Healthcare Challenges for India’s LGBTQ+ Community: Legal Advances and Persistent Barriers

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.