Queerphobic and discriminatory behavior practices such as misgendering or denial of access to medical care are still happening in the public health system, which does not appear to be fitted for the LGBTQ+ community.
“When we go to healthcare providers, especially in emergencies, we realise that nothing is fitted for trans people. Indian law is supposed to be gender-affirmative, but not much has been done since 2019 and the Transgender Persons Act,” says
She adds, “The result of this is a transphobic system. Even if some of the doctors are good, well-intentioned people, they do not have the necessary skills and knowledge to offer proper healthcare to queer and trans folks.”
Historically, the healthcare system has pathologised LGBTQ+ people. The ignorance and discrimination toward queer patients remains even after the passing of a landmark judgement by the Supreme Court that recognised transgender citizens and the decriminalisation of homosexuality. This lack of knowledge is visible when it comes to basic things, such as addressing someone with the right pronouns, but also when it comes to gender-affirmative surgeries (also called sex reassignment surgeries) or mental health issues.
“The medical vocabulary is not fitted for transgender and non-binary people. When taking care of a queer patient, health workers must be very sensitive about the language they use, but most of them are not taught how to approach the queer population in medical schools,” says Dr Bhaskar Das, a psychiatrist at NRS Medical College and Hospital, who identifies as a queer and non-binary person.
For a long period of time, LGBTQ+ healthcare was constantly associated with sexual health, especially HIV-AIDS, and sexually transmitted diseases (STDs). Healthcare providers are now facing a new challenge of considering queer people’s health as a whole beyond HIV AIDS.
“HIV tests are important and can be done, but what about the rest?” asks Amrita Sarkar, an advisor in transgender wellbeing and advocacy at Alliance India.
“What about mental health? What about common diseases like diabetes, heart problems, or asthma? Queer people are now conscious about their other needs as well, needs that should be understood and taken care of by health workers,” adds Fazlur Rahman Gulfam, a senior strategic analyst at Alliance India.
Humsafar Trust, India’s oldest community-based organisation working on health and human rights for the LGBTQ community, has for instance expanded its services to other health fields.
“We began our work around HIV prevention in 1994. Now, we have centers in Mumbai with HIV and STDs testing, but also medical consultations and mental health care,” says Tinesh Chopade, Advocacy Manager at Hamsafar Trust.
Since the recognition of transgender people by the Supreme Court and the decriminalization of homosexuality, the stigmas faced by the LGBTQ+ population have become public, as certain people and activists started to speak up. So why is queer people’s health always reduced to their sexual practices, which, by the way, remain taboo?
“For a gay man, it is still very difficult to enter a public hospital and say ‘I have anal sex’,” says Fazlur Rahman Gulfam of Alliance India.
Go public or go private?
When it comes to health, LGBTQ+ people are not equal. Upper-class/caste patients can afford private medical care, which necessarily comes at a cost, and is not affordable to everyone. Service is definitely there, but it remains very expensive.
“Very few public hospitals provide gender-affirmative surgeries in India. It is a delicate procedure, and not many plastic surgeons learn how to perform these surgeries. Alternatively, you can go private, but a vaginoplasty or phalloplasty costs at least Rs 3-4 lakhs,” says Dr Bhaskar Das.
Yet, according to the Transgender Persons (Protection of Rights) Act, 2019, the government must provide health facilities to transgender persons, including sex reassignment surgery and hormonal therapy.
From February 2022, the benefits of Ayushman Bharat healthcare insurance have been extended to transgender persons, but they are only available to those registered with the Ministry of Social Justice and Empowerment through the National Portal for Transgender Persons. However, few members of the transgender community have any kind of documentation.
“ID and other administrative documents remain a big issue for transgender folks as there is a lack of awareness within the community,” explains Dr Aqsa Shaikh. She adds that another big issue is the “very little accountability in the private system”.
She adds, “There is no guarantee of good quality service and some trans folks experienced pain or even lost their lives bays of bad surgeries.”
Trained health workers needed
In its last Standards of care for the Health of Transgender and Gender Diverse People, the World Professional Association for Transgender Health recommends that “all members of the healthcare workforce receive cultural knowledge training focused on treating gender and transgender diverse individuals with dignity during orientation and as part of annual or continuing education”.
“The curricula that we are trained into need a change. Six-hundred medical colleges in India provide education in modern medicine. The regulation is done by the National Medical Commission. They are the ones who decide on the medical curricula and syllabus. They are the ones who can take action, and colleges could follow,” says Dr Aqsa Shaikh.
Humsafar Trust offers workshops to medical schools students to bring social change and acceptance.
“We talk about sexual practices, we cover the LGBTQ+ terminology and community members get to share their experiences with the students. Before, these kinds of workshops could not take place, and the space to talk about these issues was very limited,” explains Tinesh Chopade.
“India has come a long way. Homosexuality was only decriminalised in 2018. The current health system is not ideal, but it is getting better. India is one of the few countries in the world that has an act of parliament in favour of gender affirmative care. Things are going to be stepping up,” says Dr. Sanjay Sharma of the Association for Transgender health.