Transgender Health in India
Feb. 23, 2020 • Architi Batra
On April 14, 2015 in National Legal Services Authority v. Union of India, the Supreme Court of India legally recognized the transgender community and issued directions needful to uplift the long-neglected community.
The Centre, through its Ministry of Social Justice and Empowerment, seems to still work on ways to reach out. In addition, Centre and State Governments were directed under this judgment to take proper measures to provide medical care to transgender people in the hospitals and also dispense separate public toilets and other facilities. Further, separate HIV/Sero-surveillance measures were to be provided. (1)However, all of this to be implemented on the ground level is still a distant dream as there is little to none being done when it comes to physical and mental health services for transgenders.
India is estimated to have about 2 million transgenders. But healthcare in terms of sex reassignment, gender reassignment surgeries, sexually transmitted infections, and mental health has never been a priority for transgenders simply because of the stigma it entails.
When asked about any special healthcare benefits or facilities being provided in government hospitals, Poonam, a 21-year-old transgender who belonged to Assam and now resides in Delhi stated, “Whatever we need, we manage from our own earnings.”
A similar answer resonated with the other individuals belonging to her group. The meager income they managed was by begging at traffic lights and through ceremonial blessings, through which they could only afford artificial modifications like cladding up in sarees and glossy jewelry.
In its ruling under Navtej Singh Johar v. Union of India, India’s Supreme Court declared that the “right to health is understood to be indispensable”. Under the rule change, all LGBT people in India would be guaranteed “the right to emergency medical care and the right to the maintenance and improvement of public health”, the five Supreme Court judges said. (2)
Yet after the landmark ruling, fears are growing that many trans-Indians are avoiding doctors’ visits altogether out of fear of discriminatory treatment they could possibly undergo.
“Even if you look at a visceral level, right from access to information in terms of literature available about medical problems specifically faced by the community, there is a huge gap," says Anjali Gopalan, founder of Naz Foundation (India) Trust, fighting the HIV/AIDS epidemic in India. “There are such strange questions doctors ask, particularly those whose orientation is easily visible, such as the eunuchs. If castrated, their bodies become a spectacle for many." (3)
Upon being asked about the legal side of a sex reassignment surgery, a Delhi based doctor elaborates, “Interestingly there are no clear guidelines in the Indian law. We are following American law. Before we do any such surgery, we need an affidavit in the court of law, with a witness and the doctor, describing to the patient that this is permanent.”(4) A single surgery can cost anything between ₹2,00,000 to ₹8,00,000, and the option is only available to only some of the lakhs of trans people in India.
Further expanding on the cost involved in an SRS, Vinay Chandran, Counselor and Executive Director of Swabhava states, “Each state is very different. It depends on the kind of services that are available. Some hospitals offer subsidized services and some hospitals offer full services. In terms of government SRS services, it is only available in Tamil Nadu, among the Southern states. There is no recognized service center anywhere else that I have seen (in Southern India). NALSA judgment hasn’t been implemented right across the country so we still struggle with the implementation of basic policies for trans men and women.” (5)
It is a broader field which not only includes physical well-being but also mental as well as social well-being, as recognized by the World Health Organization. (7) Not only it includes healthcare services, but it also includes the social factors which highly influence the health of an individual. These factors can be poverty, living conditions, or whether basic living amenities are available to the community or not. The perception of the society towards transgenders also plays a dominant role which impacts the mental health of an individual who’s already facing several issues created by the late acceptance of this community.
Prasad Raj Dandekar, a radiation oncologist at a top Mumbai hospital, formed the Health Professionals for Queer Indians (HPQI), an organization that trains doctors, especially mental health professionals, to understand the health needs of the LGBT community. To date, HPQI has trained nearly 1,000 medical professionals across India.
“I thought even the medical professionals know so little about homosexuality, let alone how to provide care to those within the community," Dandekar says. (8)
Upon conducting additional research and interviews, it became evident that healthcare in India is not trans-friendly. The LGBTQ people have traditionally been ignored as a part of the society, and now, when the law has finally provided them with some protection against transphobia, it is the mechanics of the society that terrorize regular life experiences and create disparities.
Following are the health problems which transgender people face:
- HIV and STIs:
Transgender people are 49 times more at the risk of living with HIV than the general population because economic vulnerability and exclusion make sex work a viable option of income. Transphobia often creates barriers in access to STI testing and treatment services. Hijras and other transgender people are recognized as a ‘core high-risk group’ by India’s National AIDS Control Organisation (NACO). Social barriers such as cissexism and lack of family support, community-level barriers such as discrimination of HIV positive hijras within hijra communities and from co-patients, and technical barriers such as obstacles within the healthcare system, inferior service and ignorance amongst professionals create challenges. In hospitals, gender-segregated wards, bathrooms can be of particular concern to gender minorities.
Another big concern is the lack of data available on the number of transgenders who are eligible for free antiretroviral treatment in public hospitals. Limited disintegrated data is provided in the table under (9) :
Additionally, the absence of sensitization and insensitive hospital policies creates an environment that relegates the present situation of trans healthcare in India.
One major example of the harsh domain in India towards transgenders as the Transgender Persons (Protection of Rights) Bill 2018 which proposed the establishment of a board to determine whether an individual is transgender or not, based on their genitals and whether they have undergone gender-affirmation surgery or not. Thankfully, the Bill lapsed when there was a huge outcry against it.
2. Substance Abuse:
Cigarette smoking among LGBT individuals in India is higher than among heterosexual individuals. More than 30,000 LGBT people die each year of tobacco-related diseases. In addition to tobacco abuse, alcohol dependence and other drug abuse are also common. This can correlate to the transphobic experiences, low self-esteem issues, and exclusion they face.
3. Suicide and self-harming tendencies:
Mental healthcare is non-existent for LGBT people in this country. According to the Indian Journal of Psychological Medicine, thirty-one percent of transgender persons in India end their life by committing suicide, and 50% of them have attempted suicide at least once before their twentieth birthday. (10) Lack of holistic care for mental health and natal support further aggravates their state.
During our discussion with a transgender group, the fact that trans children are often given away willingly by their parents came to light. The head (Guruji) of the trans community of that particular area takes away these children and imparts them with basic knowledge and facilities to sustain life, and ends up becoming a parental figure to them.
Such segregation at a young age standardizes the idea that the trans community is something divergent to them won't the mechanism of the society.
4. Victimization and violence:
No anti-discrimination laws or policies in relation to discrimination on the basis of sexual orientation or gender expression or identity are present in the system except Article 15 which speaks about the prohibition of discrimination on the grounds of religion, race, caste, sex, or place of birth. As a consequence, transgenders experience transphobic ideologies, not only of the masses but also the police.
Vilification of trans people has become the norm. A 2014 report tabled by the expert committee of the Ministry of Social Justice and Empowerment emphasized the need to develop trans-friendly policies/guidelines to ensure barrier-free access to healthcare.
To confront the present situation, it is of vital importance that transphobic violence is criminalized. And sensitizing mental health and healthcare professionals about trans identities has become of primary value. There should be explicit non-discriminatory policies regarding sexual orientation and gender identity while admission and registration in hospitals. Steps must be taken to decrease stigma and discrimination faced by trans people from the general public and health-care providers.
[The author Aishani Vij is a 3rd Year student from Vivekananda Institute of Professional Studies, affiliated with Guru Gobind Singh Indraprastha University]
- https://en.wikipedia.org/wiki/Naz_Foundation_v._Govt._of_NCT_of_Delhi
- https://www.reuters.com/article/us-india-lgbt-health/indias-doctors-from-conversion-to-conversation-on-lgbt-issues-idUSKCN1PT1HJ
- https://www.livemint.com/Politics/w6C5ws5POJ7d1O590mP6mJ/Accessing-healthcare-still-an-ordeal-for-LGBTQ-in-India.html
- https://www.youthkiawaaz.com/2017/01/sex-reassignment-surgeries-in-india/
- https://hidden-pockets.com/healthcare-challenges-faced-by-lgbt-community-in-india-in-conversation-with-vinay-chandran/
- https://www.indiatoday.in/education-today/gk-current-affairs/story/kerala-2nd-state-to-pay-for-gender-reassignment-surgeries-1309716-2018-08-09
- https://www.who.int/about/who-we-are/constitution
- https://www.livemint.com/Politics/w6C5ws5POJ7d1O590mP6mJ/Accessing-healthcare-still-an-ordeal-for-LGBTQ-in-India.html
- http://csharp.in/research_policy/Download/Health%20Care%20System%20Barriers%20Faced%0by%20Indian%20-
Transgender%20People%20In%20Accessing%20HIV_STI%20Prevention%20and%20Treatment,%20&%20What%20Can%20Be%20Done.pdf - https://medium.com/@healthcare.executive.in/lets-get-this-straight-indian-healthcare-needs-to-get-lgbt-friendly-4797e28f9578