“Visiting a medical establishment as a patient often translates to being harassed or humiliated. The public, and even some medical or support staff, are still unable to accept us as human beings who are in a hospital for treatment,” says 23-year-old Ruchi (name changed), seeking sex reassignment surgery (SRS) at India’s first dedicated transgender out-patient department at Dr. R.M.L. Hospital on Friday.
The establishment of the facility marks the Central government’s foray into providing a crucial, dedicated service for this vulnerable community. The facility is aimed at promoting an inclusive and easily accessible healthcare system for the LGBTQ+ community.
According to the World Health Organisation (WHO), transgender people are around 13 times more likely to be HIV-positive than other adults of reproductive age. It adds that overall, transgender people have low rates of access to health services due to a range of issues including violence, legal barriers, stigma, and discrimination. Experts note that while transpersons share many of the same health needs as the general population, they may have other specific healthcare needs, such as gender-affirming hormone therapy and surgery.
Inaugurated on September 17 and open every Friday from 2 p.m. to 4 p.m., the facility was started after understanding the difficulties encountered by the transgender community “in accessing healthcare services, largely due to discomfort and fear of discrimination and social apathy,” said Ajay Shukla, Director, Dr. R.M.L. Hospital.
In September last year, the Government of India included transpersons in the Ayushman Bharat scheme which provides them with an annual health cover of ₹5 lakh, and includes gender-affirming services. Also Transgender Persons Act, 2019 mandates that the government must ensure medical facilities provide care to transgender persons.
However, the reality is that transgender persons often face sociological, mental and physical health issues and “there is dearth of data regarding their major health problems”, noted a recently published study titled The Third Gender in a Third World Country: Major Concerns and the AIIMS Initiative. It adds that poverty, economic exclusion, rejection by family, mental abuse, workplace discrimination all contribute to preventing access to healthcare facilities.
They lack proper healthcare facilities due to social intolerance and stigmatisation often forces over 50% of transpersons to seek treatment with quacks or self-medicate, say experts. The study also notes that suicide rate in India for the transgender population is a staggering 31%, with about half of these attempts having been made before the age of 20. The study adds that 46.3% of transgender people have a lifetime presence of non-suicidal self-injury. Also 48% of transgender persons suffered from psychiatric disorders but none received consultation.
The study further explains that this vulnerable group also has higher rates of Human Papilloma Virus (HPV) infection and when combined with tobacco use, results in higher risk of anal and other cancers.
“Transgender persons often hide their illness from society and thus attempt self-treatment. Due to a lack of awareness and education, most transgender people prefer to receive treatment from unprofessional quacks. These quacks even perform surgeries including removing genitalia which puts their lives at risk,” it says. A study from South India shows that certain risk factors for non-communicable diseases (NCDs) are more common among transpersons than in the general population.
In India, exclusive medical care is available to the community at facilities such as Apollo Hospitals, while a dedicated clinic was recently added to the government-run Osmania General Hospital in Hyderabad. Kerala is also set to roll out a queer-friendly hospital initiative.
Meanwhile, waiting outside the RML examination room on Friday afternoon, Veronica, 23, who is seeking to transition from male to female adds: “While this is a good initiative, there is an urgent need to explain the protocols to us and also gender-sensitise the support staff.”
Recalling an insensitive reference by the hospital guard during her previous visit, she says that government intervention is vital for the community as private hospitals are not affordable.
“In private hospitals or clinics, a sex reassignment surgery can cost between ₹2-5 lakh for a male to female [MTF] transition, and between ₹4-8 lakh for a female to male [FTM] transition. We are always looking forward to help offered by the government,” the transwoman, who is pursuing her graduation online to avoid discrimination at educational institutes, said.
Anamika, who works with a local NGO helping people from the LGBTQIA+ community to access healthcare at this government facility, says: “Building trust and being treated in a humane manner will be key to sustaining this venture.” She adds that usually, at hospitals, even routine medical procedures like getting a registration card, getting a blood test and even a report often become an uphill task because of the stigma. “It is very tough for them to be out in public and claim their right as a citizen,” she said.
Meanwhile, the main features of the venture at RML include free treatment and investigations; sex change surgery; endocrinology facility with clinical-psychological assessment; plastic surgery and dermatology facility for various related surgeries; and paediatrics. It also has a separate washroom for members of the community.
India’s transgender population is 4.88 lakh as per 2011 census and though some States have wards and government and private healthcare facilities for people from the community, this is the first Central government venture.
“Evidence suggests that transpersons often experience a disproportionately high burden of disease, including in the domains of mental, sexual, and reproductive health. Some seek medical or surgical transition, others do not,” explained the on-duty doctor at RML who said that the number of people reaching out for medical help is slowly increasing and that “building trust” seems to be the most important goal right now.
“Violence against transgender people is common,” notes WHO, which is working to address the varied health needs of the community, including prevention, diagnosis and treatment of HIV, viral hepatitis, and sexually transmitted infection (STI), and developing guidelines on the health of transgender and gender-diverse people.
It will focus on five areas -- provision of gender-affirming care, including hormones; health workers education and training for the provision of gender-inclusive care; provision of healthcare for trans and gender diverse people who suffered interpersonal violence based in their needs; health policies that support gender-inclusive care, and legal recognition of self-determined gender identity.
According to government data, in India transgender population remains one of the most marginalised groups despite the fact that in 2014, the Supreme Court of India recognised that transgender people are distinct from binary people, and declared them as the third gender under the Indian Constitution.