Healthcare of Transgender and Non-Binary Persons

Session Report
Savleen Kaur

An Online International Summer School Program | A five-day immersive online certificate training course on Beyond Binaries: Understanding Sexual Identities and Queer Rights Issues in India was launched by #IMPRI Gender Impact Studies Center (GISC)IMPRI Impact and Policy Research Institute in honour of pride month.

On day two of this extremely immersive and illuminating session, Dr Aqsa Shaikh led an interactive discussion on the problems and scope of Healthcare for Transgender and Non-Binary Persons in India. Dr Aqsa Shaikh is an associate professor of community management at Hamdard Institute of Medical Sciences and Research, New Delhi.

Upon initiation, Dr Shaikh expressed gratitude to the organizers and audience for taking the initiative towards a more equitable society. She began by sharing a quote which guides the basic human tendencies and behaviour “What we don’t understand, we fear”, and how this relates to the feelings and practices adopted by people within the society when interacting with the transgender and non-binary community.

She reflected on her childhood experiences and how traditional mindsets gave rise to phobia and biases against the transgender and non-binary community. These biases that develop in society slowly creep into the healthcare sector, creating a menacing environment for the community.

She further elaborated on the traditional presumptions of the transgender community, including kinnars, and how people often forget other parts of the community, including trans-men, trans-masc people, genderqueer, gender non-conforming and their healthcare experiences. She expressed how the trans community has unequal opportunities for education compared to cis-gendered folks, resulting in lower literacy rates and unemployment rates within the community.

Legal Proceedings so far

Dr Shaikh elaborated on the landmark event within the trans community, i.e., on April 15, 2014, the NALSA vs Supreme Court judgement officially recognized transgender as a separate gender identity. Additionally, she intimated the other stepping stones towards equity, which included the IPS statement that concluded that transness and homosexuality are not a disease, the decriminalization of consensual homosexual relationships in Section 377, the initiation of the Transgender Persons (Protection of Rights) Act, 2019.

The ban on conversion therapy was officially stated in 2021 which prevented any healthcare professional from performing the same; 2022 marked the launch of health insurance for transgender folks through the Ayushman Bharat TG plus card scheme, and lastly 2022, the MTP Act began to include transgender people. 

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She shared that despite the major developments within the society, the community often faces roadblocks to an equitable environment, including the ban on transgender and gay people from donating blood, also known as permanent deferment due to a higher risk of HIV. She further explained how through these systematic government barriers, the trans community continues to face discrimination within the healthcare setup.

Discrimination in Healthcare

It has been known that trans and queer folks often have a higher need for healthcare when compared to other segments of society. This is not only due to medical factors but also the effects of social and mental stigma within society. Mental illnesses and suicide ideation and attempts are highly prevalent within the trans community.

Additionally, the incidence of substance abuse and self-medication, including over-the-counter drugs and prescription drugs for hormone therapy, are some of the highlighting factors indicating a need for greater healthcare services for the trans community. There is also an increased risk of STDs, HIV, NCD and cancer within the trans community due to reasons such as diet, stress, lack of exercise, lack of screening facilities etc. 

Moreover, the community also faces financial hindrances when it comes to insurance coverage and other official forms of insurance and the affordability of healthcare facilities. 

Dr Shaikh also conveyed the various emotional barriers faced by queer and trans people, which often stem from within or from close family and friends. This includes self-inflicted stigma and discrimination, often leading to body positivity and self-image issues. The harsh criticism and discrimination faced by the queer community might come from their own family and friends. Poor decision-making by family and the lack of support often leads to resentment and mental health issues within the trans and queer community. 

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She elaborated on the lack of affordability, availability, and accessibility of services for the trans community, including gender-affirming services. In India, despite the recognition of transgender as a separate gender identity, there is a lack of gender-affirming services in the most reputed and recognized hospitals. Even in the case of availability, medical expenses often reach sky-high limits, limiting people from accessing them. This often leads to life-threatening situations when people resort to less qualified and cheaper services, leading to botched results and life-endangering conditions. Consequently, the lack of awareness and sensitization among citizens and medical professionals is extremely alarming.

Way Foward

“Decriminalisation, Depathologisation, Demedicalisation” are the three steps which Dr Shaikh suggested to move towards a more equitable society for the trans and queer community. Decriminalization includes not only the expulsion of section 377 but also the removal of dehumanising behaviour on the part of the healthcare sector and law affirmers. Depathologisation means not only stating trans people as the third gender but also accepting them wholly and no longer treating transness as a disease. Lastly, demedicalisation includes recognizing trans people because they have medical surgeries and procedures and because they identify with that identity.

Dr Aqsa Shaikh concluded the session with the quote, “There is nothing about us without us.” Essentially, it can be easily noticed that gaps are to be bridged within the healthcare system; however, one cannot take these decisions and actions without the trans and queer community themselves.

Read more session reports from Day 2 of Beyond Binaries: Understanding Sexual Identities and Queer Rights Issues in India:

Mobilisation of Queer Community and Intervention with Focus on Rural India