Transgender activism in Kazakhstan, Kyrgyzstan and Tajikistan

ABSTRACT Although the lives of LGBT people in Central Asia have recently received scholarly attention, authors do not pay due attention to transgender (trans) issues. This paper explores living conditions of trans people in Kazakhstan, Kyrgyzstan and Tajikistan, as well as trans organizing in these countries. Semi-structured interviews with 11 trans activists were conducted in March–April 2022. According to the respondents, trans people in Central Asia face pervasive discrimination, harassment and rejection on behalf of society at large and their families. Many live in a desperate economic situation. Access to legal gender recognition aimed to align the person’s legal gender with their gender identity is limited; the process requires psychiatric evaluation, medical interventions and/or going to courts. A limited number of doctors can provide transition-related medical care (hormone replacement therapy, surgeries). Trans activists self-organize to address these issues and promote trans rights in Kazakhstan, Kyrgyzstan and Tajikistan. Their areas of work include providing direct support, educating doctors, and conducting advocacy with state institutions and international actors. The political environment is hostile towards trans activism. Organizations face problems receiving official registration; in Tajikistan, state pressure on civil society is especially severe. Anti-gender movements are another obstacle for trans activists. Political instability often disrupts activists’ advocacy efforts.


Introduction
Central Asia is among the regions of the world with a hostile environment towards LGBT people.Turkmenistan and Uzbekistan are the only post-Soviet countries that still criminalize voluntary same-sex relationships between men.Although laws criminalizing LGBT people do not exist in Kazakhstan, Kyrgyzstan and Tajikistan, public attitude is entirely negative.The current state of affairs can be characterized as 'hypervisibility', as homophobic and transphobic remarks of politicians and anti-LGBT bills have become part of everyday politics (Wilkinson 2020).Kazakhstan and Kyrgyzstan were among the post-Soviet countries where bills banning 'propaganda of non-traditional relationships' were introduced (although later withdrawn) following adoption of a similar law in Russia (Kirey-Sitnikova and Kirey 2019).In 2016, the Spiritual Directorate of Muslims of Kazakhstan published a fatwa against sex-reassignment surgeries (SRS) (Spiritual Directorate of Muslims of Kazakhstan 2016).
LGBT people are depicted in the media as sick perverts, and transgender individuals are misgendered and deadnamed (Alma-TQ 2019).
In these circumstances, many LGBT people in Central Asia have to hide their identities to survive and avoid harassment, that is, refrain from behaviour that can be 'read' by others as non-heterosexual and non-cisnormative (Bagdasarova 2018).When suffering from human rights violations, LGBT people are reluctant to report to the police out of fear for even greater violence (Human Rights Watch 2008, 2014, 2015).Not only are LGBT people excluded from society at large but even from the civil society (Hoare 2019).
Not just passive victims of intolerant societies, LGBT people employ various strategies to regulate their visibility and express their agency (Levitanus 2022).Over the past three decades, LGBT activists have been resorting to collective action to increase the public visibility of LGBT people; they have been voicing out their challenges and needs to advocate for a more tolerant society (Wilkinson and Kirey 2010;Wilkinson 2020).In their work, LGBT activists in Central Asia look for inspiration on Western Europe and North America, but also Russia, Japan, Brazil and other countries (Buelow 2012).Not only an inspiration, Europe is viewed as a donor of both money and skills (Wilkinson 2014).However, terminology and strategies are often borrowed from the West without proper analysis of their applicability to local contexts (Kirey-Sitnikova 2020).Public perception of LGBT activism as Western inspired (Dall'Agnola 2020) frequently leads to 'patriotic' and nationalist backlash, with conservative actors looking to Russia for inspiration (Wilkinson 2014).
While more works on LGBT rights in Central Asia have appeared in the past years, the authors usually mention trans issues in passing and do not give proper consideration for distinctions within the group they broadly define as 'LGBT'.Trans people have distinct needs in the medical (hormone replacement therapy, surgeries) and legal (legal gender recognition -LGR) spheres, which have no parallel for cisgender LGB individuals.Gender transition is hard to hide from the people around, which makes them more vulnerable to discrimination and violence.These and other considerations led to the establishment of a separate academic discipline of transgender studies (Stryker and Whittle 2006), which I consider myself belonging to.Nevertheless, the concept 'transgender' (and previously 'transsexual') is very much an invention of modern medicine (mainly Western but also Soviet), and its applicability to all parts of the world has been debated (Perez-Brumer, Parker, and Aggleton 2018).In particular, the phenomenon of bacha in Central Asia (Peshkova, Jenrbekova, and Vilkovisky 2022) does not allow for simple categorization in terms of Western science.Yet, 'trans' is used throughout this study as the term chosen by activists to talk about themselves.
This study seeks to provide insights into the lived realities of trans people in Central Asia through semi-structured interviews with trans activists in Kazakhstan, Kyrgyzstan and Tajikistan.It seeks to make three important contributions.First, it discusses the scale and visibility of trans activism in the region.Second, it delineates the modes of trans activism and how it addresses the political, social and medical challenges faced by trans people in Central Asia.Third, it links the successes and failures of trans activists to broader political processes.
Historically, Kyrgyzstan has been the most democratic state in Central Asia, where civil society groups had the best opportunities to self-organize.Oasis was the first LGBT organization established in 1995, but their work focused mostly on gay men.Labrys, established in 2004, served a broader audience, including lesbian and queer women, as well as trans people.While Kyrgyzstan's legislation had a vague clause permitting LGR, no detailed procedure existed (Kirey 2015).Starting in late 2005, Labrys had been advocating for a procedure adopted by the state, but the process was interrupted because of political instability following the revolution (Kirey 2015).Kyrgyz Indigo (established in 2010) is another major organization working to promote trans rights in the country.In Kazakhstan, Alma-TQ (established in 2014) works to advance the rights of trans and queer communities.In Tajikistan, an anonymous non-governmental organisation (NGO) focuses solely on trans issues, while another anonymous LGBT organization addresses trans rights in its broader work on LGBT rights.In addition to these 'general-purpose' NGOs, there are two groups working specifically on the rights of trans sex workers: MyrzAyim in Kyrgyzstan and Trans Docha in Kazakhstan.Underground LGBT activism exists in Uzbekistan, and some activities to improve access to gender transition for trans people are being conducted.However, the activists are afraid of publicity.Even a publication in English can be translated back into Russian or Uzbek and cause trouble (Khort 2022).That is why no interviews in this country were conducted.This is especially unfortunate given that the first Soviet patient officially diagnosed with 'transsexualism' was from Tashkent (Belkin 2000), but the principle 'do no harm' was paramount for this research project.Turkmenistan, Central Asia's most authoritarian country, does not have trans activism, to my knowledge.Thus, the geographical focus of this study is on Kazakhstan, Kyrgyzstan and Tajikistan.
The paper is structured as follows.In the next section I summarize the previous literature on trans activism in the post-Soviet space, especially in post-Soviet Central Asia.I argue that so far previous scholarship has neglected trans activists and their lived experiences in Central Asia.Afterwards, I introduce my methodological approach and its shortcomings.In this context, I also reflect upon my positionality and how it has influenced my access to Central Asian trans activists.The subsequent sections present the main narratives with regard to the challenges that trans people experience in Central Asia: LGR and access to health; social situation; trans activism in a politically hostile environment; collaboration between trans organisation and other NGOs.The study ends with a critical reflection on the extent to what trans activism in Central Asia differ from trans activism in other post-Communists regions.

Post-Soviet trans activisms: previous research
Just like in other parts of the world, social (as opposed to medical) research on trans issues in the post-Soviet region is mainly conducted by trans people themselves (communitybased research).Being part of NGOs' advocacy strategies, this research focuses on the immediate needs of trans people and is often shaped by priorities of international donors.This is the reason why most community-based studies focus on needs assessment, gender-affirming care, HIV and LGR, whereas only a few were devoted to trans activism.Trans activism is mentioned briefly in relation to the main goal of the text or is discussed descriptively (Andrushchenko 2019).Some texts focus on specific modes of activism such as employing digital tools to engage trans communities and disseminate information was described by Costache, Baigazieva, and Gejadze (2018).Among the more academically oriented research, Kirey (2015) gives an insight into the establishment of Labrys and its advocacy on trans rights in Kyrgyzstan.Recently, Sekerbayeva (2023) highlights the work of trans activists in shaping medical practices in Kazakhstan.Focusing on general trends, Kirey-Sitnikova and Kirey (2019) proposed a four-fold typology of trans activisms in the post-Soviet region.Those include: (1) horizontal mutual support networks, (2) legal and medical advocacy with the state, (3) human rights LGBT-style activism, and (4) 'cultural' activism aimed to disrupt normative assumptions about gender.Later, the classification was elaborated with each type of activism divided according to three areas: social, legal and health activism (Kirey-Sitnikova 2023a).The classification is based on the first author's observations and personal experience as a trans activism in Russia.How well Central Asian trans activism fits the typology, is among the questions that this article answers.

Positionality and methodology
My positionality has influenced the choice of the topic and the methods employed.I started my own gender transition in 2010 and since then have been involved in trans activism first in Russia and later across the broader post-Soviet region.In 2013, I was among the founders of Trans* Coalition, the first network uniting trans activists from Central Asia and Eastern Europe.Afterwards, I met some Central Asian activists in person at international events and communicated with them in social networks.Perhaps, the most important factor determining my connection to Central Asia is my partner who lived in Kyrgyzstan for 10 years and cofounded one of the most well-known LGBT organizations in Central Asia.Thus, my respondents were my colleagues, friends, or friends of friends.Working as a consultant for NGOs as a regional-level expert in trans issues, I felt that my expertise was distributed unequally in favour of Eastern Europe, so understanding Central Asian activism had been my long-term personal and professional goal.Besides, my colleagues from Central Asia believed that their work and agenda did not receive due scholarly attention and had a kin interest in raising their visibility in scientific literature.Thus, my motivation was both personal development and serving the trans community in Central Asia.In March 2022, circumstances coincided to create an opportunity for me to go to Kyrgyzstan.There I conducted three in-person interviews with Kanykei kyzy, founder of MyrzAyim, Daniyar Orsekov, former director of Kyrgyz Indigo, and Amina, an independent trans activist in Osh who was planning to establish her own organization.Although I had plans to visit trans activists in Kazakhstan and Tajikistan in person, it turned out problematic: reaching Kazakhstan was only possible by air because of COVID-19 restrictions, while Kyrgyzstan's land border with Tajikistan was closed because of a military conflict.The research project did not receive funding and my personal funds were limited to buy air tickets that were extremely expensive at the time when many Russians were fleeing their country.Thus, all other interviews were conducted online via Zoom.I interviewed Sanjar Kurmanov, former director of Labrys, who was the key person behind the advocacy for an improved procedure of LGR in Kyrgyzstan in 2017.In Kazakhstan, I talked to activists from Alma-TQ (Alexander Ksan, Victoria Ray and Alexey Kravchenko) and Trans Docha (Nari Alibekova).I also talked to three activists in Tajikistan: one representative of an anonymous trans-led group and two members of an anonymous LGBT organization (group interview).All the interviews were conducted in Russian.Altogether, 11 individuals representing seven organizations were interviewed.All the respondents from Kazakhstan and Kyrgyzstan explicitly expressed their wish to be named.Being leaders of their organization, these activists can be considered experts in their field.Interviewing experts is considered to be a quick way to collecting reliable data, especially when working with hard-to-reach populations.On the other hand, the elite status of experts in relation to their communities can be a source of bias (Bogner, Littig, and Menz 2009).
The three basic questions asked were: Which challenges in the social, medical and legal spheres do trans people face in your country?What do trans activists do to address those challenges?How are the processes within trans activism affected by political conditions?Additional questions were asked based on the respondents' answers and their particular experience.All the interviews were manually transcribed and tags were assigned in Taguette software.Thematic analysis was conducted afterwards.
The interviews highlighted a number of concerns common to all trans activists in the three countries.These common challenges are discussed in the subsequent section.

Legal gender recognition (LGR) and access to healthcare
LGR ('smena grazhdanskogo pola' or 'smena dokumentov' in Russian) is a vital procedure for many trans people who wish their official gender marker to align with their gender identity and perceived gender.Having one's gender officially recognized usually helps reduce discrimination at the workplace and everyday transphobia.LGR in Soviet Union was first legalized in 1926 and 1976 for intersex individuals, but trans people could also use this legislation because 'transsexualism' was considered a 'psychic version of hermaphroditism' (Kirey-Sitnikova 2022).Upon dissolution of the Soviet Union, Kazakhstan was the first country in Central Asia to mention LGR in legislation. 1A later decree defined the procedure, which required a psychiatric evaluation and medical interventions, including SRS. 2 Over the years, the procedure has been modified several times.The latest 2020 modification moved the clause on gender transition to a separate article in the Health Code and additional limitations were introduced: being 21 or older and having no psychiatric or behavioural disorders.The fact that these amendments were introduced at the legislative level means that advocating for their repeal became more difficult for activists because members of parliaments are more transphobic and less informed than the staff of ministries such as the Ministry of Health or Ministry of Justice.Besides, the Family Code allows the 'change of sex' upon undergoing a surgery.The activists approached the Ministry of Justice to help amend the law.The ministry agreed that the formulation could be amended to include a court decision among the reasons.However, the activists worry that this change would not improve the situation since the judges are ignorant and may decide on the person's sex based on stereotypes about how women and men should look like.
In Kyrgyzstan, LGR was mentioned in the legislation on the Acts of Civil Status ('akty grazhdanskogo sostoi ͡ anii ͡ a' in Russian) since 2001. 3The 2005 law 4 stated that a 'document of the established form' was required but no such form existed, so LGR was performed on a case-by-case basis.Advocacy efforts to develop the form were launched in 2007 by Labrys.The activists organized training sessions for doctors and engaged them in a working group.The staff of the Ministry of Health supported the process.The final draft was sent to the Office of the President.Unfortunately, at that same time, the 2010 Revolution occurred: Everything collapsed when the revolution happened.It was the first revolution.Akaev was overthrown, and many ministers were toppled.Among them were individuals who signed this draft, but later they no longer occupied these positions and all the work had to be started anew.[…] Then there was a lull and one of the activists who led [the process] left.
The process had to be started anew by new trans activists, but they had no experience and contacts with decision-makers.Quarrels among activists inhibited the work: Decision-makers knew [name of the leaders] personally.And when they left, no contacts remained.They would not introduce new [activists] to [decision-makers], there was some conflict.When I started this process in 2015, I asked all the leaders who led it before: 'Could you, please, help me, introduce me or tell how you did it?'They said: 'OK, we can talk to you [personally], but since you are at Labrys, we do not want to support it.'Finally, the working group was assembled in 2016.The group members decided to develop a guideline on trans health that would give instructions how to conduct a psychiatric evaluation and prescribe hormones.In 2017, both the guideline and the form of the document for LGR were officially adopted.Thus, trans people could have their legal gender amended after a psychiatric evaluation, but medical interventions or court decisions were not required.However, this joy did not last long.In the summer of 2020, when the activists were preoccupied with COVID-19 and quarantine measures, the clause in the law allowing LGR was quietly removed.None of the respondents knew for sure the reason why this happened or who was responsible.According to one version, the removal was initiated by the staff of the State Registry Service ('gosudarstvennai ͡ a registrat ͡ sionnai ͡ a sluzhba') who were outright transphobic.Before that, they had refused to change the personal identification number (PIN) to trans people who had undergone LGR (the PIN's first digit indicates sex: 1 for women, 2 for men).
In Tajikistan, the law also mentions a 'document of the established form' as a prerequisite for changing one's legal gender (both Kyrgyzstan and Tajikistan borrowed this formulation from Russia). 5 And similar to Kyrgyzstan, no form was developed, so trans people could receive LGR on a case-by-case basis.According to one activist, only three individuals changed their legal gender in Tajikistan, according to another, six.The diagnosis 'transsexualism' is required.Surgeries are required for trans women, whereas trans men can go without them.One person convinced the court he was intersex.Bribes are often necessary to have one's gender recognized.In Tajikistan, activists have no access to the Ministry of Health or other state authorities, so advocacy to improve the situation at the state level is not possible.
Psychiatric evaluation by a medical commission is required in all three countries to receive LGR.Only then are people granted access to medical procedures of gender transition such as hormone-replacement therapy and SRS.In Kyrgyzstan, the only medical commission that gives permission to initiate gender transition is based in Bishkek at the Republican Center for Psychiatric Health.Until recently, a similar situation was observed in Kazakhstan, where the only medical commission was based in Almaty.With the new regulations coming into force, medical commissions responsible for diagnostics of transsexualism can now be assembled in every region of Kazakhstan.However, in practice, the only functioning commission is still the one in Almaty.The regulations introduced lots of requirements, such as separate rooms for urologists, gynaecologists and other specialists, which cannot be satisfied anywhere else in Kazakhstan.Thus, trans people still have to travel to the capitals meaning they must pay out-of-pocket for travel expenses and accommodation.Consultations with doctors and tests demanded by the commissions are also paid by the patients.According to activists from Alma-TQ, trans people in Kazakhstan pay around 100,000 tenge (approximately US$240) before they can be evaluated by the commission.If the commission's decision is positive, they receive a medical certificate, which is valid for six months.In case a person fails to initiate medical transition within that period, they need to start the process anew.In Tajikistan, evaluation is conducted by medical commissions, which consist of three psychiatrists at a psychiatric clinic, but the respondents were not well informed on the details, the process was not regulated and worked on a case-by-case basis.
Hormone-replacement therapy can officially be initiated after one is diagnosed with transsexualism.Endocrinologists are mainly based in Bishkek and Almaty, but some of them provide consultations online, so trans people living in distant places can take tests and buy hormones in their home town without the need to travel.Taking hormones without prescription is common.Some individuals are afraid to visit doctors out of fear for their trans status becoming publicly known, while others cannot obtain the diagnosis.Officially hormones are sold by prescription, but in many pharmacies the prescription is not demanded, although it depends on the location: for example, in Almaty pharmacists usually do not check for the prescription, while they often do in central and northern Kazakhstan.Hormones are also available without prescription in Bishkek and Dushanbe.SRS are available in Kazakhstan and Kyrgyzstan but their quality leaves much to be desired.Those who can afford it prefer to go to Russia or more distant countries to get surgeries.
Just like in other regions of the world, trans people in Central Asia constitute a group at high risk for contracting HIV.And just like in other regions, many of them do not pay due attention to HIV prevention and treatment.Kyrgyzstan became the first post-Soviet country where trans people were recognized as a key population group in official documents.This became possible thanks to advocacy based on personal connections and cooperation with representatives of other key population groups, especially sex workers: I almost forcibly broke into the working group […] I entered with combat.And the support of sex workers helped.I started saying that trans people should be singled out [as a key group], I collected international recommendations, studies.
In Kazakhstan, trans people are represented in the Country Coordinating Mechanism, advocacy to recognize them as one of the key population groups is underway.Being recognized as a separate group (not part of other groups such as men having sex with men -MSM) is important because it gives access to funding and a sense of state recognition.

Social situation
According to the respondents of this study and previous research (Human Rights Watch 2008; Labrys and Kyrgyz Indigo 2016; Shenker 2021), transphobia, discrimination and violence against trans people are widespread in Central Asia, although the chance to face them differs significantly based on the place one lives in.In Osh, some trans people leave their homes only when it is dark out of fear for their safetya fact previously reported by Bagdasarova (2018).The situation is better in the capitals.Rejection by families is very common.As a result, many trans people have to leave their homes or hide their transition from family members.Facing bullying in schools, they often cannot receive proper education and find a job.Mismatch between legal gender and gender expression further exacerbates these problems.While trans men can usually find some low-paying jobs (e.g., at a car wash), the situation is dire for trans women.Many resort to sex work to survive and earn money to visit doctors and buy hormones.One activist describes the chain of events leading to these dire outcomes: Starting from school […] from birth when they assign you a wrong [gender] marker, then at school you face bullying, cannot get proper education because of your transgender identity, you study till the 9th grade, then many graduate, either after the 9th or 11th grade, and they do not go further to receive higher education because there is transphobia in the education system.[…] There is high pressure from the family, lack of understanding, lack of acceptance of the child, many trans people are left alone, without family's support, when they come out or [the families] learn that their child is a trans person.Especially trans women face this very often, every second or even first is forced to leave home and engage in illegal work such as sex work.Many trans women believe that it is the only way to survive.
Sex work is an administrative offence in Tajikistan but not in Kazakhstan and Kyrgyzstan.Trans sex workers frequently face violence on behalf of their clients and police officers.An activist from Kazakhstan recalled an organized criminal group led by a former police officer that extorted money from sex workers.The police are reluctant to investigate such cases, while trans sex workers are reluctant to approach the police out of fear and distrust: A person came, he beat her, broke her hand, broke two fingers, took her phone, money.And she has all the evidence.[…] I mean his [phone] number and his photo.[…] Come, catch him!But [the police] twice turned her away and she came to us.
Many trans sex workers overuse alcohol and drugs to engage with clients and overcome stress: At sex work, you can easily get hooked on drugs, alcohol.[…] Without them it is difficult to work.Every second client proposes that you drink or take drugs before having sex, to relax.And it is difficult to escape.
While sex work can bring decent income, it gives sex workers nothing in the longer run since they spend a lot and rarely accumulate money: On the one hand, it seems that [sex workers] can afford a lot.They boast that they earn a lot during the night, they can afford clothes, good food.But when something happensillness or violencethey lose everything momentarily.And this is the type of work that does not give you anything in the long run, no professional skills.[…] Rarely they save money to buy a flat or think about pension.
Working for NGOs is another employment opportunity for trans women.One respondent told that she had to return to activism after burnout because she had no other sources of income.There is no anti-discrimination legislation to protect trans people from discrimination in the workplace.

Trans activism in a politically hostile environment
The political environment is generally hostile towards trans activism.Even when the state authorities agree to cooperate with trans activists, they do not want their cooperation to be public out of fear for public backlash, especially because of associations with LGBT.Certain conservative groups, such as Kyrk Choro in Kyrgyzstan, put pressure on the government and contribute to a hostile political climate.In Kazakhstan, anti-gender movements recently emerged exemplified by the Kazakhstan's Parents' Union that promotes 'traditional values' and opposes, among other things, anti-discrimination legislation, legislation on domestic violence, sexual education and vaccination for children (Shoshanova 2021).According to the respondents, the movement received support from Russia.In 2014, Kyrgyzstan's parliament tried to pass legislation on 'gay propaganda' and 'foreign agents' also borrowed from Russia (Sultanalieva 2020).Although both pieces of legislation failed in the end (mostly because of the pressure from the European Union; for more, see Wilkinson 2020), activists had to divert their time and resources to oppose them: In 2014, there was a bill on propaganda, which originated from Russia, and about foreign agentsthose two came in parallel.In this process, we can see.[…] The EU gives 30 millions of project funding to Kyrgyzstan, but they have foreign agents, gay propaganda in their agenda.[…] And when the EU announced that they give money, the state withdrew these two bills.Or they introduce them when discussing the Eurasian Customs Union to distract attention.
Labrys and Kyrgyz Indigo received official registration from the Ministry of Justice in Kyrgyzstan.On the other hand, activists from Alma-TQ in Kazakhstan decided that the official registration can hardly be obtained because of the transphobia and homophobia of state officials.Trans Docha in Kazakhstan and MyrzAyim in Kyrgyzstan are also not registered because their founders and beneficiaries are trans sex workers.To receive grants they rely on officially registered NGOs that can act as financial sponsors for them.An anonymous group from Tajikistan could get registered using vague formulations in their charter.Despite the official registration, activists from this organization do not approach state authorities such as the Ministry of Health, fearing that their organization would be closed by the Committee for State Security (KGB).The only state institutions trans activists in Tajikistan can work with are state-run AIDS centres where they have connections with friendly doctors.
As noted above, political instability, such as revolutions, has negative consequences for activism because it leads to frequent replacements of officials and the need to build connections with new state employees.Although the interview guide did not include questions on COVID-19, activists in both Kazakhstan and Kyrgyzstan noted its deplorable consequences similar to those of revolutions.For example, in Kazakhstan, the Minister of Health was dismissed for failing to handle the situation with the virus, leading to perturbations within the ministry.Restrictions on in-person meetings meant that activists were unaware of internal processes going on within state institutions: Since the beginning of the pandemics in 2020, we had problems with advocacy.All the processes related to development, discussion of the Health Code, they became closed.It was increasingly more difficult to understand what was going on.[…] In the end, we learnt that [the rules of medical evaluation] had already been developed, the [public] discussion had already taken place and they had been approved.
Similarly, in Kyrgyzstan, the clause on LGR was silently removed from legislation when the activists were preoccupied with the pandemics.Activists from Kyrgyzstan complained that the country was heading towards authoritarianism after the election of Sadyr Japarov in 2020.This led to deplorable consequences for the civil society in general and trans activism in particular: This so-called 'oasis of democracy' is no longer here on many items: foreign indices of freedom, freedom of speech […] we started falling significantly.The legislation is rapidly changing.There is much more hate speech against the civil society.[…] There is clear fear of the president who does everything to usurp the power.
Simultaneously, most activists noted the growth of and positive change in trans communities.More and more trans individuals approach trans/LGBT NGOs for support and visit various activist events.At the individual level, trans groups provide support to trans people in concrete cases.For example, Trans Docha helps trans sex workers suffering from violence to file complaints to the police and initiate court cases.During the COVID-19 pandemics, trans/LGBT organizations provided trans individuals in need with medicines, food and shelter.Most NGOs run support groups, provide peer-to-peer consultations or consultations with cisgender specialists, including lawyers, psychologists and doctors.They also maintain lists of friendly doctors.Educating doctors is another important area.Such medical specialists as psychiatrists, endocrinologists and surgeons must be informed about the needs of trans people in the sphere of medical transition to provide high-quality medical care.In Kyrgyzstan, training for doctors has been organized by Labrys from 2007.Additionally, trans activists bring friendly doctors to international events, such as the conference of the European Professional Association for Transgender Health (EPATH) in Ghent (Belgium) in 2015, or the conference on trans health in Lviv (Ukraine) in 2016.Trans activists also develop educational materials for doctors: for example, a brochure Doctor, This Is For You by Labrys (Karagapolova n.d.) and My First Transgender Patient by Alma-TQ (Alma-TQ n.d.).An anonymous trans organization in Tajikistan developed a draft protocol on hormone-replacement therapy, which they used to educate endocrinologists.In addition to training and sensibilizing doctors, trans activists try to reach other professional groups.For example, Kyrgyz Indigo launched an educational course on LGBT issues for future police officers.
Connections with doctors and other professionals are employed in advocacy to approach state institutions such as the Ministry of Health.Oftentimes such advocacy is based on personal connections between activists and decision-makers, so in cases when the former or the later leave their workplace, everything must be started anew.International advocacy is an important tool because governments of Central Asian countries care much about their image at the international stage: 'Such window dressing is very important in Kyrgyzstan, you can use treaty bodies, say how it will affect the reputation of Kyrgyzstan.'A recommendation of the Committee on the Elimination of Discrimination against Women (CEDAW) was an important factor leading to the improvement of LGR in Kyrgyzstan.In Tajikistan, where activists feel unsafe to approach the state directly, United Nations mechanisms are the only way to put pressure on the authorities.Recently, trans activists in Central Asia initiated a number of research projects aimed to substantiate their demands and improve their advocacy.For example, an Integrated Bio-Behavioral Surveillance (IBBS) survey and a study on sexual health were being conducted in Kyrgyzstan at the time of the interviews.In Tajikistan, a needs assessment of trans people and a study of doctors' attitudes towards trans and intersex people has been conducted recently.

Collaboration between trans organizations and other NGOs
In case a certain request cannot be fulfilled within the organization, clients are redirected to friendly NGOs specializing in certain issues.For example, trans people in need of HIV testing or treatment are redirected to HIV-service NGOs.Some of these NGOs employ trans individuals to make their services more trans inclusive.Trans activists not only respond to requests but also actively engage trans communities by conducting outreach activities aimed to inform trans people, enhance their capacity and mobilize them.In this context, the respondents often talked about collaborations between other NGOs and trans activist groups.
Collaboration with feminist organizations is particularly important in Kazakhstan and Kyrgyzstan.Trans activists frequently participate in feminist rallies and marches with trans flags and banners.They also cooperate with human rights defenders who can provide legal support to trans people and HIV-service NGOs where trans people can be tested and receive condoms, lubricants and preexposure prophylaxis.
International collaborations are extremely important.Meetings with foreign activists at conferences and trainings abroad were described as turning points in the history of Central Asian trans organizing by several participants.For example, advocacy for LGR in Kyrgyzstan was renewed after the conference in Lviv, Ukraine.Alma-TQ was established in 2014 after activists from Kazakhstan participated in the Trans Camp in Karpaty, Ukraine, organized by Trans* Coalition (a regional-level organization working in Eastern Europe and Central Asia) and the conference by Transgender Europe in Budapest, Hungary.Sometimes trans activists from Central Asia can bring Western experts to their countries.For example, the former president of the World Professional Association for Transgender Health (WPATH) was invited to Kazakhstan and Kyrgyzstan to boost advocacy efforts for an improved procedure of LGR.The importance of UN mechanisms has already been mentioned.
Furthermore, collaborations are maintained between trans activists from different countries in Central Asia.The Central Asian LGBT+Platform has been organized twice to bring together LGBT activists from the region.Activists and friendly doctors from Tajikistan visited trainings conducted by Labrys and Kyrgyz Indigo in Kyrgyzstan.There is some cooperation with Russian NGOs as well.Activists from Tajikistan receive antiretroviral therapy against HIV for Tajik migrants working in Russia from the national AIDS Center and send it to Russia by post.Sometimes Russian HIV-service NGOs send medicines in the opposite direction to migrants from Tajikistan who decided to return to Tajikistan.Activists from Kazakhstan invited a surgeon from Russia to perform surgeries for trans people in Kazakhstan.Needless to say, all financial support comes from international donors.Working with local donors or local branches of international NGOs is seen as unsafe by activists in Tajikistan because these organizations report to the Ministry of Justice.
Conflicts between trans activists and other trans groups and other peer groups are rare but do occur.For example, one activist in Kyrgyzstan noted that trans sex workers have become less united and interested in activism: 'The topic of activism and these discussions are of no interest to them.Previously, I could motivate them.[…] But now I do not know new girls.[…] They say they do not care.'There was less cooperation between groups, and often activists from one NGO had no idea what another NGO is doing.Moreover, there is a growing competition between trans/LGBT groups over resources.An activist from one NGO said that activists in another NGO are not trans but pose as trans for donors to receive funding as a trans-led group: 'They identify as gays, as far as I understand.But in certain cases, at the proper moment, they, how you call this, change their shoes [and present themselves] as transgender.'Conflicts between activists can impede the work on shared goals.For example, back in 2014 Labrys had no trans staff but tried to engage in advocacy on LGR.The now defunct trans-led group Tendik opposed the move claiming that Labrys cannot lead this work because there were no trans people involved.

Conclusions
Societal transphobia resulting in persistent discrimination, harassment and unemployment, as well as barriers in access to LGR and medical transition were the main challenges faced by trans people in Central Asia, according to the interviewees.Therefore, these issues received most attention on behalf of the growing trans movement.The repertoire of actions of trans/LGBT NGOs usually includes the provision of direct services to trans people in need of psychological and legal support in the form of peer-to-peer consultations and consultations with specialists.They organize trainings for doctors, lawyers and decision-makers to raise their awareness on trans issues.Advocacy is conducted within state institutions, mainly the ministries of Health and Justice, to improve the situation with LGR and medical care.International advocacy (mainly UN mechanisms) is an important tool for exercising pressure on the state.To substantiate their claims, activists conduct community-based research that provides vital glimpses into the lives of trans people but, unfortunately, is not published in peer-reviewed journals.
Thus, we can see here the full range of activism typologies described by Kirey-Sitnikova and Kirey (2019), although 'cultural' activism aimed to disrupt gender norms and stereotypes is less prominent, as activists concentrate more on 'everyday' issues that bear immediate consequences for the lives of their beneficiaries.It is possible to theorize that for marginalized communities to focus on more abstract matters 'basic' needs should be satisfied first.Gender affirming medical care, one of the dire needs for trans people, has been historically more developed in the Eastern European part of the Soviet Union, and this inequality persisted in the post-Soviet period.Thus, trans activists are more determined to raise trans visibility among professional groups (doctors, psychologists, lawyers) and decision-makers than among the general public out of fear for public backlash in case the topic becomes more hypervisible (e.g., highlighted in the media).The respondents also reported that the staff of ministries did not want their negotiations with the activists to become known to the public.According to Kirey (2015), progress with the adoption of a decree regulating LGR is Kyrgyzstan was once suspended in 2012 as a result of public discussions on web forums and in the media.In July 2023, already after the data had been collected, the parliament of neighbouring Russia passed a law prohibiting LGR and transition-related medical servicessomething that could potentially happen in Central Asia if visibility becomes too high.In August 2023, Kyrgyzstan passed a Russiainspired law prohibiting the propaganda of non-traditional sexual relationships among minors.As of September 2023, a bill prohibiting the propaganda of same-sex marriage in the media is at the stage of public discussion, as well as a bill on 'foreign representatives'.These conservative and authoritarian developments reflect the recent rapprochement between Kyrgyzstan and Russia and the latter's influence on politics in Central Asia.Worldwide, trans issues are drawing increased attention on behalf of anti-gender movements, further emphasizing the importance of cautious strategies.Thus, trans activists have to ensure that trans issues are visible enough in certain spaces to make progress but not become hypervisible to hinder it.
Central Asian trans activists are engaged in multiple international network.Soviet legacy exemplified by the use of Russian language and similar legislative frameworks (including LGR) make organizations from Eastern Europe and South Caucasus their primary partners.As of this writing, activists from Central Asia are part of two international networks focused on the post-Soviet region: Trans* Coalition and the Trans People Working Group of the Eurasian Coalition for Health, Rights, Gender and Sexual Diversity (ECOM).Visa-free regimes with other post-Soviet countries make them (especially Russia) attractive destinations for Central Asian trans migrants; starting in February 2022, migration of Russian trans individuals (including activists) escaping mobilization and other governmental policies to Central Asia partly reversed the trend; these flows of migrants promote collaboration between organizations (Kirey-Sitnikova 2023b).Collaboration with European Union (EU)-based networks (Transgender Europe, ILGA Europe) is also underway, although the realities of the EU are quite different and activists complain about the lack of inclusion on equal terms (Kirey-Sitnikova 2020).No evidence of contacts with activists from neighbouring Asian countries (Iran, China) was found.
Compared with most countries in the post-Soviet region, trans activists from Kyrgyzstan and Kazakhstan enjoy unprecedented access to Ministries of Health and other state institutions.This resulted in the adoption of a rather progressive (compared with other countries in the region) procedure of LGR in Kyrgyzstan in 2017.However, advocacy is mostly based on personal contacts and must be conducted silently, unnoticed by the media and the general public.Thus, the successes of activists are based on a shaky ground and can be reversed at any moment.Exactly this happened when the legal clause permitting LGR was suddenly removed in Kyrgyzstan and the age limit was increased to 21 in Kazakhstan.Unlike the staff at ministries, members of parliaments are less informed on trans issues and inherently more conservative, so it is easier to advocate for improved decrees than to change laws.
The successes of trans activists are partly explained by the fact that laws permitting LGR were unmindfully borrowed from the Soviet or Russian models.Thus, no discussion within the parliaments was required to introduce the right for LGR in legislation, and all advocacy efforts could be limited to the level of ministries (Kirey-Sitnikova 2022).Nevertheless, even that work could be disrupted by broader political events.The 2010 revolution led to the replacement of key bureaucrats in the government.As a result, the draft decree on LGR was not signed.Similarly, the 'January's Events' in Kazakhstan created obstacles for trans advocacy.The COVID-19 pandemics also disrupted advocacy efforts in both Kazakhstan and Kyrgyzstan.Thus, unlike the political opportunity theory (Meyer and Minkoff 2004), which conceptualizes the vulnerabilities of political systems as opportunities for social movements to achieve change, political stability is a necessary condition for Central Asian trans activists to conduct quiet internal advocacy.
Thus, trans activism in Central Asia can better be characterized as a network of 'pressure groups' that prefer to act behind the closed doors and require political stability for their success.In this, they differ from Western LGBT movements that are often labelled as 'new social movements' and demand 'cultural' change within respective societies.At the same time, trans NGOs are far from classical pressure groups that 'merely seek to change their bit of the world, and are reasonably comfortable with the state of society and politics as they find them' (Crowson, Hilton, and McKay 2009).Some activists explicitly mentioned authoritarian political systems as obstacles to trans organizing.A few trans individuals participate in protests on broader political issues.Nevertheless, at its present stage, trans activism is focused more on concrete acute problems such as violence, LGR and medical care than broader political issues.
The limitations of the study resulted from the choice of respondents.All of them were leaders of their organizations and, thus, held privileged positions compared with less known activists, volunteers and beneficiaries of these organizations.All but one resided in the capitals of their countries.One respondent reflected on his privileged position recalling his visit to Osh: 'Inside them, there is a black mishmash of anxiety, fear, hatred, anger, everything.Sometimes they splashed it out on me because I came from Bishkek, I am clean, I earn money, came here to teach.' Thus, talking to a broader range of trans respondents might reveal a somewhat different picture.Future research should focus on the following questions: What are the attitudes towards activism in Central Asian trans communities?Do the priorities of activists align with those of their beneficiaries?Which groups believe they are included or excluded in activism and why?Notes