Background: In Vietnam, the rights of transgender and transsexuals to undergo sex operations, to be legally and socially accepted with their new identity have not been respected and fulfilled. These challenges have impacted their positions in the family and society as well as their access to HIV information and services. Methods: A qualitative research was conducted in the Khanh Hoa province from April 2009 to understand how to most effectively promote the health and social well-being of these groups. Interviews and one focus group discussion were conducted with 10 male and 3 female transgender and transsexuals. Results: The Decree 88/CP dated 5th August 2008 only permits those who have innate sex deformation (i.e. with genitalia) to have legal surgery. It means that almost transgender and transsexuals are not eligible to undergo these operations. Due to stigma and discrimination and an inability to obtain new identity documents, many transgender and transsexuals have to make a living by sex work - an illegal occupation in Vietnam. A network of transgender and transsexuals has been formed from groups who perform singing, dancing and playing traditional games. People move from province to province to perform and often have unsafe sexual acts with local men without using condoms and lube. Yet available HIV information and services are limited to these individuals due to stigma and discrimination, their mobility, a lack of skills from health service providers and poor availability of MSM friendly services. Conclusions: The legal and health care systems in Vietnam need to respect and fulfill the rights of transgender and transsexuals to choose and to have legal sex change operations, to support them fully live a life with their new identity. The national HIV response should include a minimum package of services which are friendly and responsive to the needs of transgender and transsexuals.
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