Pride Month 2025 | Centering Trans Leadership in HIV Responses: Community-led Strategies and Policy Influence in Armenia

In Armenia, like in many parts of Eastern Europe and Central Asia, transgender people continue to face stigma, marginalization, and healthcare exclusion. While progress has been made in the fight against HIV, trans communities have not been reached meaningfully yet. There is currently no separate HIV prevention program implemented by and for trans people. Instead, for many years trans-specific needs have been subsumed under programs designed primarily for men who have sex with men (MSM), erasing critical differences and excluding trans people from tailored support. For several months now, transgender individuals have been unable to access any HIV prevention services at all. But the narrative is shifting — not only because we are demanding a seat at the table, but because we are building the table ourselves.

As the Programs Director of the National Trans Coalition Human Rights NGO and a community expert at the European AIDS Treatment Group (EATG), my work lies at the intersection of health, human rights, and trans-led advocacy. Over the past several years, I have witnessed firsthand how meaningful change in the HIV response can only happen when those most affected are not just consulted but are the architects of the systems meant to serve them.

From the Margins to the Center 

For far too long, trans people in Armenia have been excluded from health planning processes — treated as invisible in data, as “too complex” for service providers, or entirely outside the scope of national strategies. The fact that there is still no separate HIV prevention program designed by and for trans people — and that access to prevention services has been interrupted altogether — underscores how deeply systemic this exclusion remains. This invisibility has real consequences: late diagnoses, poor access to treatment, and elevated risk of HIV transmission fueled by discrimination, poverty, and violence.

But trans communities are not passive recipients of care. We are researchers, strategists, educators, and advocates. And we’ve built structures to reflect that reality.

At the National Trans Coalition (NTC), we have led Armenia’s first-ever trans-specific HIV needs assessments, co-developed national HIV service packages tailored for trans people, and trained dozens of healthcare professionals on trans competency. Through these initiatives, we have collected data, held institutions accountable, and most importantly — offered concrete solutions.

One of our most impactful tools has been community-led monitoring (CLM). This approach allows us to systematically evaluate the accessibility and quality of HIV services from the perspective of those using them. In 2024, I presented our findings on CLM at the Fast-Track Cities conference in Paris, highlighting major gaps in the treatment journey for both MSM and trans people living with HIV in Armenia. These insights, rooted in lived experience, have become a powerful advocacy tool with national stakeholders — especially critical at a time when our communities are left without access to lifesaving prevention.

Building Coalitions and Shaping Policy 

Our work doesn’t stop at data collection. As a previous member of Armenia’s Country Coordinating Mechanism for HIV, TB, and Malaria, I represented trans communities in decision-making spaces that shape national health funding and program design. It is in these rooms that I see the stark difference between policy drafted about communities and policy drafted with communities.

Alongside other civil society actors, NTC has contributed to the Transition Plan for State Funding of HIV Services, pushing for sustainable, community-based solutions in the face of donor withdrawal. We’ve advocated for PrEP and PEP accessibility, gender-sensitive service delivery, and the inclusion of gender identity indicators in national HIV surveillance systems. These may sound technical, but they are the backbone of inclusive healthcare — and the absence of a dedicated program for trans people remains a glaring gap that must be addressed immediately.

Our advocacy also extends to international platforms. I’ve had the honor of presenting civil society reports at the UN Committee on Economic, Social and Cultural Rights (CESCR) and the Universal Periodic Review (UPR) sessions in Geneva, bringing Armenia’s trans and HIV issues to the global stage. These opportunities allow us to link national struggles to broader international human rights frameworks — and remind decision-makers that our issues are not niche; they are matters of dignity and justice.

Community Resilience Amid Adversity 

Operating in a region with conservative cultural norms, limited legal protections, and rising authoritarianism is not easy. Trans-led organizations in Armenia face constant threats — not just political, but financial and emotional. The recent interruption in prevention services highlights how fragile access can be when systems do not recognize our autonomy or prioritize our leadership. Yet we persist. Our resilience is born not out of necessity alone, but out of love — for our communities, for the lives we’re trying to protect, and for the future we’re building.

Why Trans Leadership Matters 

When trans people lead, the HIV response becomes more just, more effective, and more sustainable. We don’t only focus on access to medication; we focus on dignity, on self-determination, on changing systems that were never designed for us. We understand the nuances of our communities’ needs — from hormone access to mental health support to safe spaces where people can be who they are without fear.

But we cannot do this alone. Governments, donors, and international agencies must prioritize funding for trans-led organizations, urgently restore and expand HIV prevention services specifically for trans communities, and include trans voices in all levels of policy-making. Ensuring our safety and access to care is not a privilege — it is a right.

Looking Ahead 

The work is far from over. But we now have blueprints, momentum, and generations of activists refusing to accept invisibility as the norm. In Armenia, we are planting seeds of systemic change — and through continued advocacy, solidarity, and leadership, we will ensure that those seeds grow into structures of care, equity, and justice.

Let this be a call to action: Center trans voices. Fund trans leadership. Restore our access. And let us lead the HIV response we deserve.

Hmayak Avetisyan

Programs Director, National Trans Coalition Human Rights NGO (NTC) 
SCOPE Community Expert Member, European AIDS Treatment Group (EATG) 
 
Yerevan, Armenia 

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