whole.
Participants spoke about best practices for engaging religious leaders, instances of support among clergy, and government efforts to protect youth from sexual and gender minorities.
“Transgender people are leading the movement—not just in Pakistan but in South Asia as a whole.” — Ms. Imran
“Connecting Conversations” is a series tailored specifically for youth leaders and young people, hosted by FP2030 and Knowledge SUCCESS. Featuring five modules, with four to five conversations per module, this series presents a comprehensive look at Adolescent and Youth Reproductive Health (AYRH) topics including Adolescent and Youth Development; Measurement and Evaluation of AYRH Programs; Meaningful Youth Engagement; Advancing Integrated Care for Youth; and the four Ps of influential players in AYRH. If you’ve attended any of the sessions, then you know these are not your typical webinars. These interactive conversations feature key speakers and encourage open dialogue. Participants are encouraged to submit questions before and during the conversations.
Our fourth series, “Celebrating the Diversity of Young People, Finding New Opportunities to Address Challenges, Building New Partnerships,” began on June 24, 2021, and concluded on August 5, 2021. Our next theme will begin in October 2021.
Our first series, which ran from July 15, 2020, through September 9, 2020, focused on a foundational understanding of adolescent development and health. Our second series, which ran from November 4, 2020, through December 18, 2020, focused on critical influencers to improve young people’s reproductive health. Our third series ran from March 4, 2021, to April 29, 2021, and focused on an adolescent-responsive approach to SRH services. You can watch recordings (available in English and French) and read conversation summaries to catch up.