Stigmatized transgender people struggle to access healthcare in Vietnam

She had the surgery in early 2016 after being born a male.

She need care after the surgery in terms of hygiene and hormonal drugs, but there was no healthcare facility for transgender people in Vietnam.

"I was afraid to go to a public hospital because I did not know which sex column to check when filling out the paper work to get a checkup."

While her breast implant surgery was relatively gentle and had little impact on her health, it took her several months to recover physically and mentally after having her genitalia removed.

She occasionally experienced a burning sensation and pain in the operated area, which she could only try and relieve with a warm towel and by researching online into how to clean the area to avoid infections.

She asked Thai friends to buy hormone pills from reputable stores in their country and ship them to her.

She was frequently subjected to stigma and discrimination, which added to her psychological stress.

One time she took a chance and went to a female endocrinologist for a checkup, but the doctor sent her away saying she had never treated a patient like Minh before.

She developed depression and insomnia as a result of events like these and had to rely on sedatives to sleep at night.

Since there are no regulations covering hormone therapy and gender reassignment surgery, Minh is one of thousands of transgender individuals in Vietnam who face difficulties accessing official medical services.

Trans people thus find it difficult to access official medical services, and many end up using hormones on their own, putting themselves at great risk.

According to Huynh Minh Thao, an LGBTQ+ rights activist, there is high demand among the LGBT community for medical and mental health support as nearly half the posts in transgender online community groups being health-related questions indicate.

"When you don't know who to ask, you can only rely on word-of-mouth advice."

He points out that transgender people can overdose when trying to take hormone medications at home or get infected when untrained individuals attempt to clean the incision area after surgery.

Some 73 percent buy hormones from friends and non-medical sources, studies have found.

Since transgender people face a stigma, many are afraid to visit public hospitals and are hesitant to provide information about their gender or sexual orientation.

One of the factors preventing transgender people from receiving needed care, according to the Center for American Progress (CAP), is discrimination, which has a significant impact on the "physical, mental, and behavioral health of transgender adults."

In 2019 Binh Dan Hospital in HCMC became the first public medical institution in Vietnam to have a clinic solely to treat LGBT people, offering counseling, blood tests, hormone treatment, sexually transmitted disease treatment, post-sex reassignment surgery monitoring, and other services.

"While the LGBT community has much demand for medical examinations, most hospitals do not offer hormone treatment, sex reassignment surgeries or post-surgery care and do not even have endocrinology departments, making it difficult for LGBT people to get such services [in the country]," Thao says.

Transgender people face discrimination when it comes to healthcare not only in Vietnam but also in many other countries, including the U.S.

According to a 2021 CAP report, nearly one in two transgender people, including 68% of those of color, reported mistreatment by a healthcare provider in 2020, including "care refusal as well as verbal or physical abuse."

Because of fear of discrimination, 28% of transgender people delayed or did not receive necessary medical care.

Transgender people forego routine check-ups and even emergency services that could save their lives as a result of being dismissed by the healthcare system.

Discrimination and harassment contribute to transgender people experiencing high levels of stress.

The Covid-19 pandemic has also exacerbated this group's health disparities, with CAP discovering that a third harbored suicidal thoughts during the outbreak, and half reported that access to gender-affirming healthcare was significantly limited during this time.

Although the Vietnamese government has amended the Civil Code to recognize the gender of people who undergo sex reassignment surgery, transgender people are still not officially recognized.

A law on transgender rights is still pending passage.

"Disadvantages and difficulties are unavoidable," Dr Phan Chi Thanh of Hanoi's National Hospital of Obstetrics and Gynecology says.

Many people only associate transgenders with breast implants and genitalia surgery but they also have a slew of health issues such as an increased risk of infectious diseases, metabolic disorders, heart disease, high blood pressure, and diabetes, and require professional healthcare, monitoring and examination, he says.

Transgender people may want to store their sperms, eggs or other reproductive materials in addition to surgery, he adds.

Dr Hoang Manh Ninh, head of the plastic and aesthetic surgery department at the Hospital of Post and Telecommunications in Hanoi, agrees with him saying transgender and LGBT people still have limited access to basic healthcare and services such as endocrinology, dermatology and others.

He says the issue in Vietnam is not lack of expertise but of legislation.

In fact, doctors are constantly acquiring new skills in order to support patients and provide the best care possible, and at his own hospital many transgender men have had breast reduction surgery, he says.

"When the law on transgender rights is passed, more hospitals will be available to the LGBT community, so they will not have to get surgery abroad or at unlicensed medical facilities."

According to the 2021-30 national strategy on gender equality in the health sector, which aims to "ensure gender equality in accessing and enjoying health care services," the rate of provinces and centrally-run cities with "at least one medical facility providing healthcare for gay, bisexual and transgender people will reach 40% by 2025 and 70% by 2030."

On August 8 the Ministry of Health said since homosexuality is not a disease and thus cannot and should not be "cured," medical examination and treatment facilities must be respectful of all gender identities and provide equal healthcare access opportunities.

"I hope everyone understands the importance of transgender people living as who they are as well as bisexual and homosexual health care needs in general," Thao adds.