According to the
2011 census, there are approximately 4.88 lakh transgender people in India.
Despite this substantial number, transgender individuals often face
stigmatization in the healthcare sector and other aspects of their lives.
LGBTQIA+ healthcare encompasses a wide range of issues, including mental health
and physical health concerns such as HIV/AIDS, substance abuse disorders,
alcohol and tobacco use, depression, hepatitis, breast and cervical cancer, and
access to care for transgender individuals. Barriers and discrimination hinder
their access to quality medical services. Vulnerable communities are denied
healthcare due to a complex mix of restrictions.
With a narrow
focus on HIV and STD prevention, our healthcare system has often neglected the
overall health of transgender individuals. As a result, non-communicable
illnesses, including mental health issues, often go undetected within the
transgender population. A report on transgender human rights highlights the
prohibitively expensive nature of gender affirmation procedures for many
individuals. Additionally, there is a scarcity of hospitals in India with
qualified medical professionals to perform these procedures.
Healthcare
Disparities and trust issues for transgender individuals,
For transgender people, seeking healthcare services—even for common ailments—can be traumatic because they do not conform to traditional gender roles. Mainstream health practices still do not consistently provide sensitive, inclusive, and clinically competent care for LGBTQIA+ communities. Queer individuals often encounter prejudice and ignorance when seeking medical attention.
In healthcare settings, transgender individuals frequently face infractions, demeaning remarks, and dehumanizing actions. Additionally, lesbian and bisexual women may experience prejudice based on appearance or reluctance to disclose their relationship status. Misgendering and denial of access to medical care persist as examples of queerphobic and discriminatory behavior within the Indian public health system, which does not adequately cater to the LGBTQ+ population. Moreover, government hospitals often lack inclusive practices in areas such as wards, bathrooms, and outpatient departments, which undermines confidence in appropriate health-seeking behavior.
Research indicates that trans people often turn to government healthcare facilities as a last resort due to a lack of trust in other healthcare providers. This lack of trust can be attributed to negative preconceptions and attitudinal prejudices among healthcare professionals. Gender affirmation procedures are also expensive and out of the reach of many transgender people, and very few Indian hospitals have the medical professionals with the training necessary to conduct them, according to a report on the human rights of transgender people.
Not only that, a significant number of physicians decline to treat LGBTQ+ patients. Homophobia and transphobia persist among healthcare providers. While some doctors are willing to treat LGBTQ+ individuals, their lack of training and experience can hinder effective care delivery.
Documented cases reveal instances where doctors instructed nurses to write prescriptions
for transwomen instead of doing so themselves. Many medical professionals avoid
direct contact with transgender patients due to discomfort in managing their
care, as highlighted by a study conducted by the Humsafar Trust. Furthermore,
doctors’ perceptions of transgender people’s multi-partner sleeping patterns
are often inaccurate. Transgender individuals also face the risk of double
discrimination from the medical community if they test positive for HIV.
Unfortunately, a significant number of medical personnel remain unaware of the
health issues specific to transgender individuals. These barriers impede their
access to high-quality healthcare and exacerbate existing health disparities.
Prejudice, stigma, lack of understanding among medical professionals, and
exclusionary laws contribute to these challenges.
Educational Gaps
and Representation,
The prescribed
textbooks for the MBBS curriculum tend to underrepresented transgender bodies
and fail to address the nuanced aspects of gender beyond the binary distinction
between male and female. However, the Centre for Investigation into Health and Allied Subjects (CEHAT), in collaboration with government medical colleges in
Maharashtra, made efforts to integrate gender perspectives into undergraduate medical
education in 2015. Despite these efforts, there remains a lack of studies
analyzing medical practices from a gender perspective and examining how medical
education informs clinical practice.
legal advances
have also failed to change persistent barriers,
Despite
legislative advancements, the LGBTQ+ community in India still faces
difficulties within the healthcare system. The ‘Transgender Persons (Protection of Rights) Act, 2019,’ which aims to safeguard transgender rights, and the
NALSA ruling recognizing transgender individuals as a ‘third gender’ under
Indian law have not yet significantly impacted their situation. Discrimination
in healthcare services is prohibited by statute, and the government is
obligated to ensure that transgender patients receive care, including
gender-affirming procedures and HIV surveillance. Full legal recognition and
protections for transgender individuals are still lacking in India. As a
result, they remain marginalized and struggle to access healthcare services.
Starting in
February 2022, transgender people are eligible for 'Ayushman Bharat' healthcare
insurance benefits. However, these benefits are exclusive to those who
have registered through the National Portal for Transgender Persons with the
Ministry of Social Justice and Empowerment. Unfortunately, few transgender
individuals possess official records, exacerbating the problem.
Similarly, the
'SMILE' Scheme, launched in 2022, aims to mainstream transgender persons. It
addresses their unique psycho-social, socio-economic, and health issues.
Despite these
efforts, challenges persist, including inadequate access to healthcare and
discrimination. Advocacy and continued policy implementation are crucial to
creating a more inclusive society for transgender individuals in India.
Verbal harassment and denial of care persist at many medical clinics. The lack
of public and private healthcare insurance further isolates transgender people.
Tragically, there have been instances where transgender individuals have concealed
their identities due to abuse, hindering their ability to seek treatment.
For instance, Kerala-born transgender woman Anannyah Kumari Alex tragically
took her own life after experiencing alleged medical malpractice during genderaffirmation treatments. Similarly, 22-year-old transgender woman Anushri
Banerjee faced hospital negligence and gang rape. Transgender individuals like
Aher have encountered discomfort and ridicule in both male and female hospital
wards after testing positive for HIV.
Umesh P, who sought treatment for a kidney issue, chose not to disclose their
transgender identity to hospital staff due to fear of invasive inquiries.
Meanwhile, 33-year-old transgender woman Sonika from Bangalore reported
offensive comments from hospital employees and unwelcome curiosity from other
patients.
Another example
is Samira, an HIV-positive transwoman from Kolkata, who visited a government
hospital for an HIV test. She said the doctor and her assistant laughed at her,
saying, “Agar yeh sab bimari tumko nahin hoga toh aur kisko hoga?” (If you
people are not infected with such diseases, then who is?”)
Many transgender individuals resort to self-medication, alternative medicine, and even seek treatment from unlicensed doctors due to the discrimination they face and the lack of effective interventions. Unfortunately, private hospitals are often financially out of reach for most of them.
Even in death, transgender people do not find peace. The case of Saikat, a transgender individual who died in a train accident, highlights the uncertainty faced by doctors when deciding whether to admit them to a male or female ward.
These heartbreaking stories underscore the urgent need for improved healthcare facilities and greater acceptance of LGBTQ+ individuals in India.
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