LONDON Ever since she can remember, Katherine Cummings knew she had been born into the wrong body.
"I knew I was transgendered as far back as memories go," said the 76-year old, formerly called John, who works at Australia's Gender Center for people with gender issues. "Four years of age or so."
Since her 1930s childhood, the lives of transgender people have improved dramatically in many countries. But discrimination remains widespread. Hundreds of transgender people are killed every year and many live in constant fear of attack.
"Transgenders often suffer violence, physical and social, from their families, including spouses, parents, children and siblings," Cummings said.
She spoke to Reuters ahead of the annual Transgender Day of Remembrance (TDOR) on November 20 which commemorates those who have been killed because of their gender identity.
Founded after the 1998 murder of transgender woman Rita Hester in Massachusetts, the day now has a global following.
In the first nine months of 2011, 116 transgender people were murdered globally, according to Trans Murder Monitoring (TMM), a project coordinated by non-profit association Transgender Europe.
Their research indicates there have been at least 681 reports of murders in 50 countries since 2008.
It was at the age of 51, after marrying and fathering three children, that Cummings was finally ready for gender reassignment.
Despite the pervasive discrimination, she says gender activists are winning some battles. Cummings points to significant developments over the last decade, such as the recent ruling that Australians can change their gender on passports without surgery - to male, female or indeterminate.
"I feel, on the whole. looking back over the past few decades, that matters are slowly improving," said Cummings, whose book about her transition, "Katherine's Diary," won the Australian Human Rights Commission's 1992 non-fiction award.
Seven of this year's murders were in the United States, TMM said. Washington D.C. hit headlines this year after a series of attacks against transgender people - one of them the fatal shooting of 23-year-old transgender woman Myles Mclean.
"I look forward to the day that no one has to hide or be killed, or bullied or teased or rejected simply for being the person they believe themselves to be," said Eva-Genevieve Scarborough, 56, who is helping organize a remembrance event in Riverside, California.
"Society needs to be made aware that atrocities such as the murder of trans folks are still happening all around the world."
Many transgender people seek surgery or hormones to change their physical gender. Others don't, some by choice and some because discrimination or lack of means stop them accessing medical help.
Discrimination also damages their employment opportunities. And activists worldwide are battling to remove 'gender identity disorder' from lists of officially recognized mental illnesses.
Most of the murders of transgender people TMM recorded this year occurred in Latin America - 29 in Brazil, 22 in Mexico, 11 in Venezuela and 10 in Columbia, as well as murders in 10 other Latin American countries.
TMM also noted murders in Turkey, Pakistan, India, Indonesia, Malaysia, the Philippines, and Poland.
United Nations human rights chief Navi Pillay said in May that hate crimes against lesbians, gay men, bisexuals and transgender people are on the rise around the world.
"Transgender people face the worst challenges, regardless of which country they are coming from or situated in," Liesl Theron, executive director of Gender dynamiX, an organization supporting transgender and transsexual rights in South Africa, told Reuters.
"Usually trans people are on the fringes of society, and the most marginalized."
In a 2008 paper on transgender people in Africa, she cited examples of transgender women across the continent being beaten and imprisoned.
"Most African countries still have some form of legal action, legislation and laws against homosexuality and sodomy (which includes all forms of being a trans person)," she wrote.
Poor access to medical services is the number one challenge in much of Africa, she added.
Theron quoted one Ugandan activist as saying that doctors often refuse to treat transgender people and even sometimes tip off police, leading to arrests.
Trans people in Uganda have been forced to resort to self-medication with dangerous long-term implications, the activist added.
In South Africa, the transgender community has won some victories - the Department of Home Affairs agreed this October to change the gender and forenames of a transgender woman. Yet people awaiting gender-reassignment surgery still join a seven-year waiting list.
Slowly, gender rights are improving in many countries. But the discrimination is proving hard to stamp out.
"Humanity has an ingrained need for a 'pecking order,' that sets some people up as superior to others," said Cummings of Australia's Gender Center. "Transgender (people) will be a target for bigots for a long time."
On the other side of the world, British children's charity Mermaids works to help children who, like Cummings nearly eight decades ago, feel they were born in the wrong body.
Testimonies published on the charity's website, written by children with gender identity issues, bring home the confusion and harassment faced by so many.
"As a child, I acted as my real self, but then the bullying started," reads an extract from a poem that one of these children, Sophie, wrote at the age of 15.
"Why was I born a lie?" the piece ends.
(Editing by Paul Casciato)