LONDON, Dec 10 (Thomson Reuters Foundation) - When she transitioned from a man to a woman at the age of 27, Cecilia Chung lost her friends, her family and her job.
Ostracised from society for being transgender, and relying on sex work to survive on the streets of San Francisco, Chung was unprepared for the horror that was to follow.
"I was arrested for soliciting and put in detention for three days, where gay and bisexual men and transgender women were housed in the same cell," said Chung, 49, a strategist at the San Francisco-based Transgender Law Center.
During her detention, Chung was coerced into having unprotected anal sex with one of the male inmates, and months later, she tested positive for HIV.
"I was too afraid to fight or resist him because the entire experience of being in arrested and in jail had already overwhelmed me."
People who are transgender are described as people who feel they have been born into the wrong gender body.
Many transgender people are prescribed hormones by their doctors to change their bodies, while some undergo surgery. But not all can or will take those steps, and transgender identity is not dependent upon medical procedures.
While transgender women are accustomed to abuse, stigma and violence, one of the biggest dangers they face today is HIV.
Due to the discrimination they face, many transgender women have few options other than sex work to survive, increasing their risk of contracting the virus.
Chung spoke to the Thomson Reuters Foundation a week after a report to mark World AIDS Day said the world had finally reached "the beginning of the end" of the AIDS pandemic that has infected and killed millions in the past 30 years.
The ONE campaign said over the last year the number of HIV-positive people who joined those getting access to the medicines they need to keep AIDS at bay was higher than the number of those newly infected with HIV.
Despite this progress, transgender women are being marginalised, excluded, and left behind, Chung said.
"It's far too easy to ignore the gaps and the high rates of HIV prevalence among transgender women across the world."
Almost one in five transgender women worldwide are living with HIV, and they have a higher chance of contracting the virus than other vulnerable groups, including sex workers, gay men and drug users, according to the Joint United Nations Programme on HIV and AIDS (UNAIDS).
"Transgender women are 49 times more likely than other adults to have the virus, yet HIV prevention, testing and treatment services for transgender people are far from adequate across the board," Chung said.
According to UNAIDS, less than half of the world's countries have national AIDS strategies that include transgender people.
It also said transgender people face discrimination from the moment they enter health services, which insist on the use of only two genders and lack non-judgmental staff trained to respond to their needs.
Channing Wayne, a transgender woman and member of the San Francisco HIV Prevention Council, recalled a doctor asking her why she had breasts and a penis.
When Wayne told him she was a pre-operative transsexual, he asked what she meant.
"I explained that I was transitioning from a man to a woman and he sneeringly asked why," the 46-year-old told the Thomson Reuters Foundation.
Transgender women with HIV are often doubly discriminated against, Chung said, making them far less likely to seek out medical services which have "historically failed them".
"When transgender women are wondering where they are going to sleep, and how they're going to eat, going to a doctor and seeking medication is not a priority for them," Chung said.
There are several factors that contribute to such high HIV rates among transgender people, according to the American Foundation for AIDS Research (amfAR).
It said that transgender people often drop out of education, limiting their employment prospects, experience discrimination when it comes to housing and employment, and are rejected by their families, leaving them vulnerable to violence, drug and alcohol abuse, and selling sex to survive.
Chung said since such factors were common for transgender women worldwide, she was not surprised that rates of HIV prevalence among transgender women were consistently high across the world.
A study by medical journal The Lancet found 44 percent of transgender women had HIV in India, 34 percent in Argentina, 33 percent in Brazil, 26 percent in Indonesia, 25 percent in Italy and 22 percent in the United States.
"HIV epidemiologists would tell you that infection rates vary from region to region, but for transgender women, it is truly a global issue," Chung said.
Recounting the many occasions on which she was sexually assaulted, and an incident where she was stabbed trying to defend herself, Chung said transgender women needed more protection.
"Until the hearts and minds of entire countries start to change, we won't see any progress.
"Policy makers must come together and take action to ensure the transgender community is not left behind." (Editing by Ros Russell)