Transphobia is so endemic in India’s heathcare system that one train accident victim died because officials couldn’t decide whether to admit them to a male or female ward.
That’s just one story from a new report examining the corrosive mix of ignorance and transphobic attitudes leaving India’s trans population unsupported and at risk of developing serious illness.
It impacts not just the trans community but also – because disease is not limited by gender – on the wider non-trans community.
The Civilian Welfare Foundation (CWF) conducted the research into the medical and health problems faced by urban transgendered population.
Their study focused on the treatment of trans women within the city of Kolkata (Calcutta) and its suburbs. Attempts to include trans men in the work were hindered by the fact that few trans men dare to be out in Indian society today.
Kolkata was chosen because it was felt its treatment of the trans population was less bad than other places in India. The result of this survey suggest that may be an illusion: or if it is correct, the treatment of the trans community elsewhere in India is truly horrific.
The CWF work highlighted cases such as those of Saikat, the trans individual who died following a train accident while the hospital dithered about which ward they should be on.
There is the case of Tanushri, a trans victim of gang rape, refused examination or treatment by a doctor who also failed to recommend any anti-HIV medication.
Yet these are just the tip of the iceberg, with thousands of individuals daily facing discrimination, harassment, ridicule, rejection and exploitation at the hands of health service providers for their failure to fit neatly within the gender binary.
According to CWF, discrimination starts early, in the psychological arena.
Children who fail to conform to rigid gender roles face a range of reactions ranging from ridicule to attempts to force them to behave ‘correctly’.
Sourabbh Das, a trans individual at Amitie Trust, spoke of extensive attempts to cure their ‘illness’, revealing: ‘I was given electric shocks and even put in an asylum to be cured. Now my mother understands that this is not abnormal or a disease, and she participates in workshops to understand it more.’
Sohini, a transwoman, was thrown out of her family home by her father.
Now, she says: ‘All of us suffer from bouts of depression because all of us have faced rejection from loved ones for who we are and struggle each and every second of our existence. Starting from when we wake up in the morning, go out to work, walk on the streets, come back, we are ridiculed and laughed at and every second is a fight.’
In respect of physical treatment, the trans community faces two distinct yet overlapping issues. When it comes to common health problems, from a simple cold, to malaria or typhoid, it is a struggle to engage with health services, let alone receive appropriate treatment.
One interviewee, Bhanupriya explains: ‘The doctor comes much later, all the staff including the nurses, the ward boys, attendants, even the security laughs at us, points a finger at us and makes derogatory comments.’
Another tells of doctors who refuse treatment, or who show an unnecessary interest in trans genitals.
Many have now stopped seeking treatment that is at best grudgingly given and an administrative nightmare to obtain. Far too often, the critical period when treatment needs to begin is used up as hospitals attempt to decide whether to assign trans patients to the male or female ward.
The result is disastrous for public health in general. India is currently grappling with an explosion in sexually transmitted diseases including HIV and AIDS. Yet many of those who most need to engage with the healthcare system – individuals belonging to LGBTI minority groups – simply do not, fearing further discrimination and harassment.
Inevitably, there will be political voices blaming the LGBTI communities for this outcome: yet the reality is that individuals are simply responding rationally to a system that has already ostracized them.
As one interviewee bitterly put it: ‘After such neglect, why would they care about using protection and not spreading the infection to the society which shuns them as objects of ridicule and does not even consider them human?’
When it comes to trans-specific treatment, from hormone therapy to gender re-assignment surgeries (GRS), the picture is direr still. Doctors exhibit widespread ignorance of trans conditions: the vast majority of individuals self-medicate, without any endocrinological (hormonal medicine) guidance.
As for surgery, Deshopriyo from Amitie Trust observes: ‘While castration is totally illegal in India, [gender reassignment surgery] does not have any proper guidelines.
‘It is not clearly stated anywhere whether it is legal or not and there exist no proper guidelines regarding the same.
‘What happens is that all the trangenders go to quacks for the surgery which results in high chances of serious infections, severe side effects and even death sometimes”.
The picture painted by CWF is bleak. At best, the trans community suffers from a lack of awareness of their most basic needs, leading to lack of proper treatment, medical or otherwise, and a broader alienation from the health service as a whole. This is compounded by outright discrimination, with ridicule, exploitation and rejection at every step of the way for transgendered people seeking to access medical treatment.
Behind this lies a series of structural issues: a legal system that does not recognize the most common issues facing the trans community, from the lawfulness of gender reassignment surgery, to where, in a hospital, a trans patient is supposed to stay.
The system, they claim, needs wholesale reform: until that happens, the majority of trans people will continue to shun medical treatment, with equally disastrous consequences for themselves and the wider non-trans population.
The work was supported by non-governmental organizations such as Pratyay Gender Trust, People Like Us (PLUS), and the Amitie Trust.