Broader Discrimination

Health Care

Many of the transgender people interviewed by Human Rights Watch had experienced discrimination in the health care sector. They said health workers ogled and commented on their bodies, refused to touch them, or touched their sexual organs unnecessarily, and that they were placed in male or female wards without regard for their gender identity.

Sharan went to Sungai Buloh government hospital just outside Kuala Lumpur in 2011 for fever, sore throat, and a migraine:

I went to a nurse at the general hospital. The nurse didn’t want to touch me. She asked me to put in the thermometer myself [in my mouth], then to put it back in the tray, and then she immediately put it in a separate container with lots of Dettol. She taught me how to use the [blood] pressure machine, to squeeze it, tighten it, so that she wouldn’t have to touch me. I felt as if I have a disease—if you touch me, are you going to become transgender as well?

When I told the doctor about it he said, ‘They’re just nurses.’ I said, ‘Yes, but they’re supposed to treat patients properly.’[121]

She also faced overly curious health workers:

Another time in 2010, I had a migraine. I went to the local [private] clinic, Reddy Clinic, nearby here. The doctor asked me to lie on the examination bed. I said, ‘I have migraine.’ He was checking my crotch area, put his finger in my belly button, and said, ‘I’m checking to see if you have any stomach upset.’ I just walked out—he just wanted to feel me.[122]

Ron, a middle-class transgender man in Kuala Lumpur, said that although he found most doctors in the private sector were open-minded, “I had one case of a doctor who checked my pelvic area even though I was there for something completely unrelated.”[123]

Many trans people are unable to afford private clinics and instead seek treatment at government facilities, where they may face more serious discrimination. Naz, a transgender woman in Seremban, felt humiliated by health workers when seeking treatment for low blood pressure at Fort Dixon General Hospital, a government hospital, in 2008:

One time I overdosed on hormones. I had low blood pressure. I was raced to the emergency room. My family was there. I was on the bed half awake, aware of what was happening. There were all these trainees, new doctors. They opened my clothes, were pointing at my breasts, asking, ‘Is this a man or a woman?’ I felt humiliated and also embarrassed because my family was there. What mother would want to hear that? I felt very small at the time.[124]

Another transgender woman, also known as Nazz, went to a government hospital in Penang for treatment for dengue fever. She said, “I could hear [hospital staff] chatting while I was waiting, ‘Is that a boy or a girl? I think it’s a mak nyah,’ ‘I think it’s a sissy boy.’ It hurt, but I just kept my head down—I don’t want to cause any trouble.”

She said that following that experience, “I prefer private [hospitals], even though I have to pay more. Most of the time they treat me like a person.”[125]

Erina, in Kuala Lumpur, was hospitalized for two days in 2011 for a high fever.  She was placed in a male ward because of the “male” sex marker on her identity card, despite her request to be placed in a female ward. Doctors and nurses quizzed her about her gender identity, asking questions unrelated to the condition for which she was seeking treatment. “They treated me like they treat people with HIV. They were clearly not comfortable,” Erina told Human Rights Watch.[126]

Discrimination in the health sector is not across the board, and may reflect individual rather than systematic bias.[127] Some transwomen said that they had encountered positive experiences with doctors and nurses at public hospitals, including one HIV-positive transwoman from Kedah who said her doctor at Sultanah Bahiyah public hospital was supportive of her gender identity.[128] All six transwomen Human Rights Watch interviewed in Kuantan said they had not faced discrimination from health workers. “They treat me like a normal person,” Hafiza explained.[129]

But fear of discrimination means some transgender people abstain from seeking medical care. Dorian, an activist who has developed a network of transmen throughout Malaysia, said many who have not fully transitioned are afraid to seek out gynecological services: “For [transmen] who are stealth, they don’t go for Pap smears at all.”[130]

Rabisan, a transman who has not undergone sex reassignment surgery and who occasionally engages in sex work with male clients to make money, was anally raped by a client on one occasion. He did not seek medical treatment because he was embarrassed at the prospect of revealing his female genitalia to a doctor: “I was embarrassed. I couldn’t seek help. I would have to explain all these things, reveal my ‘parts.’”[131]

Most of the transgender people we interviewed said that they take hormones to alter their physical appearance and affirm their gender identity. Fearing stigma, most do not seek the support of medical professionals, instead buying over-the-counter hormones with no medical advice. Family Health and Development Association in Penang, one of the few service providers that assists transgender people with hormone intake, found that most participants in its outreach programs were taking excessive doses, which may produce dangerous side effects.[132]

HIV Prevalence and Inadequate Support

Discrimination in the health sector is particularly problematic given transgender women’s vulnerability to HIV.[133] It is difficult to estimate HIV prevalence among criminalized populations that are stigmatized and socially marginalized, however the most recent estimate of HIV prevalence among transgender women was 5.7 percent, significantly higher than the 0.4 percent prevalence found among the general population.[134] Public health experts suggest that this may significantly underestimate the true prevalence.[135] In addition, HIV awareness and prevention are believed to be much lower among transgender women than rates measured among the overall population. Teh Yik Koon’s study of 507 mak nyah found that respondents had low levels of awareness of HIV and of condom use, and the majority reported that they did not regularly use condoms.[136]

An official at an organization conducting HIV prevention work in Penang said,

Transgender women tend not to go to government health facilities, which are free of charge, to seek health care. They’re subjected to people sneering at them, shouting out their male names—even in anonymous HIV screening situations. One transgender woman had staff shout out, ‘This man is going to an anonymous HIV screening!’ So if this continues, no one will ever go for medical screening—if you have a bad experience, you won’t go back.[137]

A number of NGOs throughout Malaysia conduct HIV outreach to transgender people, providing the kinds of friendly services they may not find in government hospitals. The federal Department of Islamic Development, JAKIM, has also taken an interest in HIV outreach to transgender people, but their approach is problematic: at times welcoming, JAKIM also uses stigmatizing language and rejects transgender people’s own understandings of their gender identity. For instance, JAKIM’s 2010 “HIV and Islam” manual, published in partnership with the Ministry of Health, recognizes that transgender people may be at risk in part due to stigma, discrimination, low self-esteem, and lack of social support structures, but also professes that they are lacking in “religious comprehension” and need “counseling in sexuality and moral values.”[138] Advice for HIV prevention in JAKIM’s manual includes advice like: “Never commit to wrongful sexual acts like adultery, sodomy and lesbianism. The best way to protect yourself from sexually transmitted diseases like HIV is by avoiding adultery and sin.”[139]

Employment Discrimination

When asked about her biggest concern as a transwoman, Nazz, a 31-year-old transwoman in Penang, immediately responded, “Jobs.”  She continued:  

Most [transgender women] work on the streets as prostitutes because they don’t have any choices. Most are not highly educated. Most have been rejected from jobs. … Malaysia should prohibit this discrimination.[140]

The absence of any law protecting Malaysians from employment discrimination based on gender identity or expression leaves women like Nazz—who said she was turned away from several interviews for retail jobs as soon as the employer realized she was transgender—with no recourse in such situations. Beka, from the northern state of Kedah, told Human Rights Watch she had been rejected on the basis of her gender identity more than 10 times by prospective employers, including an international corporation.[141]

Natasha, a 33-year-old transgender woman in Penang, told Human Rights Watch that despite her efforts to neutralize her appearance and blend in, she still faced job discrimination:

When I go for an interview, whether a factory, shopping complex, hotel, or anywhere, I dress in a simple way—no make-up; if I have long hair at the time I bun it up. [But] they would tell me, ‘No, we don’t want transgender women.’[142]

Sharan said she thought that employers were more interested in her body than her job qualifications:

Since [the government] made us seem like aliens, it’s hard to find jobs. When I go for an interview, if the interviewer is male, the first thing he asks me is, ‘Are your breasts real? When did you decide to change?’ I explain I’m a transsexual woman. ‘Do you have a penis or a vagina? Do you have sex with men or women? Which toilet do you go to? Did you do your operation? Why did you choose to take hormones?’ It’s nothing relevant to the job. And it’s not just one place—this has happened at almost every interview I’ve gone to. And then they tell you they’ll call you in two weeks, but you don’t get any phone calls. Or they SMS asking, ‘Are you free tonight?’ There’s no agency that you can report job discrimination to.[143]

Malaysian employment law prohibits sexual harassment against employees, but not prospective employees; no law or institution in Malaysia protects transwomen from sexual harassment during the job application process.[144]

Victoria, a 33-year-old transgender woman from Seremban, has not been fired from a job because of her gender identity, but told Human Rights Watch that when she worked at a petrol station of a global company, she was forced to dress as a man. “That’s not necessary—I know who I am,” she said.[145]

Suvati, a 24-year-old trans woman in Kuala Lumpur, found that not only did one prospective employer treat her in a discriminatory manner, he also called the police on her when she tried to stand up for herself. She went for a job interview at an international call center, where her interviewer, upon realizing she was transgender, began to insult her, calling her pondan and telling her transgender people are a curse:

He said, ‘You are a she-male, I cannot accept you. The company will get a bad name.’ I started crying and arguing with the guy, trying to explain what problems we go through. The guy said, ‘Since you’re arguing with me a lot, I’ll call the police.’

Several police officers arrived at the office, and Suvati was able to explain that she had simply been speaking up in response to the interviewer’s insults. She told them she wanted to file a complaint against the company:

I said, ‘I want to come into your station to report this international company. I need to make a report on the guy by name, actually.’

The lady police officer said, ‘If you come and file a report, it will never get looked at because you’re a she-male.’ I said, ‘Just forget it.’[146]

Other employers are more accommodating, as Hezreen found when she worked for a fast food restaurant in Kuala Lumpur:

I got a job at [an international fast food chain] in the kitchen crew. I did not have a house so I was put in the male hostel. I couldn’t stand it. I asked to stay at the women’s hostel, but they were uncomfortable with me. So I transferred to a small room in the manager’s hostel.[147]

Education

Many transgender people face discrimination in school—in some cases, as early as primary school, and in other cases, in secondary school or college. Azlene, a 31-year-old transwoman in Kuantan, recalled: “I quit school at age 11 because people around me were always bullying me. I was stressed. I felt like I was going to explode.”[148]

Adik, a transwoman in Seremban who has undergone SRS, told Human Rights Watch why she dropped out of university:

There are two reasons I don’t want to continue my studies. I already feel like I’m half a woman because of the surgeries; if I go to university I’ll have to follow their dress code and wear a shirt and pants. Second, the changed shape of my body would show. Also, I would have to stay in a student hostel with other male students. I wouldn’t feel comfortable if they asked me questions. I would continue my studies if it were in a place that was more accepting of mak nyahs.[149]

Adik had been in university prior to her SRS. One reason she dropped out was that she was forced to share a room with a man and to attend all-male classes. She asked college officials to make an exception for her, but they refused.

The Education Department of the Federal Territory (Kuala Lumpur) has an explicitly discriminatory policy that calls for punishment, including caning, suspension, and expulsion, for homosexuality and “gender confusion.” [150] Women’s Aid Organization, an organization based in Kuala Lumpur, has documented one case of a lesbian expelled from secondary school due to her sexual orientation. Human Rights Watch is not aware of cases in which this policy has been enforced against trans people. [151]

Sexual Assault and Harassment in School

Four transgender women interviewed by Human Rights Watch reported sexual assault and harassment by their fellow students—and in one case, by a teacher—which may also contribute to the drop-out rate.

Aisah, who started hormone therapy at the age of 14 and began developing breasts, experienced sexual harassment in secondary school, but fought back: “Male students in school loved to squeeze my breasts, and I would punch them in the face.” Teachers were of no help, she said: one curious teacher also squeezed Aisah’s breasts, and quizzed her about whether she was taking hormone pills.[152]

Sharan said that at age 14, she had never heard the term “transsexual,” but believed she had a deformity that consisted of male genitalia cleaved onto what she experienced as a female body. She said was treated as a “girl” by the other boys in her all boys’ school, treatment that culminated in gang rape when one boy, and then others, forced themselves on her in a field outside the school:

I was in a shocked state, and couldn’t move. I was thinking to myself, ‘Run, run,’ but couldn’t do anything. He pushed me on the ground and removed my clothes. I felt like the dirtiest person on earth. I could just say, ‘Stop it,’ but couldn’t push him away.

The boy covered Sharan’s mouth to silence her, and proceeded to anally rape her. Then, she said,

I saw the grass rustle. There were seven of them and they took turns.

I had no one I could talk to. I knew the teachers or my parents would blame me for being like this because I was born deformed.[153]

Natasha, a 33-year-old transgender woman in Penang, recalled that in secondary school,

Other boys started teasing me and would touch me and make sexual advances. They would grab my hand, pinch my butt, touch my chest area. They all hinted at wanting to have sex with me. … I went to the boys’ toilet but I was always disturbed there. The boys would prevent me from leaving the toilet. They would pinch me and touch me, and call me names like ‘pondan.’[154]

Family Violence and Rejection

Some transgender people are mistreated and rejected by their own families. Dorian, a transman, said that shortly after he turned 18, when he still identified as a butch lesbian, his father found out he was dating a woman:

He slapped me across the face and said, ‘This is my house, you follow my rules. I don’t accept all this. If you still want to be like that then you can leave. I’ll help you pack and I’ll close the door behind you.’ At that point I’d had enough and said, ‘I’m going to leave.’ I told my mom I was leaving. She tried to stop me. But she was worried that Papa would kill me. My dad, when he’s angry he can’t control himself.[155]

In the six years since, Dorian has reestablished contact with his mother’s side of the family, but his father, he said, ‘still pretends I don’t exist.’[156]

Azlene, a trans woman from the northwestern state of Perlis, said her parents rejected her at the age of 8 or 9 because she was considered too feminine. Azlene went to live with more tolerant relatives, but came back to her mother’s house at age 13. However, Azlene said, ‘My mother noticed everything I was doing was feminine. She didn’t like it. My mother beat me and did not accept me as her child. I was frustrated, my heart was broken. I went back to my aunt’s house.’[157] Only after five years with no communication did Azlene’s mother reach out to her, willing to accept her for who she was.

KRYSS reported several cases of violence against trans people by family members. One transwoman reported that as a gender non-conforming child, she was beaten on a daily basis by her father: “He would use wires, metal rods to hit me. He has even broken my arms.”[158] Another transwoman told KRYSS that her father hit her and imprisoned her in the house as an attempt to regulate her gender identity, [159] while a third transwoman said that her older brother, an army commander, beat her and stripped her when he found her wearing women’s clothes.[160]

Domestic violence in Malaysia can be prosecuted under Penal Code provisions on hurt, criminal force, and assault, and a separate Domestic Violence Act sets forth procedures for seeking a protection order against a family member.[161] Human Rights Watch is not aware of any attempts by transgender individuals to use this law to seek protection or a remedy for family violence.