Trans-Yar Team

Introduction

According to statistics released by the United Nations Office on Drugs and Crime in 2019, approximately one in eight people worldwide who inject drugs live with HIV—an estimated 4.1 million individuals. In Iran, based on data from the Ministry of Health, Treatment, and Medical Education, there are around 39,000 people living with HIV.

Among all registered cases in Iran since 1986, the primary causes of HIV transmission have been shared injection equipment (60.8%) and sexual contact (21.6%). Globally, sexual transmission is the most common route of HIV infection. In Iran, sexual transmission has been increasing in recent years. Factors such as early sexual debut, multiple sexual partners, and a history of sexually transmitted infections all contribute to higher transmission risk.
HIV can be transmitted from male to female, female to male, and male to male—with male-to-male transmission posing the highest risk, and female-to-male the lowest.
Transgender individuals make up about 1% of the global population. Due to factors such as high-risk behaviors, unsafe hormone injection practices, family rejection, social stigma, poverty, and marginalization, they are at significantly higher risk of HIV infection. Global data indicates that approximately 19% of transgender women and 2.3% of transgender men live with HIV.
Because many studies do not distinguish between sex and gender identity, precise statistics on HIV prevalence among transgender populations are limited. However, estimates suggest that 2.9% of transgender individuals are living with HIV—compared to less than 0.5% among other adult groups.

Among all high-risk groups, transgender women face the highest risk. In Latin America and East and Central Asia, transgender individuals—especially transgender women—are particularly vulnerable. Transgender women of color face even higher risks: 44.2% of Black transgender women and 25.8% of Latin American transgender women are living with HIV. No specific data is available for transgender men of color.
According to the American Academy of Family Physicians (AAFP), among individuals who sought HIV diagnosis or treatment over the course of one year, 84% identified as transgender women, 15% as transgender men, and 1% as other gender identities. Of these, more than half were of African or Asian descent, while the rest were American or European. Additionally, 43% of transgender women and 54% of transgender men were from low-income backgrounds.
Due to stigma and discrimination, many transgender individuals lack access to healthcare, have limited education or disrupted schooling, and face housing insecurity and social exclusion. It is essential to support them through education and by creating inclusive social and cultural conditions.

Implementation

The project for identifying and educating transgender individuals on HIV prevention and harm reduction was commissioned by the Tehran Provincial Welfare Organization and entrusted to the Simaye Sabz Rahayi Harm Reduction Institute. As the supervising and commissioning body, the Welfare Organization held orientation sessions for selected implementing organizations in autumn 2018 (1397). Simaye Sabz Rahayi began executing the project in February 2019 (Bahman 1397).

The project began with mapping neighborhoods and assessing the current situation in Tehran. Team members were selected with the help of activists in the field and recommendations from the Iranian Gender Dysphoria Association. Employment contracts were signed with the institute, and initial orientation sessions were held to explain the program and prepare the outreach schedule.

Two four-hour training workshops were conducted for institute staff and project collaborators on the topics of “HIV/AIDS” and “Safe Sexual Practices,” ensuring accurate information delivery. In coordination with the Welfare Organization, harm reduction supplies were received, and outreach team members were equipped with condoms and rapid HIV test kits, along with training on their proper use.

Existing HIV and condom awareness brochures at the institute were used and distributed among transgender individuals. Referral center addresses—especially behavioral disease counseling centers—were provided to project staff, who were trained on the referral process.

Identification cards labeled “Trans-Yar” were issued to team members, and outreach activities began in well-known and high-traffic gathering spots for the target group. Job descriptions for project staff were prepared in accordance with the signed agreement. Trans-Yar team members were trained and committed to maintaining confidentiality and respecting ethical, human, and Islamic principles in their interactions.

Identified Gathering Spots

In the initial outreach plan, the following locations were selected as high-traffic gathering spots for transgender individuals:

– Nahj al-Balagha Park
– Saei Park
– Daneshjoo Park
– Under Karimkhan Bridge
– College Bridge
– Hafez Hotel
– Haft Hoz Square
– Around Kaj Square
– Andarzgoo Street

During the first two months of implementation and field presence by transgender team members, it was determined that some of these locations no longer had a significant transgender presence. The outreach locations were updated accordingly. It was also decided to categorize gathering spots into two types: open-air and indoor.

Indoor Gathering Spots:

– Transgender Secretariat at University of Tehran
– Group therapy sessions led by Dr. Khoei at the Addiction Studies Center, Qazvin Square
– Iranian Institute of Psychiatry
– Shaghayegh Clinic on Golbarg Street
– Shahkar Beauty Salon

Outdoor Gathering Spots:

– Near Dr. Seyed Mehdi Saberi’s office at Fatemi Square, beginning of Jouybar Street
– Near Dr. Behnam Ohadi’s office on Valiasr Street, before reaching Niayesh Highway
– Near Dr. Fereydoon Mehrabi’s office on Valiasr Street, after Saei Park
– Daneshjoo Park
– Under Karimkhan Bridge
– College Bridge
– Hafez Hotel
– Haft Hoz Square
– Around Kaj Square
– Andarzgoo Street

Project Achievements

Project collaborators expanded their efforts into digital outreach, launching the Trans-Yar Virtual Patrol to design and distribute banners and posters, and to create social media pages and channels.

A Telegram channel was established to provide virtual education for transgender individuals, enabling consistent and accurate communication with members of the trans community. Most members of this channel identify as transgender. The channel currently has over 200 members, and non-trans individuals are not restricted from joining.
(@HIVhelp)

An anonymous Q&A bot was launched, allowing channel members to ask questions related to sexual health and HIV without revealing their identity or personal details.

Multiple online polls were conducted to gather feedback on topics of interest to channel members.

The team reached out to major Instagram pages for collaboration and eventually launched a dedicated Instagram account focused on sexual minority awareness and education:
(@Equality4.all)

During the mapping of transgender gathering spots, some previously identified locations were removed and new ones were added based on updated field observations.

Since Simaye Sabz Rahayi also manages the Positive Club project under the Welfare Organization, individuals identified as HIV-positive during outreach were referred to the Positive Club for case registration and enhanced services. Notably, one transgender outreach team member was appointed as the part-time manager of the Positive Club and was officially introduced to the Welfare Organization.

The outreach team successfully recruited several transgender volunteers to assist during patrols and at the institute’s office. One of the most notable achievements was establishing a connection with a skilled and volunteer legal expert specializing in transgender rights.

Through regular participation in the Gender Dysphoria Association and Rasesh Therapy Group, the team provided services to transgender individuals and laid the groundwork for broader collaboration and closer ties between Trans-Yar members and clients of these organizations.

A special psychological intake form for transgender individuals was designed and revised with input from a Welfare Organization expert. This form is completed for every transgender client.

To improve access to organized transgender groups, the Trans-Yar mobile team focused on indoor gathering spots during the third and fourth months of outreach. Effective connections were established with the Iranian Institute of Psychiatry, Rasesh Support Group, and the Iranian Gender Dysphoria Association. Clients at these centers received group and face-to-face HIV education, underwent rapid HIV testing, and were trained in safe sexual practices.

This initiative was formally introduced to relevant institutions through an official letter from Simaye Sabz Rahayi Harm Reduction Institute and direct engagement by project managers.

Trust-building between the mobile outreach team and vulnerable transgender individuals in Tehran’s parks and gathering spots was successfully established and strengthened. Clients voluntarily shared their contact numbers with the team to stay informed about outreach schedules and locations. These contact numbers were linked through social media platforms to facilitate communication.

Challenges and Recommendations

Undoubtedly, the challenges faced by this project are deeply intertwined with the broader issues affecting the transgender community in Iran. Key concerns are outlined below:

A large number of transgender individuals face social rejection upon disclosing their true identity. Many lack access to education or vocational training, making it difficult to earn a livelihood. Even those qualified for employment in public or private sectors are often marginalized due to legal barriers, stigma, and social discrimination. As a result, they may be forced into precarious jobs such as street vending, begging, theft, or sex work. Addressing housing and employment needs for transgender individuals would enhance their engagement and allow for better service delivery.

Transgender individuals have a critical need for free, specialized individual counseling services. Many are reluctant to seek help from government centers. Their families also require psychological support to make informed decisions and to accompany their loved ones on their journey.

It is essential to recognize the diversity within Iran’s sexual minority communities. The transgender population is not limited to healthy, young, white individuals—many are elderly, very young, or living with physical or mental disabilities. A broader perspective is needed to ensure inclusive and appropriate services.

It is recommended that the gender transition process be explained to the public through a dedicated phone line or tele-counseling service, allowing people to ask specialized questions.

It is also suggested that HIV prevention posters and banners tailored to transgender individuals be designed by the Welfare Organization, bearing its official logo, and distributed to project implementers for outreach among clients.

Given that Iranian transgender girls under 18 often attend boys’ schools, and transgender boys attend girls’ schools, this group must be included in educational efforts. Sexual health and risk prevention education should be provided in schools. This is especially important considering the possibility of individuals reconsidering gender transition decisions made at a young age.

Trans-Yar outreach team members should receive training not only in harm reduction topics but also in mobile outreach methods. Since the target group includes high-risk individuals, lack of communication skills among team members could expose them to harm.

Due to the youthfulness of many service recipients, initial engagement may require offering snacks, cigarettes, or inviting them for a drink or ice cream. If the project budget accounts for such costs, this recommendation could be implemented more effectively.

As part of this initiative, organizing group educational sessions on sexual health and HIV prevention for transgender individuals would be highly beneficial.

Capturing photos and videos for reporting to institutions and organizations is difficult, as most service recipients are unwilling to appear in visual documentation.

Conducting rapid HIV tests requires more appropriate time and space. Open areas and parks make it challenging to ensure confidentiality of test results. Additionally, the presence and insistence of non-trans individuals seeking tests or services during outreach in open-air locations reduces the quality of service delivery to the target group.

Performing follow-up HIV rapid tests is difficult due to limited access to accurate personal information and the lack of fixed locations for identified transgender individuals.

Many identified gathering spots are active at night, while the mobile outreach team operates during daylight hours, making access to some locations impractical.

It is recommended that packs of 15 condoms be prepared specifically for the Trans-Yar mobile team. These packs should be sufficient in quantity and discreet in packaging, as clients prefer to receive condoms confidentially.

Outreach team members should be trained on HIV medications, their mechanisms, and side effects, and be equipped with brochures on these topics. Additional brochures should be developed to raise awareness and guide HIV-positive individuals toward appropriate treatment services.

It is essential that outreach staff receive training on needle stick emergencies, including self-care strategies and safety protocols.

Given the large number of clients and the limited capacity of outreach staff to carry harm reduction supplies, as well as the need to enhance overall safety, it is recommended that a vehicle or van equipped with harm reduction items be provided to the team. Despite carrying large quantities of condoms, shortages have frequently occurred during fieldwork.

HIV-positive transgender individuals face compounded stigma and discrimination, often avoiding public healthcare centers. Therefore, it is necessary to designate a special section within behavioral disease clinics and ensure the presence of trained professionals familiar with transgender health needs.

Since gender dysphoria is not a uniform condition and surgeries are performed to alleviate physical discomfort, legal reforms are needed to support individualized care. A collective mobilization of resources and advocacy is essential.

Although transgender individuals experience body dissatisfaction, this is not limited to sexual organs. It includes overall body shape, voice, fat distribution, and more. Therefore, if a transgender person finds peace through procedures such as mastectomy or hormone therapy alone, conditions should be provided to support them—without imposing further dissatisfaction or pressuring them into unwanted surgeries

Due to the illegality of hormone therapy without official gender transition approval in Iran—and the lengthy process required to obtain such authorization—many transgender individuals resort to unsupervised and unsafe hormone treatments. These practices can lead to serious physical complications, including liver damage, negative effects on reproductive organs (uterus and testes), and overall health deterioration. They also increase the risk of HIV/AIDS transmission, as clinics and medical centers refuse to administer hormones, and pharmacies do not dispense these medications without a prescription. As a result, transgender clients often acquire hormones through illegal channels and administer injections themselves, sometimes sharing needles.

Given the economic hardship faced by clients, widespread stigma and discrimination, limited or interrupted education, unsafe hormone injection practices, and the overall vulnerability of this population, the continuation of this project is essential. Free HIV-related services for at-risk groups help prevent future social crises.

The COVID-19 pandemic and its resulting social and economic challenges have further harmed transgender individuals. Prolonged confinement at home has intensified family conflicts and increased the likelihood of them leaving their households.

The 2021 presidential election in Iran led to heightened security in public spaces and parks, reducing the presence of transgender individuals in open-air gathering spots. Additionally, there are restrictions on Trans-Yar team personnel entering indoor venues.

Responsibilities of Project Staff Working with Transgender Individuals:

– Implement HIV prevention and harm reduction programs (identification and outreach, awareness-raising, HIV education, test referrals, rapid testing, and distribution of related supplies)
– Refer follow-up cases to appropriate services (Ministry of Health behavioral counseling centers, Welfare Organization social service centers, and specialized treatment facilities)
– Form mobile peer teams (peer training, equipping teams with harm reduction supplies and rapid HIV tests, and supervising mobile units)
– Submit comprehensive activity reports to the primary contracting party based on Gantt charts
– Provide training to other institutions involved in the project (15 institutions)
– All intellectual property resulting from the project belongs to the commissioning organization. Any use of scientific findings must be authorized by the organization.
– Obtain all necessary permits from relevant authorities and stakeholders
– Maintain confidentiality of all data and information obtained during project implementation
– Uphold ethical, human, and Islamic principles in interactions with service recipients