Despite the Philippines being one of the more LGBTQI + friendly countries in Asia, prejudice and discrimination based on an individual’s sexual orientation, gender identity and expression, and sex characteristics (SOGIESC) remain systemic, commonplace, and entrenched within Philippine society.1 SOGIESC-based prejudice and discrimination (SPD) position the LGBTQI + community as second-class citizens and this minority status makes them more vulnerable to health problems and ill-being.2 However, this vulnerability is not necessarily similarly experienced.
Trans Filipinos remain invisible and excluded in policies and programs intended to address their health problems. For instance, the generalization of the vulnerability to HIV/AIDS across key populations under the MSM label has made invisible the unique needs of trans Filipinos.3 Similarly, despite the vulnerability of the LGBTQI + community4 to mental health problems, LGBTQI + responsive mental health care remains scarce and inaccessible in the Philippines.1
Given the pervasiveness of SPD in Philippine society, an intersectional approach presents an opportunity to analyze the invisibility and potentially elucidate the unique health needs of trans Filipinos. Identifying salient structures and institutes that contribute and cultivate the oppression of trans Filipinos would expand our understanding of trans health that has largely been dominated by Western discourses on LGBTQI + health and is focused on HIV/AIDS, mental health, and gender-affirming services.5 In the succeeding sections, I map some of the oppressive structures and institutions that influence trans health among Filipinos.
Colonialism, Cisgenderism, and Capitalism as Structures of Domination
Trans health inequities must be analyzed vis-à-vis relevant structures of domination, or ideological and systemic patterns of power relations.6 Among trans Filipinos, this entails acknowledging colonization’s impact on Philippine society. Aside from the pronounced gender egalitarianism, the spiritual leaders in pre-colonial Philippines (babaylans) were either females or men who “transformed” to be more “effeminate”.7 However, Spanish colonization disrupted these norms and laid the groundwork for the stigmatization of gender diverse identities in Philippine society. The impact of colonization remains salient because of the continued privileging of heterocissexist norms of gender and sexuality among Filipinos.
The influence of cisgenderism must also be acknowledged. The disruption of biology-based gender ideology by trans individuals results in tensions that make trans individuals more “visible to stigma”.8 This visibility contributes to their invisibility in health, especially in medicine where the use of sex characteristics remains a significant identifier and mechanism for categorization. The use of MSM as a category and its inclusion of trans women3 hints at the invisibilizing impact that cisgenderism has on trans health.
The nexus of gender, sexuality, and class identities among trans Filipinos is salient as well. While trans Filipinos are allowed to work, such economic affordances must be evaluated vis-à-vis the neoliberal capitalist systems where their capacity for productive economic work is commodified and entails other forms of social and emotional labor in the workplace that cisgender co-workers do not have to do.9 Despite this, trans Filipinos are still refused employment opportunities unless they present themselves according to their sex at birth.1 These illustrate how the capitalist system in Philippine society oppresses trans Filipinos not only through the unequal distribution of economic resources among all Filipinos but by forcing them to negotiate their trans identity as well.
Religion, Law, and Education as Institutions of Oppression
In contemporary Philippine society, the influence of the identified structures of domination are especially visible in the creation, passage, and implementation of health and public policies on gender and sexuality. The roles of organized religion and the legal system are salient. For instance, the Catholic Church heavily influenced by the passage and creation of The Responsible Parenthood and Reproductive Health Act of 2012, ensuring that heteronormative values such as family formation and marriage remained central.10
Likewise, Comprehensive Sexual Education (CSE) continues to exclude narratives, experiences, and frameworks relevant and responsive to the Filipino LGBTQI + community.11 Though positioned as a preventive policy against sexual and reproductive health problems, CSE remains focused on reproductive health. This raises concerns of inclusion and access to sexual health information among trans Filipino youth whose SOGIESC does not align with heteronormative values and norms.11
Furthermore, the trans invisibility in medical education creates challenges among Filipino healthcare workers in providing quality healthcare for their trans clients.3 This is further complicated by the representation of trans identities in psychological and psychiatric sciences. For instance, the continued inclusion of gender dysphoria—preceded by gender identity disorder and transsexualism—as a mental disorder in the DSM surfaces concerns of the continued stigmatization and medicalization of trans individuals.12
As a health barrier, SPD could likewise be mitigated by anti-discrimination legislation. However, the Philippines has had difficulty passing such a law at a national level due to strong opposition from the Catholic Church and conservative legislators.13 Although several local anti-discrimination policies have been enacted, these hardly address the systemic prejudice against the LGBTQI + community that trans Filipinos are disproportionately vulnerable to.
Future Directions for Trans Health Research and Policy in the Philippines
In elucidating these co-existing ideological structures of domination and their manifestations in Philippine social institutions, the gaps in the Philippine healthcare system vis-à-vis addressing trans-specific health needs and problems are further reified. There is an opportunity for future research and policy work in the Philippines to address these gaps. Future work can begin their efforts by focusing on the following future directions:
Gender-inclusive and gender-specific approaches to trans health. Future research and policy work can explore the applications and implications of both gender-inclusive and gender-specific approaches to trans health in the Philippines. Research deploying both methodologies may further elucidate shared experiences across the LGBTQI + community without compromising the unique, intersecting experiences of oppression that informs trans health Filipinos. Similarly, adopting both approaches may contribute to mainstreaming trans health issues into the greater health discourse while also demanding for greater affordances for trans Filipinos in health.
Increased community participation and collaboration. The implementation of existing trans health research and policy work may benefit greatly from conducting regular community consultations and establishing community advisory boards. These initiatives are mechanisms for transparency and accountability that greatly empower marginalized sectors. As such, efforts must be made in ensuring that trans organizations are invited to participate and contribute to existing Philippine health policies and programs relevant to the trans health.
Centering of trans Filipino voices in health discourses. Future efforts must center the experiences of the trans community in the Philippines in public health discourses in both academic and policymaking circles. Although local LGBTQI + organizations are actively involved in the deliberations of both anti-discrimination legislations, the participation of the trans community in the policy development process must be ensured as well. The academe, especially in the health and medical sciences, must also be intentional in amplifying the voices of trans Filipino scholars.
Decolonizing and expanding the scope of trans health. Health research and policy work in the Philippines must make efforts to push the envelope and explore trans health beyond its current scope.5 Filipino scholars must be cognizant of how global, particularly Western, discourses on trans health shape local discourses within both academic and policymaking arenas. Further, local trans health research must consider exploring health experiences beyond sexual and mental health among the trans community. Though important and relevant issues, general health studies would create an impetus for the Philippine healthcare system to take next steps through policies and programs.