“The LGB groups that gain the funding for LGBTI tend to ignore the T/I, or do not know enough about T/I to do constructive work.” These are the words of an anonymous survey respondent, speaking to the authors of a new report out this month from the American Jewish World Service (AJWS) and Global Action for Trans Equality (GATE) about the funding landscape for trans and intersex activism.

Entitled The State of Trans* and Intersex Organizing: A Case for Increased Support for Growing but Under-Funded Movements for Human Rights, it seeks to paint a picture of how funding (or lack thereof) affects trans and intersex community organizing.

Through its comprehensive survey of 340 trans and intersex nonprofits, charities, activist collectives, and community groups worldwide, the report makes a dramatic assertion of the limits of “inclusivity theater.” It suggests, in other words, that labeling yourself “LGBT-inclusive”—as a funder, a donor, or an organization—without meaningfully recognizing the T’s distinctions incurs hardships on the very community you have included in name only. “As we’re T-specific,” said another interviewee, “it is difficult to access LGBT funding.” The irony of this should be lost on no one.

As the report’s authors write, there is a quantifiable cost to the empty rhetoric of inclusion:

There is far too little funding available for trans* and intersex issues. In 2010, 6% of all funding for human rights work went to promote LGBTI rights globally ($72.6 million out of $1.2 billion in total). Of that funding, only $1.6 million addressed trans* issues and just over $40,000 addressed intersex issues—in total, 0.14% of all human rights funding and just 2.3% of all LGBTI funding.

What’s more, 95 percent of the more than 300 groups surveyed have budgets below $250,000, and more than half operate with less than $10,000 annually.

It is important to recognize that the long battle to include “T” (as well as the “I” for “intersex”) in the acronym of LGBTI organizations, and rhetoric remains an important one. Language does, after all, shape how we understand our reality, and there is immense value in reminding people that transgender and intersex people are part of that reality.

Yet, as many trans people will doubtlessly tell you, it’s far too common to find one’s self dealing with organizations that are LGBT(I) in name only. There are no trans people to be found in their corridors, much less trans staff, and precious little understanding of the unique issues that community faces. This passive indifference trickles down the funding ladder, and the costs are spelled out in the AJWS/GATE report.

The research also teased out a very crucial data point: trans/intersex nonprofits led by cisgender people tend to have significantly larger budgets than those led by community members. The analysis found that intersex-led groups have a median annual budget of $0 to $5,000 and transgender-led groups have a median budget of $5,000 to $10,000, while cisgender-led groups’ median is in the $20,000-to-$50,000 range. This affects the vast majority of the groups surveyed, as 64 percent of them are trans- or intersex-led.

But the survey itself provides, in its summary, an excellent and even hopeful overview of the state of global trans and intersex activism.

The picture that emerges is exemplified by the literary mosaic that makes up the report’s cover: a collection of all the identity terms, in dozens of languages, that trans and intersex people around the world use to identify themselves. The document is punctuated throughout by insets that examine individual groups in more detail, providing a brief but enervating overview of trans and intersex organizing the world over, from Germany to Uganda to the Dominican Republic.

In addition to highlighting the vital activist work of these groups, these insets also illustrate the uniquely local challenges that make the work necessary in the first place.

For instance, the Ukrainian trans and intersex nonprofit Insight confronts a system whereby legal, medical transition for transgender people requires both surgical sterilization and a month in a locked psychiatric ward. What could the group do with more reliable funding, in the meantime? According to the report, “Insight dreams of opening a community center that could provide shelter, employment assistance, health resources and serve as a home base for trans* activism.” The study is replete with similar examples from around the world that tell similar tales of struggle, triumph, and big dreams that thwart seemingly intractable forces.

But what are the distinctions of transgender activism, as opposed to broader LGBT activism? What most often links the groups surveyed is a focus on health-care access; transition is often a medically assisted process requiring everything from hormones to various surgeries. Intersex people confront a similar need for health-care access from sympathetic professionals who can help undo or manage the non-consensual surgeries that are often imposed on intersex children to fit them into the gender binary.

As is often the case with health politics, there is a deep imbrication with issues of economic justice—fighting poverty and homelessness, which are often imposed on trans and intersex people through various layers of discrimination, and obviate access to health care in most countries—and sex workers’ rights, as many trans women in particular often engage in survival sex work.

A good example highlighted in the report is the Dominican Republic’s Comunidad de Trans-Travestis Trabajadoras Sexuales Domincana (the Dominican Trans-Travesti Sex Workers’ Community), which organises trans and travesti sex workers and provides them medical services and information—it even trains medical providers. In partnership with feminist and sex workers’ rights organizations, the group aspires to create medical and community centers that serve trans people in both the Domincan Republic and Haiti.

This intersectional approach to politics, arising from the needs of the community itself, is often a poor fit for funders and donors who only offer painfully narrow funding streams. One example of such a funding channel is that grant-making organizations will often fund something like HIV treatment, which is indeed useful for a trans community that often disproportionately experiences HIV infection. But this also creates issues for groups that, by necessity, must provide more services than HIV and AIDS treatment. Indeed, this particular restriction (that funds earmarked for HIV treatment cannot be used for other sorts of health care) was a common complaint among activists worldwide.

The needs and aspirations of these communities spill well beyond the neat boundaries of most grant applications, which are often never designed with low-income/sex-working/trans and intersex groups in mind. As one respondent suggested to donors and grant-making organizations, “simplify application procedures and provide flexibility in use of funds, including core funding.”

Many of these groups operate through a reproductive justice framework that understands how a broad issue like health care is both a lynchpin for trans and intersex peoples’ capacity to lead their lives freely, and also exists at the intersection of a whole range of political issues. As the report states, “for many trans and intersex groups it is impossible to fully separate advocacy work from service provision.” Such groups are often in the position of both agitating for political change and providing the social service infrastructure so lacking in their communities. “Many of our projects,” according to one respondent, “may be more aligned with portfolios focused on public health, access to jobs, poverty, or school success.”

This fact is as true in the West as it is in developing nations, according to the report, and it highlights the extremity of exclusion faced by trans people, especially those who are multiply marginalized by race, class, sex working status, seropositivity, and so on. When asked what they wanted extra funding for, groups overwhelmingly selected options related to direct services. Thirty-five percent wanted additional funding for “provision of social services,” and 31 percent wanted it for “provision of healthcare” specifically (groups were able to select more than one option). “Patients’ rights advocacy” was also hugely popular, with 26 percent of organizations saying they wanted funding for it. For trans people, being able to access basic health care, as well as transition-related care, is at the wide foundation of our hierarchy of needs—without it, nothing else is possible.

Indeed, the report argues:

Constituents or members who lack a baseline of stability in terms of basic health and livelihood will reap less benefit from programming and will be able to put less energy into advocacy activities. Funders should look for ways to support groups to meet these needs.

Among this richly diverse body of trans and intersex groups, then, health care is the keystone.

Funders interested in forging stronger connections with organizations like these would do well to consider the words of one respondent who averred that “the only way to empower trans communities is to have them create their own programs beneficial for the community.” The report, further, reveals a clamor for general operating support—both in terms of general funding as well as skills-training and community networking, all things that grant-making organizations excel at providing. There was also a chorus calling for greater integration between trans communities and the funding world, with a desire to see more trans and intersex people hired in the larger NGOs and nonprofits that many of these smaller community groups interact with.

The report is worth a read, not only as an excellent, if all too brief, dispatch about the state of trans and intersex activism throughout the world, but also for its useful primer in its opening pages about the dimensions of transphobia and the struggles of intersex people, as well as a useful glossary of terms to help orient the uninitiated. The survey suffers from limitations, as it was only offered in English, French, and Spanish, and was considerably easier to access for those with reliable Internet access.

This report cannot be considered exhaustive, by any means, but it did nevertheless manage to catch a tremendous number of groups working on the most far-flung margins, and what they have to say should command the attention of everyone in the funding world.